Hospital Presumptive Eligibility

Hospital Presumptive Eligibility (HPE) was established by the patient protection and Affordable Care Act (ACA).

Under the HPE program hospitals can assist you if you are getting services from or being admitted to the hospital. You can apply for temporary fee-for-service Medi-Cal benefits.

Depending on your answers during the application process, you may be presumed eligible for Medi-Cal.

DHS hospitals and eligible clinics have the option as qualified entities to make presumptive eligibility determinations.

      Who can get it?

  • Uninsured California Residents (i.e., no private insurance, Medicare, Medi-Cal etc)
  • New adults 19-64 with no children if their income is at or below $1,397* per month for an individual
  • Former Foster Care children who received Foster Care on their 18th birthday (ages 18-25)
  • Children (0-19) at or below 266% of the Federal Poverty Level (FPL)
  • Parent and Caretaker Relatives
  • Pregnant women at below 213% FPL (covers outpatient prenatal and pregnancy related services only)

      How much does it cost?

  • HPE is free

      What is required?

  • California residence
  • Self-Attestation of income

      What is covered?

  • Most health care services; doctor visits, hospital care, tests, medicines, emergency room visits, surgeries etc.

      How do I enroll?

  • DHS financial workers can help you with the HPE application process at your nearest LA County DHS hospital or clinic
  • A HPE application must be submitted during hospital stay for inpatient and hospital based outpatient services.
  • PFS staff must also take a Single Streamlined Application or provide one for the patient to take home with instructions per DHS Department Policy.

     Where do I apply?

  • Any County hospital and eligible clinics.
  • *Monthly income level above is based on the April 1, 2018 Federal Poverty Levels (FPL) for your family size.