Categories: Announcements

COVID-19 Presumptive Eligibility Program for Medi-Cal Available For All CA Residents

DHCS has a new Medi-Cal program for people who are not Medi-Cal eligible (e.g. income too high) for COVID-19 testing & treatment:
https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/COVID-19-Presumptive-Eligibility-Program.aspx

If you click through, this FAQ gives more of a description. Note it is available to all, regardless of immigration status:
http://files.medi-cal.ca.gov/pubsdoco/newsroom/COVID19_FAQ_30339_27.pdf

From www.DHCS.ca.gov:

As of March 18, 2020, the House Resolution (H.R.) 6201 Families First Coronavirus Response Act, Section 6004, authorized State Medicaid Programs to provide access to coverage for COVID-19 diagnostic testing, testing-related services, and treatment services, including all medically necessary care at no cost to the individual.

In response, DHCS is creating a new aid code that will allow individuals to seek the necessary diagnostic testing, testing-related services, and treatment services, including all medically necessary care such as the associated office, clinic, or emergency room visit related to COVID-19 at no cost to the individuals. This new aid code will be available to individuals with no insurance or currently have private insurance that does not cover diagnostic testing, testing-related services, and treatment service, including all medically necessary care for COVID-19 and are a California resident. The covered diagnostic test, testing-related services, and treatment services, including all medically necessary care such as the associated office, clinic, or emergency room visit are paid up to the maximum fee-for-service (FFS) rate, in the FFS delivery system. Individuals in this program will not be enrolled in a Medi-Cal managed care plan. This new aid code will provide access to COVID-19 diagnostic testing, testing-related services, and treatment services, including all medically necessary care such as the associated office, clinic or emergency room visit, without regard to immigration status, income, or resources and will have date specific eligibility.
The new aid code will be considered a Presumptive Eligibility (PE) aid code and will be date specific. A Qualified Provider (QP) will enroll the individual on the date of application and their PE eligibility period will end on the last day of the following month. This program will utilize existing QP(s) allowed under approved California’s existing State Plan in relation to PE programs.