Hospital Presumptive Eligibility Program Update
AI Summary
Effective May 28, 2026, California's Hospital Presumptive Eligibility (HPE) program will no longer cover patients 65 and older, and adults aged 19-64 with Medicare Part A/B will be ineligible for the New Adult coverage group. Providers must use the updated HPE application form and cannot use previous versions.
Action Required
By May 28, 2026: Hospital billing teams must obtain and implement the revised Hospital Presumptive Eligibility Medi-Cal Application (DHCS 7022) from the HPE web page and discontinue use of previous versions. Update Provider Portal workflows to screen for Medicare Part A/B coverage for adults aged 19-64 in New Adult group - these patients will be automatically denied HPE. Train staff that patients 65+ are no longer eligible for HPE and must apply for full Medi-Cal instead.
Plan Types
Medicaid
States
CA
Specialties
all-specialties