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Medi-CalMedicaid · Coverage · Provider Bulletin · CAMedium impact

Hospital Presumptive Eligibility: New Requirements Coming January 1, 2027

Effective date
Jan 1, 2027
Identified
Sep 18, 2026

Summary

Starting January 1, 2027, the Hospital Presumptive Eligibility (HPE) program will implement new 'Work and Community Engagement Requirements' for certain adults. Applicants must have a monthly income of at least $580 OR work/volunteer/attend school/job training for 80 hours in the prior month to qualify, unless they meet an exclusion or exception. This affects eligibility determinations and will require billing teams to verify applicant eligibility status.

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What to do

Action · 4 steps
01Before January 1, 2027: Billing and eligibility teams must (1) review HPE application procedures in your billing system and eligibility verification workflows; (2) train front desk and eligibility staff on the new income ($580/month minimum) and work/engagement hour (80 hours/month) requirements; (3) sign up for the Medi-Cal Subscription Service to receive updates and final guidance from the Department of Health Care Services; (4) prepare to document applicant work status, volunteer hours, school enrollment, or job training participation on HPE applications; (5) identify and document any exclusions or exceptions that may apply to your patient population.
02Coordinate with compliance and medical records teams.
03The Department of Health Care Services will release additional training resources and detailed guidance prior to January 2027.
04Contact DHCSHospitalPE@dhcs.ca.gov with policy questions.
If missed: Failure to apply these requirements will result in ineligible applicants being incorrectly enrolled in HPE, leading to claim denials and potential recovery actions.

Original notice

Hospital Presumptive Eligibility: New Requirements Coming January 1, 2027
mcweb.apps.prd.cammis.medi-cal.ca.gov · Always check the source before changing claims.
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