Update: Children’s Presumptive Eligibility
| Date: | September 25, 2024 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) |
| To: | Health Plan Providers |
| Type: | Regulatory |
| Subject: | Update: Children’s Presumptive Eligibility |
| Business: | Medi-Cal Managed Care |
As recently communicated by Health Plan and in accordance with the Department of Health Care Services (DHCS), effective July 1, 2024, the Child Health and Disability Prevention (CHDP) Gateway has been rebranded to the Children’s Presumptive Eligibility (CPE) Portal. For updated information regarding CPE, please review the below information.
Children’s Presumptive Eligibility
As a reminder, Children’s Presumptive Eligibility (CPE), Presumptive Eligibility for Pregnant Women (PE4PW), and Hospital Presumptive Eligibility (HPE) applications must be submitted electronically through the Medi-Cal Provider Portal.
- Portal Outages: The portal has scheduled maintenance every day from midnight to 2 a.m. Extended maintenance occurs on the second Sunday of every month from 2 a.m. to 6 a.m. Applications should not be submitted during this time. For more information, please visit: https://mcweb.apps.prd.cammis.medi-al.ca.gov/news/32992.
Qualified Provider (QP) Enrollment
Medi-Cal providers interested in participating in CPE as a QP can submit the Children’s Presumptive Eligibility Provider Application and Agreement form electronically through the Medi-Cal Provider Portal.
Provider applicants will receive a determination in real time, and those eligible to participate can print their contingent approval notice immediately. Upon completion of the CPE Computer-Based Training (CBT), the provider will become a QP. The QP should then complete the required Newborn Gateway CBT.
QPs must ensure all staff who will assist patients with CPE enrollment complete the required trainings and establish login credentials to the Medi-Cal Provider Portal.
For FAQs and CPE resources, please visit: https://mcweb.apps.prd.cammis.medi-cal.ca.gov/references/cpe.
CPE Determination Assistance
Applicants are potentially eligible for CPE if they are:
- Under the age of 19
- A California resident
- Not receiving Medi-Cal
- Within the income limits for their household size
- Have not exceeded two PE enrollment periods in the last 12 months
Income Denials: Children may be eligible for CPE if they meet all other eligibility criteria, as listed at https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/32590, and are within 266 percent Federal Poverty Level (FPL) for their family size. 2024 FPL numbers are available here:
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/32833 and https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/24-02.pdf.
If providers believe they received an incorrect income-based denial, they can contact DHCS for a manual review. Providers must provide the signed application and denial message.
If you have any questions about CPE or need eligibility determination assistance, contact ChildrenPE@dhcs.ca.gov.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
