CHCF report outlines opportunities to get more Californians enrolled in Medi-Cal coverage through presumptive eligibility


Soraya Marashi


A new report from the California Health Care Foundation (CHCF) illustrates opportunities for California to make it easier for Californians who receive Medi-Cal presumptive eligibility (PE) to apply for ongoing Medi-Cal health coverage.


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PE is a process allowing qualified entities (QEs), such as hospitals and clinics, to quickly enroll eligible Californians in temporary coverage. The process usually involves using shortened applications and real-time eligibility determination systems to ensure people who need it can access care immediately. 

According to the report, PE can act as an on-ramp to ongoing Medi-Cal coverage.

Hospitals observed for this study all reported 4 common challenges in assisting patients with applications for ongoing Medi-Cal coverage after gaining hospital presumptive eligibility (HPE).


  • Patient misconceptions about the importance of obtaining ongoing Medi-Cal coverage. Hospitals found that many patients do not understand that HPE coverage only lasts for about 2 months, many patients do not see the need for ongoing coverage in their lives, and many patients are worried they would be found ineligible for ongoing coverage due to factors like immigration status. 


  • Profuse length and requirements of the ongoing Medi-Cal coverage application. The enrollment assister (EA) in many cases will spend time convincing the patient that the application is worth completing, even in many cases when it’s translated to the patient’s language. EAs state that the application is particularly challenging for patients with limited English speaking skills.


  • Challenges with obtaining necessary information from applicants. Hospitals reported experiencing difficulty collecting necessary information for the application from certain patients, including undocumented or patients without stable housing. 


  • COVID-19 restrictions and impacts. EAs could no longer sit beside patients at their beds to provide application assistance due to protective distancing requirements in hospitals, and counties removed eligibility staff from hospitals at the beginning of the pandemic, in addition to the EA workforce shortages experienced by hospitals due to the pandemic itself. The report notes that hospitals are still working to rebuild their EA staff.


The report goes on to detail some recommendations for the state and its counties to “further reduce the barriers that many people who receive PE face in subsequently applying for ongoing Medi-Cal coverage.” The recommendations are as follows:


Provide clear guidance to hospitals and applicants about Medi-Cal eligibility for undocumented immigrants.

The report suggests clearly communicating recent expansions of full Medi-Cal coverage eligibility to Californians regardless of immigration status, as well as reassuring immigrants that applying for ongoing Medi-Cal coverage will not impact their immigration status. 

Make the ongoing Medi-Cal coverage application easier to complete.

The report suggests shortening both the paper and online application, as well as generally making it more user-friendly and understandable. This would involve describing terms on the application more clearly and using accessible language, as well as translating the application into common dialects.

Create opportunities for people to prove eligibility for ongoing Medi-Cal coverage.

The report suggests continuing to develop ways to make it easier for applicants to submit necessary documents and information, such as through customer portals for applicants to easily transfer documents and expanding live telephone assistance. The report states that these enhancements would be especially helpful for Californians experiencing homelessness and new immigrants who might lack access to technology or who might need more assistance due to language or other barriers. 

Maintain close connections between QEs and state systems. 

The report suggests finding new ways for hospital and county workers to maintain close communications on applications for ongoing Medi-Cal coverage to expand access to application status information so eligibility determinations can be made efficiently. The report also suggests that the state consider allowing QEs access to the eligibility system so they can check the status of an application themselves instead of having to contact the county to do so. 

The state could do this by encouraging more EAs at QEs to become state-certified application assisters to give them access to application information and connect them with trainings and resources to better assist applicants. 

Make QEs more aware of policy changes to ensure they can respond accordingly.

The report encourages the state to more regularly share updates on policy changes with QEs to ensure EAs are aware of the changes and how to implement them through things like regular virtual training sessions. The report also suggests allowing applicants to provide verbal signatures on their applications.

Include community organizations in the range of qualified entities that can conduct PE determinations.

The report says that community organizations conducting PE determinations could help increase PE determinations by reaching people in communities that Medi-Cal may otherwise fail to reach, such as immigrants or non-English speakers. 

Explore application design options to ease transitions to ongoing Medi-Cal coverage.

The report suggests exploring options to allow California’s PE portal to support automatically generating ongoing Medi-Cal applications using PE application data. 

Require QEs to assist HPE enrollees with applications for ongoing Medi-Cal coverage.

Since QEs are not currently required to support applicants of ongoing Medi-Cal coverage unless the applicant directly asks for this support, the report suggests requiring QEs to help PE and HPE enrollees complete their applications instead of only providing the application to HPE enrollees. 

Ensure communications between QEs and the state are relationship based and consistent across counties.

The report suggests making relationship based communications between QEs and the state regarding application completion for ongoing Medi-Cal coverage more consistent across counties to help QEs better support applicants.

Improve HPE and PE data collection to understand potential disparities in HPE/PE applications for ongoing Medi-Cal coverage.

The report suggests that California regularly collect data on rates of Medi-Cal applications among HPE and PE enrollees and analyze demographic data in order to “… understand whether this enrollment pathway is equally accessible to different communities.”