Get the free Medi-Cal Application (English) - web sfusd

MC 210 English 10 07.QED 4/15/08 3:34 PM Page 2 HEALTH CARE COVERAGE FOR PEOPLE WITH LIMITED INCOME OR RESOURCES MAIL-IN APPLICATION AND INSTRUCTIONS Physical Therapy Pharmacy Services Pregnant Women

How to fill out medi-cal application english

How to fill out a Medi-Cal application in English:

Gather the necessary documents:

1. Social Security number or proof of application
2. Proof of California residency (e.g., driver's license or utility bill)
3. Income verification (e.g., pay stubs, W-2 forms)
4. Proof of citizenship or immigration status (e.g., birth certificate, green card)

Access the application:

1. Visit the official Medi-Cal website or contact your local county office to obtain the application form.
2. Alternatively, you can also request a paper copy of the application from the county office or complete it online.

Provide personal information:

Fill out the application form with your name, date of birth, address, contact details, and other relevant personal information.

Include household information:

List all members of your household, including their names, dates of birth, and relationships to you. Include anyone who lives with you and shares income/expenses, even if they are not applying for Medi-Cal.

Disclose income details:

Provide accurate information about your income, including wages, self-employment earnings, unemployment benefits, and any other sources of income for all household members.

Expense and asset information:

Provide details on your expenses, such as rent, mortgage, utilities, and medical bills. You may also need to disclose any assets you own, such as bank accounts or property.

Medicaid-related programs:

If you or any household members are enrolled in or eligible for other Medicaid-related programs, such as CalFresh or Supplemental Security Income (SSI), include this information on the application.

Signing and submitting the application:

1. Once you have completed the application form, carefully review all the information entered.
2. Sign and date the application.
3. Submit the application to your local county office by mail, in person, or online, following the specified instructions.

Who needs Medi-Cal application English:

1. Individuals who live in California and require access to healthcare services but cannot afford private health insurance.
2. Low-income families and pregnant women who are seeking medical coverage for themselves and their children.
3. Seniors or disabled individuals who meet the income and asset criteria for Medi-Cal eligibility.

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