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Effective January 1 2013 Department of Health Care Services DHCS requires certain applicants and providers to submit an application fee when requesting an enrollment action. The application fee collected is used to offset the cost of conducting the required screening as specified in Title 42 Code of Federal Regulation 455 Subpart E. Please reference the Medi-Cal Regulatory Provider Bulletin Medi-Cal Application Fee Requirements for Compliance with 42 Code of Federal Regulations Section 455....
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How to fill out draft - medi-cal

01
Gather all necessary information and documents, such as your personal details, income information, and household size.
02
Visit the official Medi-Cal website or your local county social services office to obtain the draft form.
03
Carefully read the instructions on the form to understand the requirements and eligibility criteria.
04
Begin filling out the form by providing your name, address, contact information, and other requested personal details.
05
Provide accurate information about your income, including wages, self-employment earnings, and any other sources of income.
06
Indicate your household size by including yourself, your spouse, and any dependents living with you.
07
Fill out the sections related to your assets, such as bank accounts, property, and vehicles.
08
Include any additional information or documents requested on the form, such as proof of income or immigration status.
09
Review the completed draft form for any errors or missing information.
10
Make copies of the form and any supporting documents before submitting them.
11
Submit the filled-out draft form and supporting documents to the designated Medi-Cal office either in person, by mail, or online, depending on the submission options available in your area.
12
Follow any additional instructions provided by the Medi-Cal office and wait for their response regarding your eligibility for benefits.

Who needs draft - medi-cal?

01
Low-income individuals and families who cannot afford private health insurance.
02
Pregnant women seeking healthcare coverage during their pregnancy and up to 60 days after giving birth.
03
Children under the age of 19 from low-income households.
04
Individuals with disabilities who meet the specified criteria.
05
Seniors aged 65 and older who have limited income and resources.
06
Certain immigrants who are lawfully present in the United States, depending on their eligibility status.
07
Individuals and families transitioning from other public assistance programs, such as Temporary Assistance for Needy Families (TANF) or Supplemental Security Income (SSI).
08
Individuals who have experienced a significant change in their income or household size and need to reevaluate their eligibility for Medi-Cal.
09
Former foster youth up to the age of 26, regardless of income level.
10
Individuals who have recently lost their job or experienced a decrease in income due to unexpected circumstances.
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Draft Medi-Cal is a preliminary version of the Medi-Cal program that allows for feedback and changes before the final version is implemented.
Healthcare providers, facilities, and organizations that participate in the Medi-Cal program are required to file draft Medi-Cal.
Draft Medi-Cal can be filled out online through the Medi-Cal website or submitted manually using the required forms.
The purpose of draft Medi-Cal is to gather feedback, make necessary changes, and ensure that the final version of the program meets the needs of all stakeholders.
Draft Medi-Cal must include information on services provided, patient demographics, billing details, and any other relevant data.
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