Get the free State Plan Supplement to Attachment 3.1-B - DHCS - CA.gov
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ATTACHMENT 3.1A
3.1APage
Page
1
1
State/Territory:CaliforniaAMOUNT, DURATION, AND SCOPE OF MEDICAL AND REMEDIAL CARE
AND SERVICES PROVIDED TO THE CATEGORICALLY NEEDY:
1. Inpatient hospital services
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Step 1: Obtain a copy of the state plan supplement form from the appropriate state agency.
02
Step 2: Fill in your personal information, including name, address, and contact information.
03
Step 3: Provide information about your current state benefits and any changes in your circumstances that may impact your eligibility.
04
Step 4: Attach any required documentation, such as proof of income or residency, to support your application.
05
Step 5: Review the completed form for accuracy and make any necessary corrections before submitting it to the state agency.
Who needs state plan supplement to?
01
Individuals who receive state benefits and are required to provide additional information as part of their eligibility determination.
02
Individuals who have experienced changes in their circumstances that may affect their eligibility for state benefits.
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What is state plan supplement to?
State plan supplement is additional information required to be submitted along with the state plan.
Who is required to file state plan supplement to?
State agencies and organizations that have state plans approved by the relevant governing body.
How to fill out state plan supplement to?
State plan supplements can usually be filled out electronically or by completing a specific form provided by the governing body.
What is the purpose of state plan supplement to?
The purpose of state plan supplement is to provide additional details and updates to the original state plan.
What information must be reported on state plan supplement to?
State plan supplements may require information such as updated financial data, program performance metrics, and progress towards achieving state plan goals.
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