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The process for verifying your Medi-Cal eligibility, from the time your completed application is received to when you receive your Benefits Identification Card (BIC), normally takes 45 days.
MC 210 PA (05/07) - Property Assessment Statement of Facts.
Medi-Cal Form 210a: Supplement to Statement of Facts for Retroactive Coverage/Restoration See the next page for a copy of MC Form 210a. Previous Covered California Application for Health Insurance Instructions.
Request Medi-Cal retroactive coverage if To request retroactive coverage, contact the county social services office within one year of the month in which the covered services were provided to you.
4. If I get Medi-Cal will it pay for my unpaid medical bills? Retroactive Medi-Cal covers unpaid medical expenses from the three months prior to the month you apply for Medi-Cal. If you have unpaid bills from the three previous months, enter that information during the application process.
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ing to CCR, Title 22, Section 50159, the Statement of Facts (MC 210) application form, shall be used by the county department in the determination of the applicants eligibility, share of cost and other health coverage. Currently, the MC 210 application consists of 15 pages.
ing to Covered California income guidelines and salary restrictions, if an individual makes less than $47,520 per year or if a family of four earns wages less than $97,200 per year, then they qualify for government assistance based on their income.
ing to CCR, Title 22, Section 50159, the Statement of Facts (MC 210) application form, shall be used by the county department in the determination of the applicants eligibility, share of cost and other health coverage. Currently, the MC 210 application consists of 15 pages.
4. If I get Medi-Cal will it pay for my unpaid medical bills? Retroactive Medi-Cal covers unpaid medical expenses from the three months prior to the month you apply for Medi-Cal. If you have unpaid bills from the three previous months, enter that information during the application process.
To get a refund for payments made after you received your Medi-Cal card, you must have paid a provider who accepts Medi-Cal. How Do I File a Claim? To file a claim, you must submit a Medi-Cal Claim Form for Beneficiary Reimbursement.

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