Additional income and property information needed for medi-cal - dhcs ca 2025

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The document is a form from the California Department of Health Care Services requesting additional income and property information to evaluate Medi-Cal eligibility for applicants and their household members. It includes sections for detailing household composition, income sources, expenses, and property ownership, along with instructions for providing necessary documentation. The form emphasizes the importance of accurate information under penalty of perjury.

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What documents are needed for Medi-Cal in California?

What information do I need? California Drivers License or Identification Card. Proof of California Residency. Immigration status. Birth Certificates, passports, naturalization certificates. Social Security and Medicare Card.

What is countable property for Medi-Cal?

What are Real Property Assets? Real Property is land, buildings, mobile homes which are taxed as real property, life estates in real property, mortgages, promissory notes, and deeds of trust. These are considered countable assets when assessing for Medi-Cal eligibility.

What is countable household income?

Countable (base) income, including but not limited to, wages, salaries and tips; or means-tested benefits such as SSI, Social Security and veterans benefits.

What is countable income for Medi-Cal?

If you get income, you need to give proof. The form lists examples. They include pay stubs and tax returns. You do NOT need to complete the section about non-income assets and property or give proof.

What income does Medi-Cal count?

You are 19-64 years old and your familys income is at or below 138% of the Federal Poverty Level (FPL) ($21,597 for an individual; $44,367 for a family of four). You are a child 18 or younger and your familys income is at or below 266% of FPL ($85,519 per year for a family of four).

mc 604 ips 2024

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How is countable income calculated?

Countable income is the amount left over after: Eliminating from consideration all items that are not income; and. Applying all appropriate exclusions to the items that are income.

What is proof of income for Medi-Cal?

Assets are things you own, which can be counted for Medi-Cal eligibility. These items include bank accounts, cash, second vehicles and homes, and other financial resources. Please see below for examples.

Additional income and property information needed for medi-cal - dhcs ca 2025

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What is countable income for Medi-Cal?

What income does Medi-Cal count?

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