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MC 604 IPS (5/14) Page 2. Tell Us About Your Income And Expenses. Tell us about your income and expenses for you, your spouse and any of your children under 21 years of age who are living in the home, or are temporarily absent from the home for reasons such as attending school or work or is hospitalized.
Mail the form to address Access, PO Box 85027, San Diego, CA 92186. Please include the case number on the form when doing so. The form will be scanned into the system and a representative will contact you.
How to Qualify. To find out if you qualify for one of Medi-Cal's programs, look at your countable asset levels. As of July 1, 2022, you may have up to $130,000 in assets as an individual, up to $195,000 in assets as a couple, and an additional $65,000 for each family member.
Complete the Infant Registration Form\u200b and send it to MCAP within 30 days after your delivery. Fax this information to 1-888-889-9238, or send this information to MCAP at the address printed on the form. If you do not receive the Infant registration Form, call 1-800-433-2611.
The \u201cStatement of Citizenship, Alienage, and Immigration Status,\u201d Form MC 13, is part of the Medi-Cal application. 2 This form is not an immigration form. The categories on the form were created to help the State of California make decisions about your Medi-Cal.
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If you already have health insurance through Covered California, you can easily update your family information to include your new child through your Covered California account. Whether enrolling or changing your plan online, you'll be asked to enter the date of your child's birth, adoption or foster placement.
If you are enrolled in MCAP, your baby has eligibility for coverage in the Medi-Cal Access Infant Program for up to two years, unless your baby is enrolled in employer sponsored insurance or no-cost Medi-Cal or your income no longer qualifies on your infant's first birthday.
The \u201cStatement of Citizenship, Alienage, and Immigration Status,\u201d Form MC 13, is part of the Medi-Cal application. 2 This form is not an immigration form. The categories on the form were created to help the State of California make decisions about your Medi-Cal.
MC 210 RV ENG (Rev 10/20) Other health insurance. Tell us about any health coverage that you have that is not from Medi-Cal or Medicare. Reporting other health insurance premiums that you pay may lower the income Medi-Cal uses to determine your eligibility.
Form MC371 "Additional Family Members Requesting Medical" - California.

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