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California eligibility certification 2026
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- Click ‘Get Form’ to open the California Eligibility Certification in the editor.
- Begin by filling in your personal information, including your first name, last name, and date of birth. Ensure accuracy as this information is crucial for eligibility determination.
- Indicate whether you currently receive Medi-Cal benefits or have a Medi-Cal Benefits Identification Card (BIC). If applicable, provide your BIC number and issue date.
- Answer questions regarding your health care insurance status and any out-of-pocket expenses related to family planning services in the past three months.
- List all family members and their taxable income sources. This includes employment income, social security, and any other relevant financial details.
- Review your entries for accuracy before signing the form. Your signature confirms that the information provided is true and correct.
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