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California medi cal application pdf

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The document is a Medi-Cal eligibility redetermination form for long-term care beneficiaries in California. It requires detailed personal, financial, and property information from the applicant or their representative to assess ongoing eligibility for Medi-Cal benefits. The form includes questions about income, assets, real property ownership, and any changes in circumstances that may affect eligibility.

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Click ‘Get Form’ to open the California Medi-Cal application in the editor.
Begin by entering your full name, date of birth, and social security number in the designated fields. Ensure accuracy as this information is crucial for eligibility.
Provide details about your long-term care facility, including its name, address, and your marital status. If applicable, include your Medicare claim number.
In the property section, indicate whether you own any real estate or have an interest in property. Answer all follow-up questions regarding your intentions and current living situation.
Complete the income section by listing all sources of income received monthly. Attach any necessary verification documents to support your claims.
Review all entries for completeness and accuracy before signing the declaration at the end of the form. This ensures compliance with Medi-Cal requirements.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I contact Medi-Cal in California?

Telephone Service Center 1-800-541-5555 The Telephone Service Center (TSC) is available from 8 a.m. to 5 p.m., Monday through Friday, except holidays.

What is the income limit for Medi-Cal in California?

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).

What is covered by Medicaid in California?

Services for children and adults include, but are not limited to: preventative health assessment visits, well child care, screenings (e.g. pap smears, mammograms, total serum cholesterol, etc.), and immunizations. Some limitations may apply. Only for members age 21 and older.

What is the difference between Medicaid and Medi-Cal in California?

Medi-Cal is what the Federal Medicaid program is called in California. Medicare and Medi-Cal work in conjunction with other health insurance companies (such as Kaiser, Blue Cross, etc.) to provide medical services to clients.

Is California Medicaid the same as Medi-Cal?

Is Medi-Cal the same thing as Medicaid? Medi-Cal is Californias version of the Federal Medicaid program. The Department of Health Care Services (DHCS) oversees the Medi-Cal program. Your local county office manages most Medi-Cal cases for DHCS.

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Does California still have Medi-Cal?

Medi-Cal is Medicaid for California. It offers free or low-cost health coverage to people who qualify.

Who qualifies for Medicaid in California for adults?

You can also get Medi-Cal if you are: 65 or older. Blind. Disabled. Under 21. Pregnant. In a skilled nursing or intermediate care home. On refugee status for a limited time, depending how long you have been in the United States. A parent or caretaker relative of an age eligible child.

How much is Medi-Cal in California?

If eligible, you can receive full Medi-Cal coverage with $0 monthly premium. To qualify, you must: Meet the medical requirements of Social Securitys definition of disability. Be working and earning income (this can be part-time work).

California medi cal 2026

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How do I contact Medi-Cal in California?

What is the income limit for Medi-Cal in California?

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Is California Medicaid the same as Medi-Cal?

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Does California still have Medi-Cal?

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