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MC 219 (11/15) ENG2. \u2022 To verify immigration status with the Department of Homeland Security (DHS), if required. Information shared with DHS cannot be used for immigration enforcement unless you are committing fraud.
MC 219 (11/15) ENG2. \u2022 To verify immigration status with the Department of Homeland Security (DHS), if required. Information shared with DHS cannot be used for immigration enforcement unless you are committing fraud.
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.
\u200b(800) 541-5555 Medi-Cal Members and Providers: If you have a question, need help, or need to report a problem, please call (800) 541-5555 (outside of California, please call (916) \u200b636-1980) for our Telephone Service Center. DHCS' hours are Monday through Friday from 8 a.m. to 5 p.m., except holidays.
A. An authorized representative is an individual authorized under State or other applicable law to act on behalf of a beneficiary or other party involved in the appeal. Authorized representatives have all of the rights and responsibilities of a beneficiary or party, as applicable, throughout the appeals process.
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Medi-Cal is California's Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources. Medi-Cal is supported by federal and state taxes.
The attached DHS 7068 (Responsibilities of Public Guardians/Conservators or Applicant/Beneficiary Representatives) serves as your acknowledgement of your responsibilities as the representative of the applicant/beneficiary.
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.
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.
Spanish-speaking consumers also may visit the Spanish-language version of the website at www.CoveredCA.com/espanol, which provides an online application process in Spanish.

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