APPLICATION FOR MEDI - CAL - State of California - slocounty ca 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section 1, providing personal details such as your last name, first name, and home address. Ensure you do not list a P.O. Box unless you are homeless.
3. In Section 2, list information about family members or children in your care. Fill in their names, relationships, and relevant details like gender and marital status.
4. Proceed to Section 3 to provide information about income sources for all listed individuals. Clearly indicate how much income is received and how often.
5. Complete Sections 4 through 8 by answering questions regarding assets, health coverage, and any previous Medi-Cal benefits received.
6. Finally, sign and date the application in Section 9 to certify that all information provided is accurate.

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