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APPLICATION FOR MEDI - CAL - State of California - slocounty ca 2026
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- Click ‘Get Form’ to open it in the editor.
- 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.
- 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.
- Proceed to Section 3 to provide information about income sources for all listed individuals. Clearly indicate how much income is received and how often.
- Complete Sections 4 through 8 by answering questions regarding assets, health coverage, and any previous Medi-Cal benefits received.
- Finally, sign and date the application in Section 9 to certify that all information provided is accurate.
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