Here's how it works
01. Edit your medi cal redetermination form online
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02. Sign it in a few clicks
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03. Share your form with others
Send medical redetermination form via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out redetermination with our platform
- Click ‘Get Form’ to open the redetermination form in the editor.
- Begin by entering your case number and social security number if applicable. Print your name and address clearly, using ink. If your address has changed, check the box provided.
- In Section 1, report any income sources for you or family members. List each source on a separate line and attach relevant documentation such as pay stubs or tax returns.
- Proceed to Section 2 to detail any expenses or deductions. Again, list each expense on a separate line and provide proof of payment.
- Continue through Sections 3 to 8, answering questions about health insurance changes, living situations, property status, immigration status, disabilities, and other health programs.
- Finally, ensure you sign and date the form at the certification section before submitting it using the provided postage-paid envelope.
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