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Inter county transfer medi cal form 2026
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- Click ‘Get Form’ to open the inter county transfer medi cal form in the editor.
- Begin by filling in the 'Receiving county name and address' and 'Sending county name and address' sections. Ensure all details are accurate to avoid processing delays.
- In the 'Case Name/Beneficiary Information' section, provide the case name, phone number, alternate phone number, and full address. If applicable, indicate if there is an authorized representative (AR) by selecting 'Yes' or 'No'.
- Complete the 'Medi-Cal Family Budget Unit' section by listing names, aid codes, income details, and share-of-cost information for each individual included.
- Fill out any additional case information required under 'Other Case Information', including court cases or annual redetermination due dates.
- List all documents included in the transfer packet as specified in the form. This may include social security cards, identification, and income verifications.
- Finally, provide your sending county worker's information at the bottom of the form to ensure proper communication regarding your case.
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inter county transfer medi cal phone number
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