Inter county transfer medi cal form 2026

1. Click ‘Get Form’ to open the inter county transfer medi cal form in the editor.
2. 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.
3. 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'.
4. Complete the 'Medi-Cal Family Budget Unit' section by listing names, aid codes, income details, and share-of-cost information for each individual included.
5. Fill out any additional case information required under 'Other Case Information', including court cases or annual redetermination due dates.
6. List all documents included in the transfer packet as specified in the form. This may include social security cards, identification, and income verifications.
7. 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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