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Each year you must renew your or your family's Medi-Cal eligibility. The county will conduct a review to determine if you and/or your family members continue to meet Medi-Cal eligibility requirements. This review process can also be called an annual redetermination.
2022 Income Eligibility Guidelines for PE4PW Household Size213 Percent Monthly213 Percent Annually2$3,251$39,0013$4,090$49,0544$4,927$59,1085$5,764$69,1628 more rows • May 9, 2022
MC 210 RV ENG (Rev 10/20) Other health insurance. Tell us about any health coverage that you have that is not from Medi-Cal or Medicare. Reporting other health insurance premiums that you pay may lower the income Medi-Cal uses to determine your eligibility.
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The income limits based on household size are: One person: $17,609. Two people: $23,792. Three people: $\u200b\u200b29,974.
MC 219 (11/15) ENG2. \u2022 To verify immigration status with the Department of Homeland Security (DHS), if required. Information shared with DHS cannot be used for immigration enforcement unless you are committing fraud.
By Mail: Complete this form and mail it to: [Medicaid Agency] [100 State Street] [Any city, State] It is time to renew your Medi-Cal coverage. We need some information from you to help you keep your Medi-Cal for the next year.
Medi-Cal members must renew their coverage each year to keep their health care benefits. For most members, coverage is renewed automatically.
By Mail: Complete this form and mail it to: [Medicaid Agency] [100 State Street] [Any city, State] It is time to renew your Medi-Cal coverage. We need some information from you to help you keep your Medi-Cal for the next year.

medical redetermination form pdf