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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES ELIGIBILITY/STATUS REPORT PLEASE SIGN THE FORM AFTER 1ST.

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REAPPLY Related content

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Mar 23, 2021 — Important Are you enrolled in Medi-Cal? Has your contact information...
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For Medi-Cal, you must report it within 10 days. To report changes, call Covered California at (800) 300-1506 or sign in to your online account. You can also find a Licensed Insurance Agent, Certified Enrollment Counselor or county eligibility worker who can provide free assistance in your area.

Form 1095-B –Individuals who enroll in health insurance through Medi-Cal, Medicare, and other insurance companies or coverage providers will receive this form.

Use this form to join or change a health plan. For FREE help with this form, contact Health Care Options at 1-844-580-7272. Mail completed form to California Department of Health Care Services, Health Care Options, P.O. Box 989009, West Sacramento, CA 95798-9850.

Click on “Eligibility Results” under Manage Your [Year] Application. It will take you to the Household Eligibility Results Summary. Click on the “Upload Document” button for the household member who needs to submit documents. Click “Upload Document” and select the document type for the document you want to upload.

The Department of Managed Health Care (DMHC) administers and evaluates healthcare laws and regulations.

CHHS was created from a reorganization of other California agencies, including the California Health and Welfare Agency which included the California Department of Health Services....California Health and Human Services Agency. Agency overviewAgency executiveMark Ghaly, SecretaryWebsitewww.chhs.ca.gov5 more rows

You must give income and tax filing status information for everyone who is in your family and is on your tax return. You also may need to give information about your property. You do not have to file taxes to qualify for Medi-Cal.

DEPARTMENT OF HEALTH CARE SERVICES.

​The mission of DHCS is to provide Californians with access to affordable, integrated, high-quality health care, including medical, dental, mental health, substance use treatment services and long-term care. Our vision is to preserve and improve the overall health and well-being of all Californians.

Documents to Confirm Eligibility Social Security Number. Identity. Citizenship. Immigration Status. Income. Not Incarcerated. Minimum Essential Coverage. American Indian or Alaskan Native.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232