San Francisco Health Plan: Community: Assistor Tools: Medi-Cal

Medi-Cal for Children and Pregnant Women

Reference Materials

NOTICE OF REDUCTION OF BENEFITS, EFFECTIVE JULY 1, 2009 NEW!
Medi-Cal Main Website
Phone Number
Medi-Cal Local Website and Phone Number
Medi-Cal 101 Guide
Medi-Cal Frequently Asked Questions
Medi-Cal What it Means to You Brochure (English, Spanish)

Enrollment Forms

Medi-Cal Application, MC 210
Medi-Cal Applications, MC 321 (English, Chinese, Spanish)
(Please note this application can also be used to apply for the Healthy Families Program)
Medi-Cal to Healthy Families Bridge Consent Form
Record of Contact Form 8002
Record of Contact Form 5008 (recommended for CAA use)

Verification Forms/Documents

U.S. Citizens and National Applying for Medi-Cal Must show Proof of Citizenship and Identity
Proof of Citizenship and Identity Requirements--For Children who are U.S. Citizens or Nationals filling out the Healthy Families/Medi-Cal Joint Application
Affidavit of Identity for US Citizen or National Children Under 18
Affidavit of Reasonable Effort to Get Proof of Citizenship
Receipt of Citizenship or Identity Documents
Request for California Birth Record
Statement of California Residency
Statement of Citizenship Alienage and Immigration Status
Additional Forms
Translated forms

Documents and forms posted on this webpage have been created by the Medi-Cal program, and other sources. We have posted them so applications assistors can conveniently access them.