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AFFING DATA - Page 1 INSTRUCTIONS: Use this double sided form to identify all staff of the facility. Designate volunteers by placing a V after their names. Use additional sheets as needed. Counselor Information Provider #: Facility Name: (A minimum of 30% of all staff who provide counseling services shall be licensed or certified.) Last TB Date of last Date of last Test Date Training Training Registered? Yes/No/N/A Date Hired CPR: Certified? Yes/No/N/A Employee Information:.

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Center (NPIC) Toll-free At 1-877-487-2778 (TDD: 1-888-874-7793) Or By Email At NPICstate US-Q1004 PRIVATE REGISTERED BOND FOR SETOFF Transfer On Death Deed Washington State

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Medi-Cal is California's version of the Federal Medicaid program. Medi-Cal offers no-cost and low-cost health coverage to eligible people who live in California. The Department of Health Care Services (DHCS) oversees the Medi-Cal program.

Core Values: Service, Accountability and Innovation.

Claims Submission LINE OF BUSINESSADDRESSMedi-CalCalifornia Health and Wellness Plan Attn: Claims PO Box 4080 Farmington, MO 63640-3835

If your family has income at or below 138% of the Federal Poverty Level (FPL) (266% of FPL if you're a child), you may be eligible for Income-Based Medi-Cal. If you qualify for SSI (Supplemental Security Income), you are automatically eligible for SSI-Linked Medi-Cal.

Most single individuals will qualify for Medi-Cal if there income is under $1,676 per month. Most couples will qualify if their income is under $2,267 per month. If you have disabilities, your income can be slightly higher. You can qualify for Medi-Cal even if you have assets.

The Medi-Cal program determines eligibility for benefits on a “means” tested basis. If a Medi-Cal applicant's property/assets are over the Medi-Cal property limit, the applicant will not be eligible for Medi-Cal unless they lower their property/assets ing to the program rules.

ing to Covered California income guidelines and salary restrictions, if an individual makes less than $47,520 per year or if a family of four earns wages less than $97,200 per year, then they qualify for government assistance based on their income.

​Medi-Cal Eligibility Division ​​The Medi-Cal Eligibility Division (MCED) is responsible for the development, coordination, clarification, and implementation of Medi-Cal regulations, policy, and procedures to assure Medi-Cal eligibility is determined accurately and timely by the 58 county human services agencies.

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© Copyright 1997-2025
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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