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Tems OR Date: WC Recovery Program 660 J Street, Suite 270 Sacramento, CA 95814 Mail: File: Original Copy POTENTIAL THIRD PARTY LIABILITY NOTIFICATION 1. Have you used, or will you use, Medi-Cal for your injury or illness? .......................................................... Yes 2. Have you filed, or will you file, a lawsuit or insurance claim?..................................................................... Yes No No If you answered Yes to one or both of the.

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

You can also get Medi-Cal if you are: 65 or older. Blind. Disabled. Under 21. Pregnant. In a skilled nursing or intermediate care home. On refugee status for a limited time, depending how long you have been in the United States. A parent or caretaker relative of an age eligible child.

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.

Household sizeAsset limits1 person$130,0002 people$195,0003 people$260,0004 people$325,0006 more rows • Feb 15, 2023

Earned Income Most recent pay stub, written statement from employer, completed employer's income verification letter. All verification must show gross income, pay period, date received and hours worked.

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. The Medi-Cal eligibility worker looks at how much an applicant and their family has each month.

Medi-Cal can't take more than 50% of your settlement. If you fail to notify the government that you're filing a lawsuit, the DHCS can take legal action against you to obtain Medi-Cal reimbursements.

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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