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/NF-B) Quality Assurance Fee FREE TEXT (FY) Payment Invoice for FREE TEXT (Month, Day, Year) to FREE TEXT (Month, Day, Year) Department of Health Care Services Accounting Section/Cashiers Unit, Mail Stop 1101 1501 Capitol Avenue, Suite 71.2048 P.O. Box 997415 Sacramento, CA 95899-7415 Office of Statewide Health Planning and Development Number: FREE TEXT (Facility Name) FREE TEXT (Facility Address) FREE TEXT (Facility City, State, Zip Code) Due Date: FREE TEXT (Date).

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If you are leaving California temporarily to attend college in another state and you want to keep your Medi-Cal coverage, contact your eligibility worker at the Los Angeles County Department of Public Social Services . As long as you are eligible, Medi-Cal will cover emergency services and urgent care in another state.

Telephone Service Center: (800) 541-5555. Provider-Telecommunications Network (PTN): (800) 786-4346. Out-of-State Provider Support: (916) 636-1960.

Eligibility levels for parents are presented as a percentage of the 2023 FPL for a family of three, which is $24,860. Eligibility limits for single adults without dependent children are presented as a percentage of the 2023 FPL for an individual, which is $14,580.

​Contact Us ​Department of Health Care Services Office of the Ombudsman. Hours of Operation: Monday through Friday, 8am to 5pm PST; excluding holidays. By Phon​e: 1-888-452-8609. By email*: MMCDOmbudsmanOffice@dhcs.ca.gov​​

Most single individuals will qualify for Medi-Cal if there income is under $1,564 per month. Most couples will qualify if their income is under $2,196 per month. If you have disabilities, your income can be slightly higher. As of July 1, 2022, you can qualify for Medi-Cal even if you have assets.

If you are experiencing a true medical emergency, where your only choice is to go straight to the nearest hospital, then go. The hospital will provide you with the health care you need. Then, the hospital's billing department will assist you in applying for emergency Medi-Cal benefits.

Have income below the monthly limit for household size. Be a California resident. Not already have Medi-Cal. If not pregnant, have not received PE Enrollment benefits from any Medi-Cal PE Program up to the maximum limitation allowed within the past 12 months of applying.

You should keep this guide and use it when you have questions about Medi-Cal. California offers two ways to get health coverage. They are “Medi-Cal” and “Covered California.” Both programs use the same application.

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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
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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