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Medi-Cal Eligibility Division Information Letter No.: I 15-14 TO: ALL COUNTY WELFARE DIRECTORS ALL COUNTY WELFARE ADMINISTRATIVE OFFICERS ALL COUNTY MEDI-CAL PROGRAM SPECIALISTS/LIAISONS SUBJECT: Revised MC 216 Pre-Populated Renewal Form (Reference: All County Welfare Directors Letter 15-09 and 14-38) The purpose of this letter is to transmit the revised MC 216 Pre-Populated Renewal Form to counties, which is used to confirm and request verification of beneficiary information kno.

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How to fill out the Mc 216 Form online

Filling out the Mc 216 Form online can streamline the process of renewing your Medi-Cal coverage. This guide will provide you with a comprehensive step-by-step breakdown on how to navigate through the form effectively.

Follow the steps to complete the Mc 216 Form online.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Review the information about yourself and members of your household and let us know about any changes.
  3. Send or upload copies of documents that show your most current information, even if your information has not changed.
  4. Return the form or provide this information online by the specified due date.
  5. If you return this form by mail, make sure to sign the form on the last page.
  6. Complete the sections related to income and expenses, ensuring accuracy in reporting.
  7. Review your household members' information, checking for correctness and making necessary adjustments.
  8. Once completed, save changes, download, or print the form as needed.

Complete your Mc 216 Form online today for a hassle-free renewal experience!

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Medi-Cal members must renew their coverage each year to keep their health care benefits. For most members, coverage is renewed automatically. Sometimes the county will send you a renewal form that you must review and return, along with any additional required information.

MC 604 IPS (5/14) Tell Us About Your Income And Expenses. Tell us about your income and expenses for you, your spouse and any of your children under 21 years of age who are living in the home, or are temporarily absent from the home for reasons such as attending school or work or is hospitalized.

Each year, your county will conduct a review to determine if you and/or your family members continue to meet Medi-Cal eligibility requirements. This review process is called your annual redetermination.

Retroactive Medi-Cal covers unpaid medical expenses from the three months prior to the month you apply for Medi-Cal. If you have unpaid bills from the three previous months, enter that information during the application process. If you qualify for Medi-Cal, you will also be evaluated for retroactive coverage.

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