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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.

Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.

If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

We protect your documents and personal data by following strict security and privacy standards.
Members can submit information online by logging in or creating an online account at benefitscal. To submit information by phone, members can call DPSS at 1-866-613-3777 Monday – Friday from a.m. – p.m. (excluding holidays).
Identity Copy of driver's license or photo ID. Social Security Number (actual card) A copy of immigration documentation or card.
Simply submit your information, and we'll get back to you about if you qualify for Medi-Cal through Covered California. This is your fastest option if you're interested in signing up for Medi-Cal.
Request Medi-Cal “retroactive coverage” if services were provided. To request retroactive coverage, contact the county social services office within one year of the month in which the covered services were provided to you.
You are 19-64 years old and your family's income is at or below 138% of the Federal Poverty Level (FPL) ($21,597 for an individual; $44,367 for a family of four). You are a child 18 or younger and your family's income is at or below 266% of FPL ($85,519 per year for a family of four).
Medi-Cal renewals can be completed online. Visit .BenefitsCal to renew your Medi-Cal plan. If members of your household have Medi-Cal, they will receive a Medi-Cal renewal form from their local county human services agency.
Easy Application Online through Covered California, at or by calling 1-800-300-1506. Call DPSS at 1-877-410-8827.