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Medi-Cal Renewal Form

Medi-Cal Renewal Form It is time to renew your Medi-Cal coverage. We need some information from you to help you keep your Medi-Cal for the next year. How to Complete this Form To make sure you or your family continue to have Medi-Cal coverage, you must let us know if there are any changes or not to the information on this form. 1. Please review the information about you and members of 3. Return this form or provide this information online. your household and let us know about any changes. 4. If you return this form by mail, please make sure to sign the 2. Send us or upload copies of documents that show your most form on the very last page. current information even if your information has not changed. Whose Information We Need We need the most current information about every member of your household who is living with you or is listed on your tax return, if you file taxes.

Medi-Cal Renewal Form How to Complete this Form. To make sure you or your family continue to have Medi-Cal coverage, you must let us know if there are any changes or not to the information on this form. 1. Please review the information about you and members of your household and let us know about any changes. 3.

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