The form MC371, titled “Additional Family Members Requesting Medi-Cal,” is a document issued by the Employment and Human Services Department (EHSD) for use in Contra Costa County, California. This form is specifically designed to allow individuals already applying for or receiving Medi-Cal benefits to add family members to their application or current Medi-Cal coverage.
What Is This Form For?
The MC371 form requests Medi-Cal coverage for additional family members who were not included in the initial Medi-Cal application or have since become eligible for coverage. Medi-Cal is a program that offers free or low-cost health coverage for children and adults with limited income and resources.
Why Is It Needed?
This form is necessary to ensure that all eligible family members can receive Medi-Cal benefits. It allows for including new family members, such as newborns, newly adopted children, or other dependents who have recently become part of the household and require health coverage.
Who Should Use It?
The intended audience for this form includes Medi-Cal beneficiaries or applicants in Contra Costa County who need to add additional family members to their Medi-Cal coverage. This could be due to changes in the family structure or the discovery of eligibility for previously unenrolled family members.
How Should The Form Be Filled Out?
Instructions for filling out the form typically include:
- Providing detailed information about the primary applicant or current Medi-Cal beneficiary.
- Listing the additional family members being added, including their personal information, such as full names, dates of birth, Social Security numbers (if applicable), and their relationship to the primary applicant.
- Answering questions related to the additional family members' income, residency, and other eligibility criteria for Medi-Cal.
- Sign and date the form to certify the accuracy of the information provided.
What Are The Key Pieces Of Information That The Form Requires?
Essential information required on the form usually encompasses:
- Personal identification details of the additional family members.
- Relationship to the primary Medi-Cal beneficiary.
- Income and resource information for eligibility assessment.
- Residency and citizenship status.
When Should It Be Submitted?
There are no specific deadlines mentioned for submitting this form. Still, it's generally advisable to submit it as soon as there's a need to add a family member to Medi-Cal coverage to avoid delays in their access to healthcare services. Prompt submission following the eligibility of a new family member is crucial.
Where And How Should The Form Be Submitted?
While specific submission instructions might not be provided, forms like these can typically be submitted through various channels, including:
- Online, through the county's benefits administration portal, if available.
- By mail, send the completed form to the address specified by the Contra Costa County EHSD or the Medi-Cal office.
- In person, by visiting a local EHSD or Medi-Cal office to submit the form directly.
How Much Does It Cost To Submit Or File The Form?
There is usually no cost to submit the MC371 form or any other application for Medi-Cal benefits. Medi-Cal is designed to provide health coverage to low-income individuals and families at no or low cost.