Medi-Cal Mail-In Application Form

The Medi-Cal Mail-In Application is available in 11 languages in a View and Print Version. (See Chart Below)

Please mail your completed Medi-Cal Mail-in Application to your nearest County Social Services Office.

Should you require additional assistance after reading the Mail-In Instructions, contact your nearest
County Social Services Office.

NOTE: Some links on this page are documents in Adobe Acrobat Portable Document Format (PDF); unless indicated are smaller than 2 MB. PDF documents require Adobe Reader. If you need to install or upgrade to the latest version, click the “Download Free Readers”.

Language	Introduction	Application	Instructions
Armenian	View	View	View
Chinese	View	View	View
English	View	View	View
Farsi	View	View	View
Hmong	View	View	View
Khmer	View	View	View
Korean	View	View	View
Lao	View	View	View
Russian	View	View	View
Spanish	View	View	View
Vietnamese	View	View	View

Last modified on: 4/16/2013 9:48 AM

California Department of Healthcare Services

Medi-Cal Mail-In Application Form