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Medi-Cal Members:
Keep your coverage
. Log on to
your account
or contact
your county office
to update your information.
Important
Are you enrolled in Medi-Cal? Has your contact information changed in the past two years? Give your local county office your updated contact information so you can stay enrolled.
Find your local county office.
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Forms By Name - G
GHPP Application to Determine Eligibility
(DHCS 4000 A)
GHPP Initial/Annual Income Verification
(DHCS 4000 B)
GHPP New Referral
(DHCS 9052)
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Last modified date: 11/12/2025 3:55 PM
