ਮੈਡੀ-ਕੈਲ ਯੋਗਤਾ ਡਿਵੀਜ਼ਨ MC 100 ਫਾਰਮ
MCED ਫਾਰਮ ਮੁੱਖ ਪੰਨੇ 'ਤੇ ਵਾਪਸ ਜਾਓ
ਮੈਡੀ-ਕੈਲ ਯੋਗਤਾ ਡਿਵੀਜ਼ਨ (MCED) ਫਾਰਮ ਫਾਰਮ ਨੰਬਰ ਦੁਆਰਾ ਵਰਣਮਾਲਾ ਅਨੁਸਾਰ ਹੇਠਾਂ ਦਿੱਤੇ ਗਏ ਹਨ ਅਤੇ ਜੇਕਰ ਉਪਲਬਧ ਹੋਵੇ ਤਾਂ ਵਿਕਲਪਿਕ ਭਾਸ਼ਾਵਾਂ ਸ਼ਾਮਲ ਹੋ ਸਕਦੀਆਂ ਹਨ। PDF ਭਰਨ ਅਤੇ ਪ੍ਰਿੰਟ ਕਰਨ ਵਾਲੇ ਫਾਰਮ ਔਨਲਾਈਨ ਭਰੇ ਜਾ ਸਕਦੇ ਹਨ ਅਤੇ ਹਾਰਡਕਾਪੀ ਵਿੱਚ ਪ੍ਰਿੰਟ ਕੀਤੇ ਜਾ ਸਕਦੇ ਹਨ ਤਾਂ ਜੋ ਦਸਤਖਤ ਕੀਤੇ ਜਾ ਸਕਣ ਅਤੇ ਡਾਕ ਰਾਹੀਂ ਭੇਜੇ ਜਾ ਸਕਣ ਜਾਂ ਪ੍ਰਕਿਰਿਆ ਲਈ ਕਿਸੇ ਯੋਗਤਾ ਕਰਮਚਾਰੀ ਨੂੰ ਵਿਅਕਤੀਗਤ ਤੌਰ 'ਤੇ ਜਮ੍ਹਾ ਕੀਤੇ ਜਾ ਸਕਣ।
MC 100 ਫਾਰਮ:
- MC 171 (05/07) – Medi-Cal Long-Term Care Facility Admission and Discharge Notification
- MC 174 (05/07) – Medi-Cal Notice to Providers Clarification of Liability (Eng/Sp)
- MC 175 I (05/07) – Sneede v. Kizer Income Screening Questions
- MC 175-2 (05/07) – Sneede v. Kizer Responsible Relative Determination
- MC 175-3I (05/07) – Sneede v. Kizer Net Nonexempt Income Determination
- MC 175-3I.1 (05/07) – Sneede v. Kizer Net Nonexempt Income Determination-Continuation Sheet
- MC 175-3I.2A (05/07) – Section 1931(b) Sneede v. Kizer Net Nonexempt Income Determination and Mini Budget Unit (MBU) Determination – Applicant
- MC 175-3I.2R (05/07) – Section 1931(b) Sneede v. Kizer Net Nonexempt Income Determination and Mini Budget Unit (MBU) Determination – Recipient
- MC 175-P (05/07) – Sneede v. Kizer Property Screening Questions
- MC 175-3P (05/07) – Sneede v. Kizer Property Work Sheet
- MC 175-4 (10/23) – Sneede v. Kizer Mini Budget Units And:
- MC 175-5 (05/07) – Federal Poverty Level (FPL) Programs for Pregnant Women and Infants (Income Disregard, 200 Percent); Children Ages 1 through 5 (133 Percent); and Children Ages 6 through 18 (100 Percent) (For County Use Only)
- MC 175-6 (05/07) – Sneede v. Kizer Allocation from an SSI or IHSS Person
- MC 175-7 (05/07) – Sneede v. Kizer Allocation Work Sheet Board and Care Person to Spouse and/or Children at Home or LTC Person (AFDC/MN/MI)With No Community Spouse to Children at Home
- MC 176-1 QMB/SLMB/QI (05/07) – Qualified Medicare Beneficiary (QMB)/Specified Low-Income Medicare Beneficiary (SLMB)/Qualifying Individual (QI)Eligibility Work Sheet For All Applicants: Individual(s), Couple(s), and Child(ren) (LTC Individual in MFBU)
- MC 176-2A QMB/SLMB/QI (09/08) – Qualified Medicare Beneficiary (QMB)/Specified Low-Income Medicare Beneficiary (SLMB)/Qualifying Individual (QI)Income Eligibility Work Sheet, Couple or Applicant with an Ineligible Spouse, With or Without Child(ren)
- MC 176-2B QMB/SLMB/QI (05/07) – Qualified Medicare Beneficiary (QMB)/Specified Low-Income Medicare Beneficiary (SLMB)/Qualifying Individual (QI)Income Eligibility Work Sheet, Child Applying with or without Ineligible Parent(s)
- ਐਮਸੀ 176 ਏਡੀ (06/12) – ਬਜ਼ੁਰਗ ਅਤੇ ਅਪਾਹਜ ਸੰਘੀ ਗਰੀਬੀ ਪੱਧਰ ਪ੍ਰੋਗਰਾਮ ਵਿੱਤੀ ਯੋਗਤਾ ਫਾਰਮ
- MC 176 D (05/07) – Medi-Cal Special Treatment Programs
- MC 176 EP (05/07) – Exempt Payment Form
- MC 176 M (05/07) – Share of Cost Determination – MFBUs Which Do Not Include LTC Persons
- MC 176 MA Applicant-Recipient (05/07) – Section 1931 Applicant/Recipient Budget Form: For Determining Net Non-Exempt Income and Section 1931 Income Eligibility for Applicants; And for Recipients Under Alternative B
- MC 176 MA Recipient (05/07) – Section 1931 Recipient Budget Form: For Determining Net Non-Exempt Income and Section 1931 Income Eligibility for Recipients Under Alternative A
- MC 176 M-LTC (11/07) – Share of Cost Determination – MFBUs with LTC Persons Included – LTC
- MC 176 P (05/07) – Property Reserve Worksheet
- MC 176 PA-1/PA-2 (05/07) – Property Worksheet/Assessment for Institutionalized Spouses (Eng/Sp)
- MC 176 P-A QMB/SLMB/QI (09/08) – Qualified Medicare Beneficiary (QMB)/Specified Low-Income Medicare Beneficiary (SLMB)/Qualifying Individual (QI)Property Work Sheet, Adult
- MC 176 PA-A (05/07) – Medi-Cal Property Assessment Application
- Alt: ਸਪੇਨੀ (01/09)
- MC 176 P-C QMB/SLMB/QI (05/07) – Qualified Medicare Beneficiary (QMB)/Specified Low-Income Medicare Beneficiary (SLMB)/Qualifying Individual (QI)Property Work Sheet, Child
- MC 176 PI (07/22) – Period of Ineligibility for Nursing Facility Level-of-Care Work Sheet
- ਐਮਸੀ 176 ਪੀਵੀ (05/07) - 1931 ਸਮੂਹ ਲਈ ਵਾਹਨ ਨਿਰਧਾਰਨ ਵਰਕਸ਼ੀਟ
- MC 176 QMB-3 (05/07) – Qualified Medicare Beneficiary (QMB) Referral
- MC 176 QDWI (05/07) – Qualified Disabled Working Individual (QDWI) Income Eligibility Work Sheet-Instructions
- MC 176 QDWI-2 (05/07) – Qualified Disabled Working Individual (QDWI) Property Work Sheet
- MC 176 S (03/09) – Medi-Cal Status Report
- MC 176 TMC (05/07) – Transitional Medi-Cal (TMC) Quarterly Status Report
- Alt: ਸਪੇਨੀ (10/08)
- ਐਮਸੀ 176 ਡਬਲਯੂ (05/08) – ਵੰਡ/ਵਿਸ਼ੇਸ਼ ਕਟੌਤੀ ਵਰਕਸ਼ੀਟ
- MC 176 W.1 (01/24) – Stepparent Computation
- MC 179 (11/07) – Disability Determination Service Division
- Alt: ਸਪੇਨੀ (01/08)
- MC 194 (07/12) – Social Security Administration Referral Notice
- ਐਮਸੀ 195 (07/17) – ਐਸਐਸਆਈ ਪ੍ਰਾਪਤ ਕਰਨ ਵਾਲੇ ਐਮਸੀਆਈਈਪੀ ਬਿਨੈਕਾਰਾਂ ਲਈ ਕਾਉਂਟੀ ਟ੍ਰਾਂਸਮਿਟਲ
- MC 196 (03/20) – Transmittal Form for Notifying DHCS of MCIEP Changes in Status for County Medical Probation or Compassionate Release Inmates