www.dhcs.ca.gov
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URL:
https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/SingleStreamApps.aspx
Submission: On December 02 via api from US — Scanned from CA
Submission: On December 02 via api from US — Scanned from CA
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<!-- Important Banner -->
<div role="alert" class="alert alert-info alert-banner">
<div class="container" style="line-height:normal;">
<span style="color:#000"><strong>Medi-Cal Members:</strong> <a href="/pages/keep-your-medi-cal.aspx"><u>Keep your coverage</u></a>. Log on to <a href="/keep-your-Medi-Cal/Pages/Update-my-information.aspx"><u>your account</u></a> or
contact <a href="/services/medi-cal/Pages/CountyOffices.aspx" aria-label="Find your county office.">
<u> your county office</u>
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<span style="color:#000">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. <a href="/services/medi-cal/Pages/CountyOffices.aspx" aria-label="Find your local county office.">
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<a class="ca-gov-icon-facebook" title="Facebook channel" alt="Facebook: @DHCS.CA" tabindex="0" href="https://www.facebook.com/DHCS.CA">
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<h1>Covered California - Single Streamlined Application</h1> <a href="/services/medi-cal/pages/applyformedi-cal.aspx">Back to Apply for Medi-Cal </a>
<p>
<a href="http://www.coveredca.com/"><img align="right" alt="Apply for Health Coverage at Covered California in 2014" src="/PublishingImages/coveredCA.png" border="0" style="border-width:0px;border-style:solid;border-color:initial;"></a>
</p>
<p><span>The Department of Health Care Services (DHCS) and Covered California have partnered to create a Single Streamlined Application for affordable health care coverage.<span> </span>You can </span><span>use the Single
Streamlined Application to apply for a range of affordable health care coverage options, including free or low cost Medi-Cal.<span> </span>The application process can be completed online, in-person, by phone, fax or
mail.<span> </span><span></span></span></p>
<div><span>The Single Streamlined Application is available in English and additional languages.<span> </span>Go to </span><a href="https://www.coveredca.com/"><span>Covered California </span></a><span>to complete an online
application for Medi-Cal or low cost health insurance. <span> </span>Or you can print and fill out the Single Streamlined Application provided below in English and additional languages.</span></div>
<div><span><span> </span></span></div>
<div><span>You can mail your completed and signed application to:</span></div>
<div><span></span> </div>
<div><span>Covered California</span></div>
<div><span>P.O. Box 989725</span></div>
<div><span>West Sacramento, CA 95798-9725</span></div>
<div><span></span> </div>
<div><span>Or mail it to your <a title="Local County Offices" href="http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx">local county office</a>.</span></div>
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<div id="linkitem" class="item link-item bullet"><a href="/services/medi-cal/eligibility/Documents/2014_CoveredCA_Applications/ENG-CASingleStreamApp.pdf" target="" title="">English</a>
<div class="description"></div>
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<div id="linkitem" class="item link-item bullet"><a href="/services/medi-cal/eligibility/Documents/2014_CoveredCA_Applications/ARA-CASingleStream-022014.pdf" target="" title="">Arabic</a>
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</li>
<li>
<div id="linkitem" class="item link-item bullet"><a href="http://www.coveredca.com/PDFs/paper-application/CA-SingleStream-App-Form-HMO.pdf" target="" title="">Hmong</a>
<div class="description"></div>
</div>
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Skip to Main Content Turn on more accessible mode Turn off more accessible mode Skip to Main Content 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. * Home * # * * # * # * Home * About DHCS * Translate Menu Search * Home * Services * Individuals * Providers & Partners * Laws & Regulations * Data & Statistics * Forms & Publications * Search Search for this site: Page Content COVERED CALIFORNIA - SINGLE STREAMLINED APPLICATION Back to Apply for Medi-Cal The Department of Health Care Services (DHCS) and Covered California have partnered to create a Single Streamlined Application for affordable health care coverage. You can use the Single Streamlined Application to apply for a range of affordable health care coverage options, including free or low cost Medi-Cal. The application process can be completed online, in-person, by phone, fax or mail. The Single Streamlined Application is available in English and additional languages. Go to Covered California to complete an online application for Medi-Cal or low cost health insurance. Or you can print and fill out the Single Streamlined Application provided below in English and additional languages. You can mail your completed and signed application to: Covered California P.O. Box 989725 West Sacramento, CA 95798-9725 Or mail it to your local county office. * English * English (Large Print) * Arabic * Armenian * Chinese * Farsi * Hmong * Khmer * Korean * Russian * Spanish * Spanish (Large Print) * Tagalog * Vietnamese Last modified date: 3/23/2021 3:53 PM Non-Discrimination Policy and Language Access Access Health Care Language Assistance Services (SB 223) العربية | Հայերեն | ខ្មែរ | 繁體中文 | فارسی | हिंदी | Hmoob | 日本語 | 한국어 | ລາວ | Mienh waac | ਪੰਜਾਬੀ | Русский | Español | Tagalog | ภาษาไทย | Українська | Tiếng Việt About Us | Careers | Conditions of Use | Privacy Policy | Contact Us | Accessibility Certification Copyright © 2023 State of California Original text Rate this translation Your feedback will be used to help improve Google Translate