Fill Out Your Mc216 Medical Renewal Form
The MC 216 Medical Renewal form plays a crucial role in the process of maintaining Medi-Cal benefits for eligible individuals and families in California. This revised document, communicated through the Health and Human Services Agency, is designed to gather essential information at the time of annual renewal. By confirming and requesting verification of beneficiary details, the form helps ensure that individuals continue to receive the health coverage they need. One notable update in the recent version is the change in language regarding income reporting in Section 3, specifically for those with fluctuating incomes. Instead of asking for income expectations over the next 12 months, it now specifically requests estimates for the current calendar year, promoting clarity and precision. Recipients are encouraged to review not only their details but also those of household members, including anyone who may wish to apply for Medi-Cal. Accurate reporting of income and expenses is vital; the form requests recent documentation to support any claimed income. Additionally, it addresses changes in household circumstances, such as new insurance coverage or any changes in living situations. Overall, the MC 216 form is central to the renewal process, aiding both individuals and the state in maintaining access to this essential health care program.
Mc216 Medical Renewal Example
State of
Department of Health Care Services
JENNIFER KENT |
EDMUND G. BROWN JR. |
Director |
Governor |
May 19, 2015
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TO: |
ALL COUNTY WELFARE DIRECTORS |
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ALL COUNTY WELFARE ADMINISTRATIVE OFFICERS |
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ALL COUNTY |
SUBJECT: |
Revised MC 216 |
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(Reference: All County Welfare Directors Letter |
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The purpose of this letter is to transmit the revised MC 216
The single change to the form is specific to Section 3 titled “Income and Expenses” on Page 3, subsection “Fluctuating Income”, the question “What do you think your income will be for the next 12 months?” has been replaced with “Tell us what you think your income will be for the current calendar year?”.
If you have any questions regarding this letter, please contact Deborah Palmer at
(916)
Original Signed By
Alice Mak, Acting Chief
Attachments
1501 Capitol Avenue, MS 4607, P.O. Box 997417, Sacramento, CA
(916)
Respond By: [MM/DD/YY] |
Case Number: [xxxxxxxxx] |
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[Insert Date] |
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You can get this notification in another language or in large print or another way that’s best for you. Call
It is time to renew your
You Can Renew Your
■ By Mail: Complete this form and mail it to: |
■ Online: renewing nline is quick and easy. Go to |
[Medicaid agency] |
www.coveredca.c m [saWs online portal] |
[100 state street] |
to upload your d cuments. |
[any city, state] |
Purposes |
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■In Person: Visit our office at
[Medicaid agency] [100 state street] [any city, state].
Office hours are [8:30 a.m. to 5 p.m. Monday to Friday].
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How to Complete this Form |
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Informational |
ge, you must let us know if there are any changes or not to |
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to make sure you or your family continue to have |
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the information on this form. |
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Please review the information about you and members of |
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return this form or provide this information online by |
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your household and let us know about any cha ges. |
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[Insert Date]. |
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2. |
send us or upload copies of documen s hat sh w y ur most |
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If you return this form by mail, please make sure to sign |
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current information even if your inform ion h s not changed. |
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the form on page [Insert PaGe #]. |
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Whose Information We Need
We need the most current inf |
ation about every member of your household who is living with you or is listed on your tax |
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return, if you file taxes. We need information from: |
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■ |
People in your h useh ld who currently have |
apply for |
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■ People in your household who would like to apply. |
and used only to help those in your household who want |
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to keep or apply for |
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We may eed some information about people in your |
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household who live with you |
are listed on your tax |
You do not need to file a tax return to apply for or renew |
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etu n, who do not have |
your |
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What Happens if My Information is Different?
If anyone in your household does not qualify for
will be kept private and will be used only to see if you or your family qualifies for affordable health coverage. We may need more information from you to find you the most affordable health coverage. You do not need to file a tax return to apply for or renew your
Questions? Call [state agency name] at
MC 216 (Rev 04/15) |
Page 1 |
For Informational Purposes Only
1Your Current Household
Please check the information below and tell us if there are any changes.
Is the address below correct? |
Yes |
If correct, go to Section 2. |
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[reCIPIent naMe] Home address: [aDDress 2] [Address 3]
Mailing address: [HOMe aDDress] [aDDress 2] [Address 3]
Phone:
Home: [nuMber1]
Other: [nuMber2]

no. If not, please write the correct information below.
name (first, middle, last & suffix)
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Home address |
apartment # |
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City (home) |
state |
ZIP code |
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Mailing address, only if different from above. |
apartment # |
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City (mailing) |
state |
ZIP code |
What number can we call to contact you? Home |
Cell |
Work |
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number: |
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What is the best time to reach you at this number? |
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(Optional) Is there another number we can use to call y |
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Home Cell Work |
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number: |
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(Optional) What email address can we contact you? |
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2Who is in Your Household?
Please check the information below about people in your household who want to renew
Name (first, middle, last & suffix)
Tax Filing Status |
How is this Person Related to the |
Who Claims this Person Correct Information? |
(e.g., primary tax filer, dependent) |
Primary Tax Filer or Head of Household? |
as a Dependant? |
Yes |
no |
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Yes |
no |
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Yes |
no |
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Yes |
no |
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If the information above is ot correct, please write the correct information into the space provided below. If there are other members of your household, please write their information in below.
Name (first, middle, last & suffix) |
Tax Filing Status |
Related to Tax Filer |
Who Claims this Person |
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as a Dependant? |
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Page 2
For Informational Purposes Only
3Income and Expenses
We were not able to renew your
the income information below is only for individuals within your household we could not otherwise verify. If you have members of your household not listed below it is because we were able to verify their income and no other income information is needed for the individual.
Our records show that this individual’s monthly income is: |
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this estimate includes the income sources and amounts below. Please let us know if this information is correct or has changed. If this information has changed, please tell us the correct information.
Income 1 |
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How often received? |
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Is this correct? |
Yes |
no |
If no, enter correct information |
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Income 2 |
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How often received? |
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Is this correct? |
Yes |
no |
If no, enter correct inf rmati n |
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Income 3 |
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How often eceived? |
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Is this correct? |
Yes |
no |
If no, enter co ect information |
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Please enter below any additional income you expect that is not shown above:
source of Income |
amount |
How Often received? |
Informational |
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Fluctuating Income |
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You told us that your income changes from mon h m nth and gave us an estimate of what you thought your income would be for the
past 12 months. Last year, you told us your income would be |
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tell us what you think your income will be |
the current calendar year? |
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Expenses/Tax Deductions
Our records show that this individual had the following tax expenses (deductions) last year. Please let us know if this will be the same for next year or not:
Tax Deduction 1 |
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How often paid? |
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Is this correct? |
Yes |
no |
If no, enter correct information |
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Tax Deduction 2 |
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How often paid? |
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Is this co ect? |
Yes |
no |
If no, enter correct information |
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Tax Deduction 3 |
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How often paid? |
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Is this c rrect? |
Yes |
no |
If no, enter correct information |
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Page 3
For Informational Purposes Only
4Other Health Insurance
Please let us know if the information below is still correct. If someone in your family now has other health insurance nOt listed below, please write it in below.
name |
type of Insurance |
Do You still Have this Coverage? |

Yes
no

Yes
no
5Incarceration
Our information shows that one or more people in your household is incarcerated. Is this information correct?
name |
Is this Individual Incarcerated? |
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Yes
no

Yes
no
6 Deceased
Our information shows that one more in your househo d has died. Is this information correct?
name
Yes no
Informational

Yes 
no
Page 4
For Informational Purposes Only
7Other Household Changes
Is anyone in your household between the ages of 18 and 26 years old and was either in foster care, in any state, on his or her 18th birthday or who lost foster care assistance, in any state, due to having reached the maximum age limit?

Yes
no If yes, who?
Is anyone in your household 19 to 20 years old and a

Yes 
no If yes, who?
Does anyone in your household have a physical, mental, emotional, or developmental disability?

Yes 
no If yes, who?
Does anyone in your household need help with

Yes 
no If yes, who?
Is anyone in your household pregnant?
Yes |
no If yes, who? |
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If yes, what is her expected due date? |
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Informational |
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How many babies are expected? |
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Has anyone in your household moved into or out of the home in the p st 12 months? |
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Yes |
no If yes, who? |
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What is your relationship to this person? |
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Do any of these individuals want to apply |
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Yes |
no If yes, who? |
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If anyone in your household who cu |
ently has |
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list the name(s) below: |
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Name Pers |
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New status |
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Page 5
For Informational Purposes Only
8Signature
PRIVACY STATEMENT |
RIGHTS AND RESPONSIBILITIES |
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This renewal form is for renewing benefits through the department |
the information I gave on this renewal form is true as far as I know. |
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of Health Care services (dHCs) and determining eligibility for |
I know that I may be subject to a penalty if I do not tell the truth. |
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health insurance through Covered California. the personal and |
I understand that the information I give will be used only to see |
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medical information you provide on it is private and confidential. |
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if those in my family who are applying to renew hea th insurance |
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Covered California or DHCs needs it to identify you and the other |
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will qualify. |
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people on this renewal form and to administer our programs. We |
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will share your |
information with other state, federal, and local |
I understand that Covered California and the |
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agencies, contractors, health plans, and programs only to enroll |
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will keep my information private, as the law requires. For more |
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you in a plan or program or to administer programs, and with other |
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information, or access |
to personal information in records |
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state and federal agencies as required by law. |
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Purposes |
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maintained by the |
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You must answer all of the questions on this renewal form unless |
I can contact my county social ervices office or I can contact |
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the Covered California |
Privacy Officer at |
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they are marked “optional.” If your renewal form is missing anything |
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(TTY: |
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that we require, we will contact you to get it. If you do not provide it, |
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we will not be able to make a decision on your renewal. You may |
I understand that to be eligible for |
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have to submit a new application, or you may not be able to get |
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apply for other inc me |
benefits to which I or any member of |
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health insurance through Covered California, or your application |
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my household is entitled, unless he or she has good cause for |
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for benefits renewal may be denied. |
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not doing so. exam les of such income or benefits are pensions, |
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In most cases, you have the right to see personal information |
government benefits, retirement income, veteran’s benefits, |
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about you that is in federal and state records. You can see it in |
ann ities, disability benefits, social security benefits (also |
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an alternative format (such as large print) if you need that. For |
called OAsdI or Old Age, survivors, and disability Insurance), |
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more information or to see Covered California records, contact the |
and unemployment benefits. But such income or benefits do |
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Privacy Officer at: |
not include public assistance benefits, such as CalWOrKs or |
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Informational |
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Covered California |
Ca Fresh. If I have a question about a possible source of income, |
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I can call my county social services office or Covered California at |
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Attn: Privacy Officer |
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P.O. Box 989725 |
I know that I must tell Covered California or my |
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West sacramento, CA |
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Phone: |
social services office about changes to anything I stated in this |
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TTY: |
renewal form. to report changes, I can call my county social |
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For the Department of Health Care Services, |
services office. Or I can call Covered California at |
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(TTY: |
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contact the Information Protection unit t: |
I know that Covered California or the |
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P.O. Box 997413, Ms 4721 |
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sacramento, Ca |
not discriminate against me or anyone on this renewal form |
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because of race, color, national origin, religion, age, sex, sexual |
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Phone: |
orientation, marital status, veteran’s status, or disability. If I think |
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TTY: |
Covered California or the |
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these state and federal laws give us the right to collect and keep |
against me, including the failure to provide reasonable accom- |
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modations as required under state and federal law, I can make a |
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the information |
the re ewal form: Covered Ca: 42 u.s.C. § |
complaint by contacting the u.s. Department of Health & Human |
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18031; CA Gove nment Code §§ 100502(k) and 100503(a) dHCs: |
services at www.hhs.gov/ocr/office/file or the California |
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CA Welfa e and Institutions Code § 14011 and Article 3, Chapters |
Office of the Attorney General at http://oag.ca.gov/contact/ |
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5 and 7, Parts 2 and 3, division 9. We must give you this Privacy |
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statement under CA Civil Code § 1798.17. |
If I believe that Covered California or the |
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You can find the Notices of Privacy Practices for the |
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discriminated against me or anyone else on this renewal form in |
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program at www.dhcs.ca.gov and for Covered California at |
connection with a |
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www.CoveredCA.com. |
a complaint with the department of Health Care services, Office |
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of Civil rights by calling |
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Page 6
For Informational Purposes Only
I understand that any changes in my information or information |
I know that I can find out how to appeal by calling |
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of any member(s) in the applicant’s household may affect the |
(TTY: |
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eligibility of other members of the household. |
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If applying for |
enrollees. |
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I know that I must file an appeal within 90 days of the decision. I |
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insurance on this renewal form is confined, after the disposition of |
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charges (judgment), in a jail, prison, or similar penal institution or |
know that I can represent myself or have someone else represent |
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correctional facility. |
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me in my appeal, such as an authorized representative, a friend, |
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I understand that I must report income changes to my |
a relative, or a lawyer. |
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I know that if I need help, someone at Covered Ca ifornia, the |
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county social services office or Covered California because it may |
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affect the eligibility for |
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assistance (or tax credits) that I may be eligible to receive. I |
my case to me. |
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also understand if I receive too much premium assistance (or |
DECLARATION |
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tax credits) during the benefit year, I will have to repay the extra |
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premium assistance back to the Irs when I file my federal income |
I declare under penalty of perjury under the laws of the state of |
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taxes for the benefit year. |
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California that what I say below is true and correct. |
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I give my permission to the |
I understood all questions on this n |
wal form and gave true and |
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to check other agencies’ computer records to verify citizenship, |
correct answers as far as I know. Wh |
re I did not know the answer |
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satisfactory immigration status, tax information, and other |
myself, I made every rea onable att |
mpt to confirm the answer |
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information related only to eligibility to see if I and other people on |
with someone who did kn w. |
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this renewal form qualify for health insurance. If someone on the |
I know that if I do n |
t tell the truth on this renewal form, there may |
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renewal form qualifies for |
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I know that if |
be a civil or c iminal |
enalty for perjury that may include up to four |
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years in jail. (see California Penal Code section 126.) |
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or anyone on this renewal form get from other health insurance |
I know that the information in this renewal form will be used to |
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or legal settlements related to that expense will go to |
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as payment for the expense until the expense is paid in full. For |
decide if the people who are applying qualify for health insurance. |
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parents whose child or children qualify for |
the |
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information private, as required by federal and California law. |
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I know I will be asked to help the agency that collects medic |
Purposes |
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I agree to notify the |
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support from any parent |
this renewal |
who does not live |
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with the child and does not send support |
the child. If I thi k |
county social services offices or Covered California by |
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that helping will harm me |
my children, can tell the |
calling |
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program and I will not have to help. |
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CoveredCa.com if anything changes on this renewal form |
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Your right to appeal: If |
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think |
Covered |
Cal forn a or the |
for any person applying for health insurance. |
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mistake, c |
ppe |
l i s decision. |
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to appeal means to tell someone |
Covered C |
lifornia or the |
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a fair review of the action. |
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signature of applicant or auth |
rized representative |
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Date and Place: |
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signature: Informational
Page 7
For Informational Purposes Only
[Insert Date]
You can get this notification in another language or in large print or another way that’s best for you. Call
It is time to renew your |
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Purposes |
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you to help you keep your |
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You Can Renew Your |
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■ By Mail: Complete this form and |
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Office hours are [8:30 a.m. to |
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mail it to: |
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5 .m. Monday to Friday]. |
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[Medicaid agency] |
■ Online: renewing online is quick |
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[100 state street] |
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and easy. Go to |
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[any city, state] |
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Informational |
www.coveredca.com |
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■ In Person: Visit our office at |
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or [saWs online portal] |
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[Medicaid agency] |
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to upload your documents. |
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[100 state street] |
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[any city, state] |
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How to Complete this Form
to make sure y u or your family continue to have
on this |
. |
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1. Please review the information |
2. send us or upload copies of |
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ab ut you and members of your |
documents that show your most |
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h usehold and let us know about |
current information even if your |
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any changes. |
information has not changed |
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Continued on next page
Questions? Call [state agency name] at
MC 216 (Rev 04/15) |
Page 1 |
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For Informational Purposes Only
How to Complete this Form - Continued from page 1
3.return this form or provide this information online by [Insert Date].
4.If you return this form by mail, please make sure to sign the form on page [INSERT PAGE #].
Whose Information We Need
We need the most current information about every member of your household who is living with you or is listed on your tax return, if you file taxes. We need information from:
■ People in your household who |
have |
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currently have |
want to apply for |
|
■ People in your household who |
informati n will be kept private and |
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used only to help those in your |
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would like to apply. |
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household who want to keep or |
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■ We may need some information |
apply for |
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about people in your household |
You do not need to file a tax return |
who live with you or are listed
What Happens if My Informa n is Different?
on yourInformationaltax return, who do not to apply for or renew your
If anyone in your household does |
kept private and will be used only to |
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not qualify for |
see if you or your family qualifies for |
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the information on this form has |
affordable health coverage. We may |
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changed, we will use your new |
need more information from you to |
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information to check to see if you |
find you the most affordable health |
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or other people in your household |
coverage. You do not need to file a |
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qualify |
other affordable health |
tax return to apply for or renew your |
cove age, including Covered |
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Calif rnia. Your information will be |
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Questions? Call [state agency name] at
MC 216 (Rev 04/15) |
Page 2 |
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For Informational Purposes Only
Form Characteristics
| Fact Name | Fact Details |
|---|---|
| Governing Law | The MC 216 Medical Renewal Form is governed by California state law regarding Medi-Cal regulations. |
| Purpose | This form is used to confirm beneficiary information and request verification for Medi-Cal renewal on an annual basis. |
| Language Accessibility | The MC 216 form is provided in all threshold languages to ensure accessibility for all beneficiaries. |
| Update Notification | The form was revised and transmitted to counties in a letter dated May 19, 2015. |
| Income Reporting | The updated Section 3 now asks for expected income for the current calendar year, replacing previous wording. |
| Document Submission | Beneficiaries can submit documents showing current income via mail, online, or in person to the designated agency. |
| Privacy Protection | Information collected from the form is kept private and is only used to determine eligibility for Medi-Cal and other health coverage. |
Guidelines on Utilizing Mc216 Medical Renewal
Renewing your Medi-Cal coverage is an important step to ensure you maintain access to health care services. The MC216 Medical Renewal form helps gather essential information to keep your coverage active. Here's how to fill it out correctly and efficiently.
- Carefully read through the pre-filled information about yourself and your household members. Note any changes that need to be made.
- Update your current home address, mailing address, and phone numbers if they differ from what is on the form.
- Fill out the "Who is in Your Household?" section. Make sure to verify the names and tax filing statuses of everyone in your household who wants to renew Medi-Cal coverage.
- In the "Income and Expenses" section, confirm the accuracy of the income details provided. If your income has changed, provide new information and attach documentation that verifies your income.
- Check and confirm the status of any other health insurance coverage your household might have. If there’s new insurance coverage, add this information to the form.
- Answer questions regarding any members of your household who may be incarcerated or deceased. Confirm if the information provided is correct or requires updating.
- Finally, sign the form on the designated page to verify that the information provided is accurate and complete.
Once you have completed the form, you can submit it through various channels: by mail, online, or in person. It's crucial to return the form promptly to prevent any gaps in your coverage.
What You Should Know About This Form
What is the MC216 Medical Renewal form?
The MC216 Medical Renewal form is a document used in California to help individuals confirm and verify their eligibility for Medi-Cal during the annual renewal process. This form is essential for ensuring that all necessary information about income, changes in household composition, and other relevant factors is accurately reported to maintain health coverage.
How do I complete the MC216 form?
To complete the MC216 form, first review the information about yourself and your household members. Make sure to indicate any changes. You will also need to provide documentation that shows your current income and expenses. Once completed, you can return the form by mail, online, or in person at your local Medi-Cal office.
What should I do if my information has changed?
If there have been any changes to the information previously provided, you must update it on the MC216 form. This includes changes to income, household members, or contact information. Providing accurate information ensures you or your family members continue to receive the correct health coverage.
How is my information used after submitting the MC216 form?
Your information will be used to verify your eligibility for Medi-Cal and to determine if you qualify for other health coverage options if necessary. Rest assured that all personal details provided will be kept confidential and utilized only for the purposes of assessing health coverage eligibility.
Can I apply for Medi-Cal without filing a tax return?
Yes, you do not need to file a tax return to apply for or renew your Medi-Cal coverage. The application process considers various income sources and household information regardless of tax filing status.
Where can I get help if I have questions about the MC216 form?
If you have questions or need assistance while completing the MC216 form, you can contact your local county welfare office or the Medi-Cal Eligibility Division. They can provide guidance and help clarify any uncertainties you may have.
What if someone in my household is incarcerated?
If there is someone in your household who is currently incarcerated, it's important to indicate that on the MC216 form. This information will help determine eligibility and coverage requirements accurately.
Common mistakes
Filling out the MC216 Medical Renewal form can be straightforward, but some common mistakes can cause delays in processing or even lead to denial of benefits. One common error is failing to update personal information. People may overlook changes in their address, phone number, or household members. Keeping contact information current is essential, as it ensures that the county can reach you with any questions or updates regarding your application.
Another frequent mistake is neglecting to report changes in income. Many applicants provide outdated income figures or forget to include additional sources of income. Since income can fluctuate, it's crucial to give an accurate picture of what you expect to earn in the upcoming year. Failure to do so might result in eligibility issues or incorrect estimates made by the county.
Some individuals may also forget to provide necessary documentation. Even if the reported information is correct, without the required paper proof, such as pay stubs or tax returns, the form might be considered incomplete. This step is vital because it helps verify the claims made on the application. Remember to include all the documents requested to help streamline the renewal process.
Lastly, many applicants overlook the importance of reviewing the completed form before submission. Failing to double-check can result in simple errors, like incorrect spellings or numbers. These mistakes can cause unnecessary complications or delays in processing the renewal. Taking a few moments to review the entire form can prevent these issues and ensure that everything is accurate and complete.
Documents used along the form
The MC216 Medical Renewal Form is a vital document for individuals seeking to renew their Medi-Cal coverage in California. As part of the renewal process, there are several additional forms and documents that may be required to ensure a smooth evaluation of eligibility and benefits. Below is a list of common documents that work in conjunction with the MC216 form.
- Income Documentation: This includes various forms of proof regarding income, such as recent pay stubs, tax returns, or award letters from government assistance programs. This documentation helps verify the income reported on the MC216 form.
- Application for Benefits: Sometimes referred to as the initial application form, this document is used by new applicants to establish eligibility for Medi-Cal. It includes detailed questions about income, household size, and other relevant factors.
- Health Insurance Information: This form is used to inform the Medi-Cal program of any other health insurance that beneficiaries may have. It ensures that all available resources are considered when determining eligibility for Medi-Cal coverage.
- Change of Address Form: If there are any changes in the recipient's address, this document should be submitted to keep the Medi-Cal file current. A correct address is essential for receiving timely notifications and ensuring continuous coverage.
- Deceased Notification Form: In cases where a household member listed in the Medi-Cal records has passed away, this form acts as a notification to update the program's records, thus eliminating any confusion regarding coverage.
- Incarceration Notification Form: This document informs Medi-Cal of any household members who are incarcerated. This information can impact eligibility and coverage options, making it necessary to report accurately.
Gathering these documents along with the MC216 form will facilitate a comprehensive review of each beneficiary's situation, allowing for accurate determination of benefits. Ensuring that all information is up-to-date and submitted promptly is essential in maintaining coverage and accessing necessary healthcare services.
Similar forms
- MC 213 Notice of Action: This document notifies individuals about changes to their Medi-Cal eligibility. Like the MC 216, it collects updated information to maintain coverage.
- MC 20 Medi-Cal Application Form: Similar to the MC 216, this form is used to apply for Medi-Cal benefits. It also requires detailed income and household information for assessment.
- MC 253 Medi-Cal Verification Form: This form seeks verification of income and household details for Medi-Cal recipients, just like the MC 216 does during renewal periods.
- MC 381 Health Insurance Premium Payment Request: Used for requesting payment of premiums for health insurance, it requires information about income and household members, akin to the MC 216’s requirements.
- MC 048 Medi-Cal Program Change Form: This form allows recipients to report changes that affect their Medi-Cal eligibility. Like the MC 216, it focuses on household information.
- MC 435 Eligibility Determination Form: This document is utilized for determining eligibility for Medi-Cal. It gathers similar information about income and household as the MC 216.
- MC 110 In-Home Supportive Services Application: This form is related to in-home services for eligible Medi-Cal recipients. Both forms involve detailed household and income information.
- MC 202 Medi-Cal Renewal Form: Often used for individuals who do not receive a pre-populated form. It requests comparable updates regarding household composition and income.
- MC 320 Notice of Required Documents: This notice requests specific documents required for maintaining Medi-Cal eligibility, similar to the income verification sought in the MC 216.
- MC 401 Questions about Your Medi-Cal Renewal: This form addresses inquiries related to Medi-Cal renewals. It requires the same type of information regarding the household and financial status.
Dos and Don'ts
When filling out the MC 216 Medical Renewal form, attention to detail is essential. Here are some important do's and don'ts:
- Do: Review all pre-filled information carefully.
- Do: Report any changes in household or income accurately.
- Do: Ensure that required documentation is attached.
- Do: Sign and date the form before submission.
- Do: Contact the agency if you have any questions about the process.
- Don't: Ignore discrepancies in your information.
- Don't: Leave any sections of the form blank unless specified.
- Don't: Forget to check for signatures on required documents.
- Don't: Delay in submitting the form by the required deadline.
- Don't: Hesitate to seek assistance if needed.
Misconceptions
- Misconception 1: The MC216 form is only for those who currently have Medi-Cal.
- Misconception 2: You must file a tax return to renew your Medi-Cal.
- Misconception 3: You can only submit the MC216 form by mail.
- Misconception 4: The MC216 form only needs to be filled out once.
- Misconception 5: Any changes in information don’t need to be reported immediately.
- Misconception 6: All information provided is publicly accessible.
This is not true. The MC216 form is also for individuals who wish to apply for Medi-Cal. It collects information necessary for both renewing and applying for benefits.
This is false. You do not need to file a tax return to apply for or renew Medi-Cal. The program is accessible to everyone, irrespective of tax filing status.
This is incorrect. The MC216 can be submitted online as well as in person. Multiple submission options are available to accommodate different preferences.
This misconception overlooks the annual renewal requirement. Even if your information hasn’t changed, you still need to submit the form each year to maintain your Medi-Cal coverage.
This is misleading. It is essential to report any changes to your household or income promptly to ensure accurate eligibility and prevent future complications.
Many may mistakenly believe this. However, all personal information submitted on the MC216 form is kept confidential and is used solely for determining Medi-Cal eligibility.
Key takeaways
Filling out the MC216 Medical Renewal form is essential for maintaining your Medi-Cal coverage. Here are some key takeaways to ensure a smooth process:
- Review and Update Your Information: Carefully check all the details on the form. If any information about your household has changed, be sure to update it.
- Document Verification: Provide copies of necessary documents to show your most current income and expenses. This could include pay stubs, tax returns, or other relevant financial information.
- Income Reporting: Respond to questions about your income accurately. The question regarding future income has changed, so remember to report what you expect for the current calendar year.
- Submission Methods: You can renew your Medi-Cal coverage via mail, online, or in person. Choose the method that works best for you.
- Confidentiality and Support: Information about your household is kept private. If you have questions or need assistance, don’t hesitate to reach out to the designated contacts provided in the form.
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