This program is administered
by the Managed Risk Medical Insurance Board (MRMIB).
You may apply for the AIM Program by providing either your current household income or your previous year's household income. Either way, you must include both the pregnant woman's income and the income of the husband/father of the baby. (If you are not married to the father, count his income only if he lives in the home with you and you have another child together.) Income includes:
- wages before taxes
- bonuses/overtime pay
- self-employment net profit
- unearned income (for example: unemployment, disability, social security, alimony, pensions)
- income earned in other states or foreign countries
Do not include child support and public assistance program benefits as income.
You may use any of the following documents to show GROSS household income. Note that you can use last year's income or this year's income. Include a copy of the proof along with your application.
Proof of Last Year's Income:
Federal Income Tax return.
From previous year: 1040, 1040A, 1040EZ, 1040NR or 1040NR-EZ Form (if self-employed, see below); or,
All documents to show unearned income.
For example, copies of award letters for the calendar year, checks or bank statements showing the amount of Social Security, disability insurance, alimony, spousal support, etc., from previous year.
Exception: Income from self-employment, partnerships or independent contracts requires:
- Submission of the previous year's Federal Income Tax Form 1040 AND the Schedule C, E or F (or equivalent schedule); or
A profit and loss statement for the most recent three-month period prior to the date the program receives the application.
Note: Countable income is Net Profit. Depreciation, meals and entertainment expenses are added back into net profit. Negative figures (losses) on the 1040 and profit and loss statement are counted as zero.
The following must be included in the profit and loss statement or it will not be accepted::
- Name, address and phone number of the business.
- Itemized gross income and expenses for each separate month in the three-month period.
- Signature of the person who earned the income along with the following sentence, "Information provided is true and correct."
Proof of Current Income:
Paycheck or unemployment stub
Showing gross income for a period which ended within 45 days of the date the program receives the document. The following must be included on the stub or it will not be accepted:
- Gross and net wages.
- Name of employee.
- Pay date or pay period.
- Name of business; or
Letter from Employer
The following must be included in the letter or it will not be accepted:
- Letterhead identifying business name, address and phone number.
- Date of the employer letter.
- Employee's name.
- Employee's current gross monthly income for a period ending 45 days from when the program receives the document.
- Statement: "Information provided is true and correct to the best of the signer's knowledge."
- Signature and job title of authorized personnel.
Click here for a sample employer letter.
All documents to show unearned income. For example, copies of award letters for the current calendar year, checks or bank statements showing the amount of Social Security, disability insurance, alimony, spousal support, etc.
Medi-Cal Notice of Action (NOA)
The NOA must include an income amount or a budget worksheet (may be separate), and must be issued within two months of the date of your application, showing that you do not qualify for no-cost Medi-Cal.