Medi-Cal Privacy Notice
Federal and State law requires us to provide the following information: Welfare and Institutions Code §14011 requires Medi-Cal applicants to provide the information requested in this application. It may be shared with federal, state, and local agencies for purposes of verifying eligibility, and for verification of the immigration status of those persons seeking full scope Medi-Cal benefits. (Federal law says the U.S. Citizenship and Immigration Services [CIS], formerly the Immigration and Naturalization Service [INS] cannot use the information for anything else except cases of fraud.) It will also be used to process Medi-Cal claims and make Benefits Identification Cards (BICs). Failure to provide the required information may result in denial of the application. Information required by this form is mandatory. Social Security Numbers are required by §1144(a)(1) of the Social Security Act unless applying for emergency or pregnancy-related benefits only.
You have a right to access your Medi-Cal records. Contact your county Medi-Cal office. |