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Denti-Cal and Healthy Families : Enrollment
To enroll in either Medi-Cal for Families or Healthy Families, print out and complete the application below and send it to:

Forms :


Healthy Families/ Medi-Cal for Families and Pregnant Women
P.O. Box 138005
Sacramento, CA 95813-9984

Please include with the completed application the following documents:
1. A copy of your birth certificate or
Proof of your immigration status or a receipt from the INS verifying that you have applied to replace your lost document.
2. Proof of deductions listed in Section 5 of the application.
3. Proof of California residency (or proof of income).
4. If you are pregnant, proof of pregnancy from a doctor or medical facility.
5. Proof of income. Please send a copy of your most recent pay stub or a copy of last year's federal income tax return


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