Depending on your household situation, you might need a specific PDF version: 1. The Single Streamlined Application (SS 239) This is the most common form. Use this if you are: An individual or family under age 65. Pregnant or have children. Applying based on income levels (MAGI Medi-Cal). 2. The MC 210 Series Use this version if you are: Aged 65 or older. Blind or disabled. In need of Long-Term Care (Nursing Home) coverage. Key Information Required for the 2023 Application
Recent pay stubs, tax returns, or self-employment records.
A California ID, utility bill, or rental agreement.