This program is administered
by the Managed Risk Medical Insurance Board (MRMIB).
Download an EE/CAA Authorization Form
Most items are in Acrobat pdf format, and you will need Acrobat Reader to see them. Click here to download a free copy of Adobe Acrobat Reader if you do not have the program.
After you download and fill out the EE/CAA Authorization form, mail to:
Healthy Families/Medi-Cal for Children & Pregnant Women
P.O. Box 138005
Sacramento, CA 95813-8005