Healthy Families Program - A healthier tomorrow starts today!

Download the Premium Re-evaluation Form

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Form

Download the Premium Re-evaluation Form.

Last updated 02/2010

Federal Income Guidelines

Use the Federal Income Guidelines chart to help determine a person's possible eligibility for Healthy Families or Medi-Cal.

Last updated 04/2012

After you download and fill out the Premium Re-evaluation Form, mail to:

Healthy Families/Medi-Cal for Children & Pregnant Women
P.O. Box 138005
Sacramento, CA 95813-8005