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Download a Re-enrollment 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.
- Re-enrollment Form (English) 699 KB
- Re-enrollment Form (Spanish) 773 KB
- Re-enrollment Form (Chinese) 576 KB
- Re-enrollment Form (Korean) 507 KB
- Re-enrollment Form (Vietnamese) 629 KB
After you download and fill out the Re-enrollment form, mail to:
Healthy Families/Medi-Cal for Children & Pregnant Women
P.O. Box 138005
Sacramento, CA 95813-8005