Worksheets for Determining Eligibility Under the Aged & Disabled Federal Poverty Level (A&D FPL) Medi-Cal Program

Publications
#5450.01

This publication and the accompanying worksheets are to be used to determine if an individual, couple or an individual in a family qualify for the A&D Medi-Cal program. This is a no-share-of-cost Medi-Cal Program.

 

Click links below for a full downloadable version.

Publication #5450 (pdf)
Publication #5450 (rtf)

Publication #5450 - Worksheet Individual (pdf)
Publication #5450 - Worksheet Individual (rtf)

Publication #5450 - Worksheet Couple (pdf)
Publication #5450 - Worksheet Couple (rtf)

Publication #5450 - Worksheet Individual with Spouse and/or children (pdf)
Publication #5450 - Worksheet Individual with Spouse and/or children (rtf)