This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California.
The document is provided in Tagalog. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is Form MC176 S?
A: It is a Medi-Cal Status Report form in California.
Q: What is Medi-Cal?
A: Medi-Cal is California's Medicaid program which provides free or low-cost health coverage to eligible individuals.
Q: Who needs to complete Form MC176 S?
A: Individuals in California who have Medi-Cal coverage and need to report changes in their circumstances.
Q: What information is required on Form MC176 S?
A: The form asks for personal information, income details, current health coverage details, and any changes in circumstances.
Q: Is assistance available to complete Form MC176 S?
A: Yes, individuals can reach out to their local county welfare department or Medi-Cal office for assistance with completing the form.
Q: Is there a deadline for submitting Form MC176 S?
A: The form should be submitted within 10 days of any changes in circumstances to ensure continued eligibility for Medi-Cal.
Q: Are there consequences for not submitting Form MC176 S?
A: Failure to report changes in circumstances on time may result in loss of Medi-Cal coverage or penalties.
Q: Is there a fee to submit Form MC176 S?
A: No, there is no fee to submit Form MC176 S.
Q: Are translations of Form MC176 S available?
A: Yes, translations of Form MC176 S are available in multiple languages, including Tagalog.
Form Details:
Download a fillable version of Form MC176 S by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.