This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is DHCS9094?
A: DHCS9094 is a form used in California to request suspension of Medi-Cal payment eligibility.
Q: Who can use DHCS9094?
A: DHCS9094 can be used by individuals in California who want to suspend their Medi-Cal payment eligibility.
Q: What is Medi-Cal?
A: Medi-Cal is a program that provides free or low-cost health coverage for eligible low-income individuals and families in California.
Q: Why would someone want to suspend their Medi-Cal payment eligibility?
A: Someone may want to suspend their Medi-Cal payment eligibility due to changes in their income or other circumstances that make them temporarily ineligible for the program.
Form Details:
Download a fillable version of Form DHCS9094 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.