This version of the form is not currently in use and is provided for reference only. Download this version of Form DHCS6209 for the current year.
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 Form DHCS6209?
A: Form DHCS6209 is a Medi-Cal Supplemental Changes form used in California.
Q: What is Medi-Cal?
A: Medi-Cal is California's Medicaid program that provides free or low-cost health coverage to eligible individuals.
Q: What are Medi-Cal Supplemental Changes?
A: Medi-Cal Supplemental Changes refer to any updates or revisions made to a Medi-Cal application or enrollment.
Q: Who needs to complete Form DHCS6209?
A: Form DHCS6209 needs to be completed by Medi-Cal beneficiaries or their authorized representatives when there are changes to their information.
Q: What kind of changes can be reported on Form DHCS6209?
A: Form DHCS6209 can be used to report changes in address, income, household composition, and other relevant information.
Form Details:
Download a fillable version of Form DHCS6209 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.