Medi-Cal Status Report - State Of California - Health And Human Services Agency Page 7
Download a blank fillable Medi-Cal Status Report - State Of California - Health And Human Services Agency in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Medi-Cal Status Report - State Of California - Health And Human Services Agency with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7
8
9COMMUNITY-BASED ADULT SERVICES (CBAS) FAIR HEARING DELAY PENALTY
PAYMENT
Enclosed is a check for you because you are eligible for a penalty payment since your CBAS
fair hearing decision was not processed within 90 days of your request for a hearing.
This payment will not be counted as either income or property for Medi-Cal Program purposes.
However, please remember that the amount of the payment must be reported on your Medi-Cal
Status Report Form (MC176S) as a “Ball Payment” due to the Ball V. Swoap court order.
If you have any questions, please contact the Department of Social Services, Public Inquiry and
Response at (800) 952-5253.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Application For Administrator Certification - State Of California - Health And Human Services Agency
Legal
Form Qr 3 - Mid-quarter Status Report For Cash Aid And Food Stamps - 2006 - State Of California - Health And Human Services Agency
Legal
Confidential Report Of Suspected Dependandent Adult / Elder Abuse - State Of California - Health And Human Services Agency
Legal
Form Cdph 8391 - Report Of Name Or Address Change - State Of California-health And Human Services Agency
Legal
Roster Of Participants - For Vendor Use Only- Ictp Or Ceu Courses - State Of California - Health And Human Services Agency
Legal
Family Child Care Home Addendum To Notification Of Parents' Rights (regarding Removal/exclusion) State Of California - Health And Human Services Agency
Legal
Related Categories
Parent category: Business