California Healthy Families

You can call the office of our Healthy Families Enrollment Entity and have a CAA fill out an application for you. The representative will ask you questions, fill out a form, then mail the form to you so you can sign it. To apply by phone, call 1-888-599-7056. The call is free.
The phone call will take about 20 minutes. You will need to have these items when you call:

• A pen or pencil and paper to write down information.
• A pay stub you received within 45 days or last year’s Federal Income Tax Form 1040 for everyone receiving income in your household.
• If someone is self-employed, the most recent 3-month profit and loss statement or last year’s Federal Income Tax Form 1040 and Schedule C.
• Birth dates for every child applying in your household.
• Amounts for child daycare expenses.
• Amounts for disabled dependent care.
• Amounts for any child support or alimony either paid or received.

After the call, Healthy Families CAA Eric Tapia will mail you a pre-printed application. You will need to make sure that the information is correct and sign the application. Mail the application back to Healthy Families along with papers that are asked for, such as proof of income, expenses, and citizenship documentation.

2. Download and print out the application

                                                                     Download your Application Click Here!!!
                                                                                

You can download an application instantly here. Once you print out the application, please complete it, sign it and date it. There are two spots that you sign and date the application (On page 4 under Declaration and Signature as well as under Fill out below ONLY if working with a CAA). As CAA's we will be assisting you to complete this application so you have to sign and date it in both locations that ask for Applicant Signatures.  We then can assist you in completing the application as well as we can call on your behalf to check status of your application.
You can then fax the signed and dated application to (909)895-3646 so that we can review it to make sure it is completed properly. (Make sure you also fax the required income verification as well as birth certificate(s) or citizenship paperwork and other forms if necessary.)

                                   Haga clic aquí para obtener la solicitud en español:  

If you do not have access to a fax machine please mail the application along with copies of the requested forms to:
Seguro Medico Insurance (EE# 90443)
417 W. Allen Ave. Suite #114 San Dimas, CA 91773.
Once we receive your application, we’ll notify you by phone if the application is 100% complete or if we need more information.

Once we have a 100% completed application it will be sent to the state for review.

3. Health E-Application
We can complete a Health-E-A-App for you. Health-e-App is an easy-to-use, interactive, online application process that supplements the paper application process. Using Health-e-App when applying for the Healthy Families Program (HFP) and/or Medi-Cal has many advantages over the traditional paper application. The biggest advantage of using Health-e-App is that it provides a faster avenue for the HFP to screen and determine eligibility for the applying children by streamlining the application process and ensuring complete entry of required information. The information gathered is then submitted electronically via the Internet, rather than on paper by mail. 

We can also select health, dental, and vision plans and providers from lists automatically generated based on the applicants' county of residence. Using Health-e-App also minimizes mistakes caused by illegible handwriting on paper applications.

The online application process takes 20-30 minutes to complete and offers the following enhanced features:  

• Preliminary eligibility screening in just seconds
• Electronic payment of the HFP initial monthly premium
• Automated computing of income and deductions
• Electronic signatures

We are Health-E-App certified and will use this prefered method to streamline your application processing.

What is a Certified Application Assistant?
Certified Application Assistants (CAAs) are people from community organizations who have been trained to help you fill out the joint Medi-Cal and Healthy Families application. The community organizations that CAAs work with are called Enrollment Entities (EEs). 

     Income guidelines for joining Healthy Families and no-cost Medi-Cal.
(April 2009- April 2010) 
                    PLEASE CALL TO SEE IF YOUR INCOME QUALIFIES  (888)599-7056

Toll Free: (888) 599-7056
Local: (909)599-7056
Fax: (909)895-3646
Email:  erictapia@yahoo.com 

    HEALTHY FAMILIES IS AVAILABLE IN THESE CALIFORNIA COUNTIES
 Healthy families Alameda              Healthy families Alpine                   Healthy families Amador            Healthy families Butte               Healthy families Calaveras
Healthy families Colusa          Healthy families Contra Costa         Healthy families Del Norte         Healthy families El Dorado        Healthy families Fresno
Healthy families Glenn         Healthy families Humboldt           Healthy families Imperial          Healthy families Inyo                  Healthy families Kern
Healthy families Kings           Healthy families Lake              Healthy families Lassen               Healthy families Los Angeles        Healthy families Madera
Healthy families Marin          Healthy families Mariposa       Healthy families Mendocino       Healthy families Merced                  Healthy families Modoc
Healthy families Mono       Healthy families Monterey        Healthy families Napa                 Healthy families Nevada                Healthy families Orange
Healthy families Placer          Healthy families Plumas          Healthy families Riverside       Healthy families Sacramento              Healthy families San Benito
Healthy families San Bernardino      Healthy families San Diego       Healthy families San Francisco          Healthy families San Joaquin        Healthy families San Luis Obispo
Healthy families San Mateo        Healthy families Santa Barbara           Healthy families Santa Clara         Healthy families Santa Cruz          Healthy families Shasta
Healthy families Sierra        Healthy families Siskiyou       Healthy families Solano          Healthy families Stanislaus      Healthy families Sutter       Healthy families Tehama
Healthy families Trinity       Healthy families Tulare         Healthy families Tuolumme       Healthy families Ventura         Healthy families Yolo          Healthy families Yuba