California - CA

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Acceptable Subsidies

The standard eligibility programs that may be used as proof of subsidy include Temporary Assistance to Needy Families (TANF), Supplemental Security Income (SSI), Food Stamps (CalFresh), Medicaid - Medi-Cal, National Free School Lunch Program, Federal Public Housing Assistance (FPHA), and Low-Income Home Energy Assistance Program (LIHEAP), Veterans and Survivors Pension benefit.


State-Specific Eligibility Programs

  • Women, Infants, and Children Program (WIC)
  • TANF Programs:

California Work Opportunity and Responsibility to Kids (CalWORKs), Stanislaus County Work Opportunity and Responsibility to Kids (StanWORKs), Welfare-to-Work (WTW), Greater Avenues for Independence (GAIN)


State-Specific Tribal Eligibility Programs

  • Tribal TANF
  • Bureau of Indian Affairs General Assistance
  • Head Start Income Eligible (Tribal Only)
  • Food Distribution Program on Indian Reservations


See General Rules for more information.

UNACCEPTABLE Subsidy Proof Examples

Ca-unacceptable ssa form.gif


  • Verification of Benefit forms
  • Issuance Summary forms
  • Human Services Agency Passport to Services forms


Acceptable Subsidy Proof Examples

CalFresh EBT Card EBT front.pngEBT Back.jpg

  • An image of the front and back of the card (with the applicant’s signature) must be uploaded
  • The card must display the applicant’s name, or the name of applicant’s benefit qualifying person (BQP)
  • A purchase receipt that displays a date that is no more than 7 calendar days prior to the date of the application and that displays the last 4 digits of the accompanying EBT card must be uploaded with the SAME image of the EBT card


Notice of Approval for CalFresh Benefits SNAP-Calfresh Notice Letter of Approval.png

  • Notice of Approval For CalFresh Benefits must appear on the document
  • The applicant’s name, or the name of the applicant’s benefit qualifying person (BQP) must appear on the document
  • A certification period “from” date that is not more than 7 calendar days prior to the date of the application must appear on the document



CalFresh Notice of Action SNAP-Calfresh Notice of Action.png

  • The NOTICE OF ACTION form identifier must appear on the document
  • The applicant’s name, or the name of applicant’s benefit qualifying person (BQP) must appear on the document
  • Must specifically mention CalFresh on the document
  • The Notice Date must be no more than 7 calendar days before the date of the application





Medicaid/Medi-Cal Cards Ca-medi cal.pngCa=la care medX2.gifCa-another medi-cal card.pngCa-anthem medi-calX.gifCa-caloptima medX.gifCa-calviva medi-calX.gifCa-chw medi-cal.gifCa-community medX.gifCa-hp sj medX.gifCa-hpsm medX2.gifCa-mediconnedct la careX.gifCa-sc medX.gifCa-sf medX.gifCa-sfhp medX.gifCa-anthem oakland medi-calX.gifCa-different la care medi-calX.gifCa-alliance mcalX.gifCa-sfhp mediX.gifCa-iehp dualX.gifCa-sc med connectX.gifCa-anthem mediconnectX.gifCa-old bcbs medi-calX.gifCa-caloptima med-icalX.gifCa-hpsj medi-caX.gifCommunity health medi-calX.gifCa-health net medi-calX.gifCa-access med-calX.gifCa-hpsj medi-cal4X.gifCa-liberty medi-calX.gifCa-another benefits ID card-medi-calX.gifCa-community medi-connectX.gifCa-cchp medi-calX2.gifCa-another chw medX.gifCA-optima mediconnectX.gifCa-spanish mcX.gifCa-mcal proofX.pngCa-molina mediconnectX.gifCa-health net medi-calX.gifCa-hpsm cal mediconnectX.gifCa-hpsm medi-calX.gifPhpc.gifCa-phcp 2.1.gifCa-new la care hp.gifCa-sc fammedi-cal.gif



Ca-anthem la care side 1.gifCa-anthem la care side 2.gif

  • BOTH sides must be uploaded.



Ca-new anthem la care 1.gifCa-new anthem la care 2.gif

  • BOTH sides must be uploaded.



Ca-healthnet med-cal1.gifCa-healthnet med-cal2.gif Ca-new health net card.pngCa-new health net card 2.png

  • BOTH sides must be uploaded.
  • Issue and Expiration dates must be within current calendar year.


Ca-la care chp med2.gif

  • BOTH sides must be uploaded.



Ca-kern medi-cal onlyX.gifCa-gold coast medi-calX.gifCa-calviva med2X.gif

  • Kern Family Health Care, Gold Coast Health Plan, and CalViva offer only Medi-Cal.




Medicaid/Medi-Cal Approval Letters Ca-med approval letter.png Ca-medi cal approval.png Ca-medi-cal id letterX.png Ca-cc medii-cal letterX.gif Ca-med-cal printout2X.gif Ca-med-cal letterX2.gif Ca-gchp medi-calX2.gif Ca-cover medi-cal letterX.gif Ca-med-cal print.gif Ca-med-cal print2.gif Ca-kern co med letter.png Ca-covered ca medi-cal printoutX.gif Ca-cover cal med letter.gif Ca-prison release medi-cal.png Ca-medi-cal-verif-letter.gif

  • Must show valid eligibility dates.


San joaquin letterX.gif

  • Must show valid eligibility dates.


TANF

Ca-cal-works benefits summary.png Ca-calworks form.png Ca-welfare to work.png Ca-wtw tanf.png Ca-wtw tanf (2).png Ca-calworks 2.gif

  • No amount need be given; just participating in the program qualifies them



Supplemental Security Income (SSI)

  • Must be dated within the past year.

SSI2b.gif



FPHA/Section 8Ca-section 8.gifCa-sc sec 8.gifCa-sec 8 confirm letter2.jpg



WIC Ca-new wic card.gif

  • cards that do not display a name must be accompanied by a grocery receipt that shows an active balance, be dated within 3 months of the LifeLine application, and the last 4 digits of the WIC card number shown on the receipt must match the WIC card number.

Ca-wic receipt 2.gif


Acceptable WIC App screen shots Ca-wic screenshot.jpgCa-wic screenshot2.jpg


National Free School Lunch Program Ca-free lunch.gif Ca-free school lunch3.gif Ca-free school lunch2.gif Ca-nfslp.gif


Food Distribution Program on Indian ReservationsCa-fdpir.gifCa-fdpir letter.gifCa-fdpir letter2.gifFdpir letter 2.jpg



Tribal TANF Tribal tanf.gif Ca-tribal tanf letter.gif


Acceptable Income Proof Examples

SSDI (must be dated within the past year) SSIb.gif

  • NOT PROOF OF SSI
  • Can be used to demonstrate low income eligibility.



Unemployment Benefits Printout Ca-unemployment.png

  • Can be used to demonstrate low income eligibility.



Emergency Unemployment Benefits Extension Award Letter (Spanish) Ca-ui spanish.gif

  • Can be used to demonstrate low income eligibility.



Disability Insurance Claim Letter Ca-disability income.gif

  • Can be used to demonstrate low income eligibility.



Acceptable ID Examples

Ca-dl.jpgCa-dl2.jpgCa-dl3.jpgCa-dl4.jpgCa-dl5.jpgCa-dl7.jpgCa-indian id.gifCa-sf id.gifDischarge ID.gifCa-richomnd id.gifCa-older DL.gifCa-senior id.gif




Mexican id.gifId-new mex id.gif

  • Acceptable in California ONLY



Parolee ID CA Parole ID.jpg

  • Acceptable in California ONLY



Parolee ID CDCR ID.gif

  • Acceptable in California ONLY



Ca-mexican passport.gifCa-iran passport.gif

  • FOREIGN passports acceptable in California ONLY

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