Difference between revisions of "California - CA"

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== UNACCEPTABLE Subsidy Proof Examples == <!--[[File:Ca-not_med.gif]][[File:Ca-not_proof.gif]]*Does not specify benefits received.-->
 
== UNACCEPTABLE Subsidy Proof Examples == <!--[[File:Ca-not_med.gif]][[File:Ca-not_proof.gif]]*Does not specify benefits received.-->
 
[[File:Ca-unacceptable ssa form.gif]]
 
[[File:Ca-unacceptable ssa form.gif]]
 +
 +
 +
* Verification of Benefit forms
 +
* Issuance Summary forms
 +
* Human Services Agency Passport to Services forms
  
  
 
== Acceptable Subsidy Proof Examples ==
 
== Acceptable Subsidy Proof Examples ==
  
−
'''Food Stamps/CalFresh Card'''
+
'''CalFresh EBT Card'''
−
[[File:Ca-fs.jpg]]
+
[[File:EBT front.png]]
 +
* An image of the front of the card 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'''
 +
[[File: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'''
 +
[[File: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
 +
 
 +
 
 +
 
 +
 
 +
 
 +
'''Medi-Cal Cards'''
 +
[[File:Ca med BIC ID no.png]]
 +
 
 +
<!--[[File:Ca-medi_cal.png]][[File:Ca=la care medX2.gif]][[File:Ca-another medi-cal card.png]][[File:Ca-anthem medi-calX.gif]][[File:Ca-caloptima medX.gif]][[File:Ca-calviva medi-calX.gif]][[File:Ca-chw medi-cal.gif]][[File:Ca-community medX.gif]][[File:Ca-hp sj medX.gif]][[File:Ca-hpsm medX2.gif]][[File:Ca-mediconnedct la careX.gif]][[File:Ca-sc medX.gif]][[File:Ca-sf medX.gif]][[File:Ca-sfhp medX.gif]][[File:Ca-anthem oakland medi-calX.gif]][[File:Ca-different la care medi-calX.gif]][[File:Ca-alliance mcalX.gif]][[File:Ca-sfhp mediX.gif]][[File:Ca-iehp_dualX.gif]][[File:Ca-sc med connectX.gif]][[File:Ca-anthem mediconnectX.gif]][[File:Ca-old bcbs medi-calX.gif]][[File:Ca-caloptima med-icalX.gif]][[File:Ca-hpsj medi-caX.gif]][[File:Community health medi-calX.gif]][[File:Ca-health net medi-calX.gif]][[File:Ca-access med-calX.gif]][[File:Ca-hpsj medi-cal4X.gif]][[File:Ca-liberty medi-calX.gif]][[File:Ca-another benefits ID card-medi-calX.gif]][[File:Ca-community medi-connectX.gif]][[File:Ca-cchp medi-calX2.gif]][[File:Ca-another chw medX.gif]][[File:CA-optima mediconnectX.gif]][[File:Ca-spanish mcX.gif]][[File:Ca-mcal proofX.png]][[File:Ca-molina mediconnectX.gif]][[File:Ca-health net medi-calX.gif]][[File:Ca-hpsm cal mediconnectX.gif]][[File:Ca-hpsm medi-calX.gif]][[File:Phpc.gif]][[File:Ca-phcp 2.1.gif]][[File:Ca-new la care hp.gif]][[File:Ca-sc fammedi-cal.gif]][[File:Ca-molina healthnet medi-cal.gif]]
 +
 
 +
 
 +
 
 +
 
 +
[[File:Ca-anthem la care side 1.gif]][[File:Ca-anthem la care side 2.gif]]
 +
*BOTH sides must be uploaded.
 +
 
 +
 
 +
 
 +
 
 +
 
 +
[[File:Ca-new anthem la care 1.gif]][[File:Ca-new anthem la care 2.gif]]
 +
*BOTH sides must be uploaded.
 +
 
 +
 
 +
 
 +
 
  
 +
[[File:Ca-healthnet med-cal1.gif]][[File:Ca-healthnet med-cal2.gif]]
 +
[[File:Ca-new health net card.png]][[File:Ca-new health net card 2.png]]
 +
*BOTH sides must be uploaded.
 +
*Issue and Expiration dates must be within current calendar year.
  
  
−
'''Food Stamps/CalFresh Action Letters'''
 
−
[[File:Ca-cal-fresh_approval_letter.png]][[File:Ca-cal-fresh_action_letter.png]][[File:Ca-cal-fresh_recert_letter.png]][[File:Ca-cal-fresh_expiration_letter.png]][[File:Ca-fs_letter2.gif]][[File:Ca-snap_letter.gif]][[File:Ca-snap_cf_letter.gif]][[File:Ca-calfresh verification letter.gif]][[File:Ca-fs agency printout.gif]][[File:Ca-snap printout.png]][[File:Ca-sc benefits verification letter.gif]]
 
  
 +
[[File:Ca-la care chp med2.gif]]
 +
*BOTH sides must be uploaded.
  
  
  
  
−
'''Medicaid/Medi-Cal Cards'''
+
[[File:Ca-kern medi-cal onlyX.gif]][[File:Ca-gold coast medi-calX.gif]][[File:ca-calviva med2X.gif]]
−
[[File:Ca-medi_cal.png]][[File:Ca=la care med2.gif]][[File:Ca-another medi-cal card2.png]][[File:Ca-anthem medi-cal2.gif]][[File:Ca-caloptima med2.gif]][[File:Ca-calviva medi-cal2.gif]][[File:Ca-chw medi-cal2.gif]][[File:Ca-community med2.gif]][[File:Ca-hp sj med2.gif]][[File:Ca-hpsj medi-cal2.gif]][[File:Ca-hpsm med2.gif]][[File:Ca-mediconnedct la care2.gif]][[File:Ca-sc med2.gif]][[File:Ca-sf med2.gif]][[File:Ca-sfhp med2.gif]][[File:Ca-anthem oakland medi-cal2.gif]][[File:Ca-different la care medi-cal2.gif]][[File:Ca-alliance mcal.gif]][[File:Ca-sfhp medi.gif]][[File:Ca-iehp dua2l.gif]][[File:Ca-iehp_dual3.gif]][[File:Ca-sc med connect.gif]][[File:Ca-anthem mediconnect.gif]][[File:Ca-old bcbs medi-cal.gif]][[File:Ca-caloptima med-ical.gif]][[File:Ca-hpsj medi-ca2l.gif]][[File:Community health medi-cal.gif]][[File:Ca-health net medi-cal2.gif]][[File:Ca-access med-cal.gif]][[File:Ca-hpsj medi-cal4.gif]][[File:Ca-liberty medi-cal.gif]][[File:Ca-another benefits ID card-medi-cal.gif]][[File:Ca-community medi-connect.gif]][[File:Ca-cchp medi-cal.gif]][[File:Ca-another chw med.gif]][[File:CA-optima mediconnect.gif]][[File:Ca-spanish mc.gif]][[File:Ca-mcal proof.png]][[File:Ca-molina mediconnect.gif]][[File:Ca-health net medi-cal3.gif]][[File:Ca-hpsm cal mediconnect.gif]]
+
*Kern Family Health Care, Gold Coast Health Plan, and CalViva offer only Medi-Cal.
  
  
  
 +
[[File:CA - humana d-snp med.png]]
 +
*Must display "D-SNP"
  
  
  
−
[[File:Ca-kern medi-cal only.gif]][[File:Ca-gold coast medi-cal.gif]][[File:ca-calviva med2.gif]]
+
[[File:CA - healthy blue med.png]]
−
*Kern Family Health Care, Gold Coast Health Plan, and Calviva offer only Medi-Cal.
+
*Must display "D-SNP"
 +
*Must display 8-digit+1-letter or 10-digit ID No.-->
  
  
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[[File:Ca-med_approval_letter.png]]
 
[[File:Ca-med_approval_letter.png]]
 
[[File:Ca-medi_cal_approval.png]]
 
[[File:Ca-medi_cal_approval.png]]
−
[[File:Ca-medi-cal_id_letter.png]]
+
[[File:Ca-medi-cal_id_letterX.png]]
−
[[File:Ca-cc_medii-cal_letter.gif]]
+
[[File:Ca-cc_medii-cal_letterX.gif]]
−
[[File:Ca-med-cal printout2.gif]]
+
[[File:Ca-med-cal printout2X.gif]]
−
[[File:Ca-med-cal letter.gif]]
+
[[File:Ca-med-cal letterX2.gif]]
−
[[File:Ca-gchp medi-cal.gif]]
+
[[File:Ca-gchp medi-calX2.gif]]
−
[[File:Ca-cover medi-cal letter.gif]]
+
[[File:Ca-cover medi-cal letterX.gif]]
−
[[File:Ca-sc benefits verification letter.gif]]
+
[[File:Ca-med-cal print.gif]]
−
[[File:Ca-covered ca medi-cal printout.gif]]
+
[[File:Ca-med-cal print2.gif]]
 +
[[File:Ca-kern co med letter.png]]
 +
[[File:Ca-covered ca medi-cal printoutX.gif]]
 +
[[File:Ca-cover cal med letter.gif]]
 +
[[File:Ca-prison release medi-cal.png]]
 +
[[File:Ca-medi-cal-verif-letter.gif]]
 +
[[File:Ca verifcation receipt.gif]]
 +
[[File:Ca-caloptimahealthmedi-cal.png]]
 +
[[File:Ca-caloptimamedi-calauthsum.png]]
 +
 
 +
 
 +
[[File:Magejpeg 0.jpg]]
 
*Must show valid eligibility dates.
 
*Must show valid eligibility dates.
  
  
−
[[File:San joaquin letter.gif]]
+
[[File:Ca-medi-cal notice of action approval letter.png]]
 +
*Must be dated within the past year.
 +
 
 +
 
 +
[[File:San joaquin letterX.gif]]
 
*Must show valid eligibility dates.
 
*Must show valid eligibility dates.
 +
 +
 +
[[File:CA - LA County Medi-Cal AVES Cert.png]]
 +
 +
 +
 +
[[File:CA - LA County Medi-Cal Check.png]]
 +
 +
 +
  
  
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[[File:Ca-calworks_2.gif]]
 
[[File:Ca-calworks_2.gif]]
 
*No amount need be given; just participating in the program qualifies them
 
*No amount need be given; just participating in the program qualifies them
 +
  
  
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−
'''FPHA/Section 8'''[[File:Ca-section_8.gif]][[File:Ca-sc sec 8.gif]]
 
  
 +
 +
'''FPHA/Section 8'''[[File:Ca-section_8.gif]][[File:Ca-sc sec 8.gif]][[File:Ca-sec 8 confirm letter2.jpg]]
 +
 +
 +
 +
 +
 +
 +
'''WIC'''
 +
[[File: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.
 +
[[File:Ca-wic receipt 2.gif]]
  
 +
 +
Acceptable WIC App screen shots
 +
[[File:Ca-wic screenshot.jpg]][[File:Ca-wic screenshot2.jpg]]
  
  
−
'''WIC'''[[File:Ca-wic_voucher.png]][[File:Ca-wic_id.gif]]
 
  
  
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[[File:Ca-free school lunch3.gif]]
 
[[File:Ca-free school lunch3.gif]]
 
[[File:Ca-free school lunch2.gif]]
 
[[File:Ca-free school lunch2.gif]]
 +
[[File:Ca-nfslp.gif]]
 +
 +
 +
  
  
  
 +
'''Food Distribution Program on Indian Reservations'''[[File:Ca-fdpir.gif]][[File:Ca-fdpir letter.gif]][[File:Ca-fdpir letter2.gif]][[File:Fdpir letter 2.jpg]]
  
−
'''Food Distribution Program on Indian Reservations'''[[File:Ca-fdpir.gif]][[File:Ca-fdpir letter.gif]][[File:Ca-fdpir letter2.gif]]
 
  
  
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'''Tribal TANF'''
 
'''Tribal TANF'''
 
[[File:Tribal tanf.gif]]
 
[[File:Tribal tanf.gif]]
 +
[[File:Ca-tribal tanf letter.gif]]
 +
 +
 +
 +
 +
'''Low Income Energy Assistance Program (LIHEAP)
 +
[[File:Ca-heap.png]]
 +
 +
  
  
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*NOT PROOF OF SSI
 
*NOT PROOF OF SSI
 
*Can be used to demonstrate low income eligibility.  
 
*Can be used to demonstrate low income eligibility.  
−
 
−
 
  
  
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 +
'''Emergency Unemployment Benefits Extension Award Letter (Spanish)'''
 +
[[File:Ca-ui spanish.gif]]
 +
*Can be used to demonstrate low income eligibility.
  
  
−
'''Disability Insurance Claim Letter"
+
'''Disability Insurance Claim Letter'''
 
[[File:Ca-disability income.gif]]
 
[[File:Ca-disability income.gif]]
 
*Can be used to demonstrate low income eligibility.  
 
*Can be used to demonstrate low income eligibility.  
 +
 +
 +
  
  
  
 
== Acceptable ID Examples ==
 
== Acceptable ID Examples ==
−
[[File:Ca-dl.jpg]][[File:Ca-dl2.jpg]][[File:Ca-dl3.jpg]][[File:Ca-dl4.jpg]][[File:Ca-dl5.jpg]][[File:Ca-dl7.jpg]][[File:Ca-sac_id.gif]][[File:Ca-indian_id.gif]][[File:Ca-sf_id.gif]][[File:Ca-mta_id.gif]][[File:Ca-shelter_ID.gif]][[File:Discharge_ID.gif]][[File:Ca-richomnd id.gif]][[File:Ca-older DL.gif]][[File:Ca-senior id.gif]]
+
[[File:Ca-dl.jpg]][[File:Ca-dl2.jpg]][[File:Ca-dl3.jpg]][[File:Ca-dl4.jpg]][[File:Ca-dl5.jpg]][[File:Ca-dl7.jpg]][[File:Ca-indian_id.gif]][[File:Ca-sf_id.gif]][[File:Discharge_ID.gif]][[File:Ca-richomnd id.gif]][[File:Ca-older DL.gif]][[File:Ca-senior id.gif]]
  
  
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 +
 +
 +
'''Parolee ID''' [[File:CA Parole ID.jpg]]
 +
*Acceptable in California ONLY
 +
 +
 +
 +
 +
'''Parolee ID''' [[File:CDCR ID.gif]]
 +
*Acceptable in California ONLY
 +
 +
 +
 +
[[File:CA - LA County Sheriff’s Department, Community Transition Unit’s Post Release Services.png]]
 +
*Acceptable in California ONLY
  
  

Latest revision as of 08:52, 12 August 2024

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.png

  • An image of the front of the card 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



Medi-Cal Cards Ca med BIC ID no.png




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 Ca verifcation receipt.gif Ca-caloptimahealthmedi-cal.png Ca-caloptimamedi-calauthsum.png


Magejpeg 0.jpg

  • Must show valid eligibility dates.


Ca-medi-cal notice of action approval letter.png

  • Must be dated within the past year.


San joaquin letterX.gif

  • Must show valid eligibility dates.


CA - LA County Medi-Cal AVES Cert.png


CA - LA County Medi-Cal Check.png




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



Low Income Energy Assistance Program (LIHEAP) Ca-heap.png



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 - LA County Sheriff’s Department, Community Transition Unit’s Post Release Services.png

  • Acceptable in California ONLY


Ca-mexican passport.gifCa-iran passport.gif

  • FOREIGN passports acceptable in California ONLY

Important Links

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