Download the Application Package or the Application Form

Most items are in Acrobat pdf format, and you will need Acrobat Reader to see them. Click here to download a free copy of Adobe Acrobat Reader if you do not have the program.

Form only

If you do not need specific instructions, you can download the Application Form without Instructions. This version will take less time to download and print.

• Application Form without Instructions (English) 671 KB
• Application Form without Instructions (Spanish) 798 KB
• Application Form without Instructions (Arabic) 1,140 KB
• Application Form without Instructions (Armenian) 1,807 KB
• Application Form without Instructions (Chinese) 729 KB
• Application Form without Instructions (Farsi) 1,099 KB
• Application Form without Instructions (Hmong) 672 KB
• Application Form without Instructions (Khmer/Cambodian) 3,151 KB
• Application Form without Instructions (Korean) 724 KB
• Application Form without Instructions (Russian) 619 KB
• Application Form without Instructions (Tagalog) 668 KB
• Application Form without Instructions (Vietnamese) 615 KB

New Federal Income Guidelines & Program Updates

Use this document to see if a person may qualify for Healthy Families. This document also has new and important information about Healthy Families. Click here.

Application Form & Important Healthy Families Information

The Application Package is a complete, 12-page, full-color version of the Healthy Families application. The Application Package also has important information about Healthy Families. Due to its large file size, the Application Package may take a few minutes to download and print.

There have been changes to the Application Package. Please also download and print this document too! Click here.

• Application Package (English) 636 KB
• Application Package (Spanish) 769 KB
• Application Package (Arabic) 1,106 KB
• Application Package (Armenian) 1,813 KB
• Application Package (Chinese) 732 KB
• Application Package(Farsi) 1,107 KB
• Application Package (Hmong) 683 KB
• Application Package (Khmer/Cambodian) 3,168 KB
• Application Package (Korean) 735 KB
• Application Package (Russian) 646 KB
• Application Package (Tagalog) 679 KB
• Application Package (Vietnamese) 629 KB

After you download and fill out the application form, mail to:

Healthy Families/Medi-Cal for Children & Pregnant Women
P.O. Box 138005
Sacramento, CA 95813-8005