Community: Assistor Tools: Healthy Families
Healthy Families Program
Reference Materials
- Healthy Families Program Main Website
- Contact Information
- Reference CAA User Manual
- Healthy Families Member Handbook
- Federal Poverty Level (FPL) Guidelines for Health Programs
- Income Guidelines (Effective April 1, 2012)
- Premium Categories (Effective April 1, 2012)
- Premium Increases
- Income Calculation Worksheet Instructions
- Health-e-App & Instructions
- CAA Tutorial & Refresher
- Healthy Families Newsletter
Enrollment Forms
- Applications (English, Chinese, Spanish)
(Please note this application can also be used to apply for Medi-Cal for Children & Pregnant Women) - Income Calculation Worksheet
- Add a Person
- Annual Eligibility Review
- Reviewed and Continued Enrollment
- Re-enrollment
- Program Review
- Electronic Funds Transfer
- Authorized Representative
- Premium Re-Evaluation
- Sponsor Registration
- Sponsor Payment
- EE/CAA Authorization Form
Verification Forms/Documents
- Child Day Care Form (English, Chinese, Spanish)
- Child Support Received Form (English, Chinese, Spanish)
- Gift Letter Form (English, Chinese, Spanish)
- Income Documentation for Renting a Room Form (English, Chinese, Spanish)
- Rental Income Worksheet (English, Chinese, Spanish)
- Sample Employer Letter (English, Chinese, Spanish)
- Sample Profit & Loss Statement (English, Chinese, Spanish)
- Sample Self Affidavit of Income Letter (English, Chinese, Spanish)
Accessibility Statement
