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Choose a county from the drop down list to see materials for that county.

This page helps you understand the “informing” materials you get in the mail. It also helps you choose a health plan and enroll in the Medi-Cal Managed Care HCO program.

You must have the newest version of Adobe Reader to use these forms. You can download Adobe Reader for free here Adobe PDF icon.

In-person help

  • Presentation sites
    We have information sessions near you. The sessions are about choosing Medi-Cal managed care plans. You can go to any session to hear about your choices and ask questions in person. Use this form to find meeting places and times for Los Angeles.

Choice enrollment forms

Exception and exemption to plan enrollment forms

  • Request for medical exemption from plan enrollment
    Use this form if you do not want to join a medical plan for medical reasons. It will help you ask for an exemption (release) from having to join a plan. If you need help filling out the form, call 1-800-430-4263 (TTY 1-800-430-7077).
  • Request for Indian Health Program non-medical exemption from plan enrollment
    Only use this form if you are in an Indian Health Program. Use this form if you do not want to join a medical plan for non-medical reasons. It will help you ask for an exemption (release) from having to join a plan. If you need help filling out the form, call 1-800-430-4263 (TTY 1-800-430-7077).
  • Request for Coordinated Care Initiative non-medical exemption from plan enrollment
    Only use this form if you are in a Coordinated Care Initiative (CCI) county and you 1) are an American Indian or 2) have been diagnosed with HIV or AIDS. Use this form if you do not want to join a medical plan for non-medical reasons. It will help you ask for an exemption (release) from having to join a plan. If you need help filling out the form, call 1-844-580-7272 (TTY 1-800-430-7077).

Medical exemption request documents

You have the right to inspect, review and get a copy of your Medical Exemption Request (MER) documents. You must be the person or the parent, guardian or personal representative of the person whose documents you want to see. To ask for your MER documents, go to one of the links below and download the fillable form you need. You can email your completed form to the Managed Care Quality & Monitoring Division, State Hearing Unit at: MCQMDStateFairHearings@dhcs.ca.gov. Or you can print the form and mail it to the address on the form.