Medi-Cal Member Navigation Toolkit
This toolkit provides practical tools, workflows, and guidance to help community partners support adult Medi-Cal members with coverage questions and tasks.
Resources include member orientation; Medi-Cal eligibility, renewal, verification, and six-month eligibility checks; work and community engagement requirements; BenefitsCal navigation; and escalation support.
Start with the member’s immediate need: Identify whether they are applying for, renewing, maintaining, or restoring Medi-Cal coverage. Then use the tool that best matches the next action needed.
The toolkit supports navigation and member assistance. The member’s county Department of Social Services (DSS) determines Medi-Cal eligibility and assesses whether work and community engagement requirements apply or are met.
When to use:
Use this tool first when using the Medi-Cal Member Navigation Toolkit to understand the toolkit’s purpose and boundaries, see how the tools and appendices are organized, and choose where to begin based on the member’s situation.
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When to use: Use this tool to give a member a brief introduction to upcoming work and community engagement requirements and six-month eligibility checks, including what may happen if they do not respond and where to get help.
Download PDF in: English Spanish
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When to use: Use this tool when a member or partner asks, “Why did this happen?” or needs a clear, plain-language explanation of a Medi-Cal coverage change. The tool can help reduce confusion and frustration while reinforcing that many coverage issues may be resolved through timely action.
Download PDF in: English Spanish
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When to use: Use this tool when a member, partner, or staff person is unsure whether a Medi-Cal question should go to Department of Social Services (DSS) or CenCal Health.
Download PDF in: English Spanish
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When to use: Use this tool to give the member clear, easy answers about Medi-Cal coverage, renewal, notices, and common reasons coverage may stop, change, or need follow-up.
Download PDF in: English Spanish
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When to use: Use this tool when a member brings in a Medi-Cal notice or letter and needs help understanding it and identifying next steps.
Download PDF in: English Spanish
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When to use: Use this tool when contact with a hard-to-reach Medi-Cal member creates an important opportunity to review, update, or confirm case information. Because future contact may be difficult, the information gathered may allow the Department of Social Services (DSS) to complete a change-in-circumstance redetermination and establish a new eligibility period. The county—not the assisting organization—makes that determination.
Download PDF in: English Spanish
Member Orientation
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When to use: Use this tool when you need to understand whether a member may be in the Medi-Cal New Adult Group.
Download PDF in: English Spanish
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When to use: Use this tool when a Medi-Cal member receives a notice about a six-month eligibility check or needs help understanding whether they may need to renew Medi-Cal twice a year, what DSS may request, and how to respond.
Download PDF in: English Spanish
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When to use: Use this tool when a member is asked by DSS, via a mailed Medi-Cal Notice Action or an e-Notice through BenefitsCal.com, to verify information for an application, renewal, reported change, or eligibility review. Navigators may help the member understand the request, gather documents, and upload verification, but DSS decides what verification is required and whether it is acceptable.
Download PDF in: English Spanish
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When to use: Use this tool when a member has an upcoming Medi-Cal renewal, six-month eligibility check, verification request, or related deadline and needs help setting reminders before coverage is at risk.
Download PDF in: English Spanish
Medi-Cal Eligibility, Renewal & Verification
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When to use: Use this tool to explain who may need to meet work, job training, school, volunteer, or community service requirements, what activities count, and who may be exempt.
Download PDF in: English Spanish
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When to use: Use this tool when a member may be subject to work and community engagement requirements and may qualify for an exemption. Navigators can help identify possible exemptions, but DSS determines whether the requirements apply, whether an exemption applies, and what verification is required.
Download PDF in: English Spanish
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When to use: Use this tool when a member may qualify for an exemption from the work and community engagement requirements and DSS has requested information or supporting documentation. These requirements apply only to certain adults in the MAGI New Adult Group. Navigators may help members understand requests and gather or upload documents, but DSS determines whether an exemption applies and what verification is required.
Download PDF in: English Spanish
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When to use: Use this tool when a member may need to meet Work & Community Engagement requirements and wants help finding workforce development services, job-search assistance, employment support, or job training resources in San Luis Obispo or Santa Barbara County.
Download PDF in: English Spanish
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When to use: Use this tool when a member may need to meet Work & Community Engagement requirements and wants to explore becoming an In-Home Supportive Services (IHSS) provider as a possible employment option.
Download PDF in: English Spanish
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When to use: Use this tool when a member may need to meet Work & Community Engagement requirements and wants help identifying education opportunities in San Luis Obispo or Santa Barbara County that may help them meet the requirements.
Download PDF in: English Spanish
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When to use: Use this tool when a member may need to meet Work & Community Engagement requirements and wants help finding volunteer or community service opportunities that may help them meet the requirements.
Download PDF in: English Spanish
Work & Community Engagement
BenefitsCal
Which BenefitsCal Tool Should I Use?
When to use: Use this tool first when a member needs help with BenefitsCal and you are unsure which BenefitsCal guide or resource best fits their situation.
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When to use: Use this tool when a member does not have a BenefitsCal account and needs help creating one.
Download PDF in: English Spanish
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When to use: Use this tool when a member needs help completing or managing two-step verification when signing in to BenefitsCal.
Download PDF in: English Spanish
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When to use: Use this tool when a member has forgotten their BenefitsCal password or needs help resetting it.
Download PDF in: English Spanish
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When to use: Use this tool when a member has a BenefitsCal account but their existing case does not appear and needs to be linked to the account.
Download PDF in: English Spanish
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When to use: Use this tool when a member needs help finding case information, program status, pending tasks, appointments, notices, documents, or other features on their BenefitsCal dashboard.
Download PDF in: English Spanish
BenefitsCal:
Account Access & Setup
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When to use: Use this tool when a member needs help viewing or sending messages or reviewing and completing an action sent through BenefitsCal.
Download PDF in: English Spanish
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When to use: Use this tool when a member wants to receive electronic notifications and access eligible notices through BenefitsCal instead of relying only on paper notices.
Download PDF in: English Spanish
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When to use: Use this tool when a member needs help locating their assigned caseworker or county contact information available through BenefitsCal.
Download PDF in: English Spanish
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When to use: Use this tool when a member wants to request, review, cancel, or request to reschedule a county appointment through BenefitsCal.
Download PDF in: English Spanish
BenefitsCal:
Notices, Communication & Help
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When to use: Use this tool when a member wants to start, complete, or submit a new benefits application through BenefitsCal.
Download PDF in: English Spanish
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When to use: Use this tool when a member is completing a benefits application and needs help uploading documents as part of the application process.
Download PDF in: English Spanish
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When to use: Use this tool when a member has a renewal due and needs help completing and submitting it through BenefitsCal.
Download PDF in: English Spanish
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When to use: Use this tool when a member has a periodic report due and needs help completing and submitting it through BenefitsCal.
Download PDF in: English Spanish
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When to use: Use this tool when a member needs to report a change to an active benefits case through BenefitsCal or review a change previously reported.
Download PDF in: English Spanish
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When to use: Use this tool when a member needs help uploading documents to an existing case or submitted application.
Download PDF in: English Spanish
BenefitsCal: Applications, Renewals & Case Updates
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When to use: Use this tool when a navigator or CBO needs to determine where to direct a BenefitsCal or CalSAWS question or issue, including when the county should be contacted.
Download PDF in: English Spanish
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When to use: Use this tool when a CBO needs to request organizational access to BenefitsCal or establish the appropriate CBO account.
Download PDF in: English Spanish
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When to use: Use this tool when a CBO Assister or Manager needs help using the BenefitsCal CBO Dashboard and its available organizational functions.
Download PDF in: English Spanish
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When to use: Use this tool when a CBO wants to create or use a BenefitsCal referral link or QR code for outreach and track related activity.
Download PDF in: English Spanish
CBO BenefitsCal Tools
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When to use: Use this tool when a member wants to request an available support service through BenefitsCal, such as a replacement Medi-Cal or EBT card or another support offered for their program and county.
Download PDF in: English Spanish
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When to use: Use this tool when an applicant wants help using the optional Truv feature in BenefitsCal to electronically retrieve and submit available income and employment information during an application.
Download PDF in: English Spanish
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When to use: Use this resource when a member or navigator would benefit from a visual, step-by-step demonstration of how to complete common tasks in BenefitsCal.
Download PDF in: English Spanish
Other BenefitsCal Tools
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When to use: Use this tool when a navigator is unable to address the member’s Medi-Cal issue and needs support directly from DSS and CenCal Health.
Download PDF in: English Spanish
Escalation Support
Appendix
Appendix - BenefitsCal CBO Release of Information (ABCDM 229)
Appendix - DHCS Authorization for Release of Protected Health Information (DHCS 6236)
Appendix - MAGI Medi-Cal Renewal Form - English (MC 216 ENG Rev 10.20)
Appendix - MAGI Medi-Cal Renewal Form - Spanish (MC 216 SPA Rev 10.20)
Appendix - MAGI Medi-Cal Renewal Form - English (MC 216 ENG Rev 10.20)
Appendix - MAGI Medi-Cal Renewal Form - Spanish (MC 216 SPA Rev 10.20)
Appendix - Mixed Household Medi-Cal Renewal Form - English (MC 217 ENG Rev 10.20)
Appendix - Non-MAGI Asset Limits
Appendix - Non-MAGI Medi-Cal Renewal Form - English (MC 210 RV ENG Rev 10.20)
Appendix - Program Eligibility by Federal Poverty Level for 2026
Appendix - Retroactive Medi-Cal Coverage
Appendix - Sample MAGI Medi-Cal Approval Notice (MC-MAGI-A Rev 11.15)
Appendix - Sample MAGI Medi-Cal Change Notice (MC-MAGI-C Rev 11.15)
Appendix - Sample MAGI Medi-Cal Denial Notice (MC-MAGI-D Rev 11.15)
Appendix - Sample MAGI Medi-Cal Discontinuance Notice (MC-MAGI-T Rev 11.15)
Appendix - Sample Medi-Cal Notice of Action - Denial-Discontinuance of Benefits (MC 239A Rev 05.07)
Appendix - Sample Medi-Cal Renewal Reminder Notice (CSF 164 Rev 11.20)
Appendix - Sample Medi-Cal Request for Information - English (MC 355 ENG Rev 07.18)
Appendix - Sample Medi-Cal Request for Information - Spanish (MC 355 SPA Rev 07.18)
Appendix - San Luis Obispo County - Multi-Agency Referral & Client Release of Information (Form 815)