California Department of Social Services - State Hearings Division
Notes from the Training Bureau - May 1, 2003

Pursuant to Welfare and Institutions Code (W&IC) §14006.7, effective January 1, 2003, counties must provide a DHS 7077A form to all non-institutionalized aged, blind and disabled Medi-Cal-Only applicants. The DHS 7077A explains that an individual may transfer his/her ownership in a home for less than fair market value without affecting Medi-Cal eligibility.

The DHS 7077A is to be provided to the Medi-Cal applicant, the applicant's spouse, legal representative or agent. While the form includes a line for the applicant or other recipient of the form to sign, failure to sign will not result in ineligibility for Medi-Cal.