When there is a mail-in application for Medi-Cal, the date used to protect the beginning date of aid and retroactive eligibility is the date on the SAWS 1 as follows:

• If a Medi-Cal applicant picks up an application at the county office and has contact with a county employee, the county employee is responsible for obtaining a SAWS 1 at the time the request for an application is made. The beginning date of aid is the date the applicant completes and signs the SAWS 1.

• If the applicant calls the county office and requests the county to mail an application, the county employee who takes the application request must complete the SAWS 1 on behalf of the applicant. The county employee must also forward a copy of the SAWS 1 to the applicant along with the Medi-Cal application. The beginning date of aid is the date the applicant calls the county to request the county mail the application.

• If the applicant obtains an application without direct contact with a county employee, the date of application will be the date the application is received in the county office.

The county must include the following in the application packet regardless of whether the application is mailed or given to the applicant:

• A cover letter developed by DHS. (no substitute is permitted) The cover letter is an attachment to this ACWDL.
• The appropriate Medi-Cal application (either the MC 321 HFP for families, pregnant women and/or children or the MC210 for aged, blind, disabled or long-term care applicants).
• A list of verifications that the applicant will need to submit for approval of Medi-Cal benefits, including the date verifications must be returned to the county office.
• The MC 219 (Rights and Responsibilities) form.
• The MC 13 (Statement of Citizenship) form.
• The MC 007 (Medi-Cal information notice).
• A postage paid pre-addressed return envelope.