Completing the California MC 13 Medi-Cal Form: 2026 Change and Sections B and C

The MC 13 form is a one-page California declaration you complete during the Medi-Cal application process to state, under penalty of perjury, whether you are a U.S. citizen, a U.S. national, or a non-citizen with a specific immigration status.1Legal Information Institute. California Code of Regulations Tit. 22, 50304 – Written Declaration of Status as a Citizen of the United States, a National of the United States, or an Alien You can download it from the Department of Health Care Services website or pick one up at your county social services office.2Department of Health Care Services. Statement of Citizenship, Alienage, and Immigration Status The county uses your answers to decide whether you qualify for full-scope benefits or only restricted-scope coverage.

When You Need to Complete It

The MC 13 is used when someone applying for full-scope Medi-Cal doesn’t have documentation of a qualifying immigration status on file and the status can’t be verified electronically. If you’re a U.S. citizen whose identity has already been confirmed through other channels, the county may not ask you to complete it separately. If there’s any question about your citizenship or immigration status, you’ll be asked to fill one out.

What’s at stake is the difference between full-scope and restricted-scope Medi-Cal. Full-scope coverage includes medical, dental, mental health, vision, family planning, substance use treatment, prescriptions, and transportation to appointments.3Department of Health Care Services. Frequently Asked Questions About Your Benefits Expanding in Medi-Cal Restricted-scope coverage pays for emergency services and pregnancy-related care but not prescriptions or primary care visits. If you don’t provide a completed MC 13 when the county asks for one, you’ll be treated as eligible only for restricted-scope benefits.

The 2026 Enrollment Change

Starting January 1, 2026, adults who do not have Satisfactory Immigration Status can no longer newly enroll in full-scope Medi-Cal. If you already have full-scope coverage, you can keep it as long as you renew during your renewal month.4Department of Health Care Services. Medi-Cal Immigrant Eligibility FAQs That makes accurate completion of the MC 13 especially important if you are establishing or re-establishing your immigration category.

What to Have in Front of You

Pull your documents before you start writing. Working from memory is the most common cause of a transposed digit or mismatched date that holds up an application.

  • Your Social Security number, if you have one. If you don’t, you aren’t required to provide one, particularly for restricted-scope benefits.
  • Your Alien Registration number (A-Number) from your green card (Form I-551) or other immigration documents. It’s typically eight or nine digits starting with “A.”
  • Your Alien Admission number from your I-94 arrival/departure record.
  • Any employment authorization card, H-1B visa, student visa, or similar record you hold.
  • The date you first entered the U.S., the name you used at entry, your country of citizenship, and your place of birth.2Department of Health Care Services. Statement of Citizenship, Alienage, and Immigration Status

Filling Out Section B

Section A at the top of the form is informational. Read it, but don’t write anything there. The questions start in Section B.2Department of Health Care Services. Statement of Citizenship, Alienage, and Immigration Status

Question 1 asks whether the applicant is a citizen or national of the United States. If you check “Yes,” write your city and state of birth. You’re done with the status portion; skip Section C.

If you check “No,” answer Questions 2 through 4:

  • Question 2: Are you an amnesty alien with a valid and current I-688?
  • Question 3: Are you a lawful permanent resident?
  • Question 4: Are you a PRUCOL alien (permanently residing under color of law)?

If you answered “Yes” to Question 4, Question 5 asks you to pick which of 15 PRUCOL subcategories applies. The subcategories are printed on the form itself and include refugees, asylum applicants, people granted withholding of deportation, and parolees, among others. If you aren’t sure which subcategory fits, your county eligibility worker or an immigration legal aid organization can help you choose.

Qualifying categories under California’s rules include lawful permanent residents (including conditional permanent residents), refugees and asylees, Cuban and Haitian entrants, individuals paroled into the U.S. for at least one year who are exempt from or have met the five-year waiting period, amnesty aliens with adjusted status who are aged, blind, disabled, or under 18 (or for whom more than five years have passed since they received lawful temporary resident status), and PRUCOL individuals. Refugees, asylees, trafficking victims, and certain veterans’ families are exempt from the five-year wait.5Legal Information Institute. California Code of Regulations Tit. 22, 50301 – Citizenship or Immigration Status for Full Medi-Cal Benefits

Filling Out Section C

Complete Section C only if you answered “Yes” to Question 2, 3, or 4. There are five lines:

  • Line 1: Your Alien Registration number or Alien Admission number from the I-94.
  • Line 2: The date you first entered the United States.
  • Line 3: The name you used when you first entered the United States, if different from your current legal name.
  • Line 4: Your country of citizenship.
  • Line 5: Your place of birth.

Copy each entry straight off your immigration document. The county uses the A-Number or admission number to verify your status through federal databases, and a single wrong digit can flag a mismatch that delays everything.

Signing and Submitting

Sign and date the bottom of the form. Your signature is a declaration under penalty of perjury that what you’ve written is true. For a child under 21, a parent, caretaker relative, or legal guardian signs for the child.1Legal Information Institute. California Code of Regulations Tit. 22, 50304 – Written Declaration of Status as a Citizen of the United States, a National of the United States, or an Alien

You can turn in the completed form three ways:

  • In person at your county social services office. Ask for a receipt.
  • By mail to the address for your county’s eligibility branch. Use certified mail or another trackable method.
  • Online through BenefitsCal, by uploading a clear scan or photo of the signed form to your account. Make sure every checkbox and handwritten entry is legible.6BenefitsCal. Reporting Features Awareness Update

Keep a copy of the signed form. If the county later asks you to re-verify your status, having the original on hand saves time.

After You Submit

The county has up to 45 days to process your Medi-Cal application, or 90 days if your application is based on a disability.7Department of Health Care Services. My Medi-Cal Comparison During that window, you may be contacted if federal verification returns a mismatch on your A-Number or status category. Respond promptly to keep things moving.

You’ll get a Notice of Action letter when the county decides. It will tell you whether you’ve been approved for full-scope or restricted-scope Medi-Cal, or denied, and explain why. If you disagree with the decision, you have 90 days from the date the notice was mailed to request a State Hearing; the back of the Notice of Action explains how.8California Department of Social Services. State Hearing Requests

What Happens to the Information You Provide

The MC 13 states in bold that immigration status information provided with a Medi-Cal application is confidential and cannot be used for immigration enforcement purposes unless you are committing fraud.2Department of Health Care Services. Statement of Citizenship, Alienage, and Immigration Status The form still references “INS,” the former Immigration and Naturalization Service now known as USCIS, but the confidentiality protection is still in effect.

DHCS is required by federal law to send demographic and eligibility data for every Medi-Cal member to the Centers for Medicare and Medicaid Services. In December 2025, a federal court ruled that CMS may share certain basic information, including citizenship or immigration status, address, phone number, and date of birth, with Immigration and Customs Enforcement, but only for individuals who are not “lawfully residing” in the United States. Data on lawful permanent residents, U.S. citizens, and other lawfully present individuals cannot be shared under that ruling.4Department of Health Care Services. Medi-Cal Immigrant Eligibility FAQs

On public charge, under the federal rule in effect as of early 2026, immigration officers generally consider only cash assistance programs and government-funded long-term institutional care such as nursing home stays paid for by Medicaid. Standard Medi-Cal coverage is not counted.9USCIS. Public Charge Resources A new proposed rule could change what counts, but until a new regulation is finalized the current policy stands. If public charge is a concern in your situation, talk to an immigration attorney before making coverage decisions.