How to Complete California Form MC 604 IPS: Income and Property for Medi-Cal

California Form MC 604 IPS is the supplemental Income and Property Statement that county eligibility workers use to gather the extra financial details Non-MAGI Medi-Cal requires. If a county worker sent you one, it’s because the electronic records check on your application didn’t produce enough information to decide whether you qualify. Complete every section that applies, attach documentation for each “yes” answer, and return the form by the date on the cover letter. The rest of this guide walks through what to gather, how to fill out each part, and what happens after you send it in.1Department of Health Care Services. MC 604 IPS – Additional Income and Property Information Needed for Medi-Cal

Who Gets Asked to Fill This Out

Non-MAGI Medi-Cal covers people who are 65 or older, blind, or disabled. It uses different income-counting rules than the Modified Adjusted Gross Income programs most working-age adults fall into, and it also imposes limits on how much property you can own. The MC 604 IPS is how the county collects the financial details those rules require when electronic sources come up short.2Department of Health Care Services. All County Welfare Directors Letter 17-26

You don’t need to request the form on your own. If the county needs it, they’ll send it to you, usually with a cover letter that already has your case number, the eligibility worker’s name, and a return-by date filled in. You can also download a blank copy from the Department of Health Care Services website or pick one up at the county social services office.1Department of Health Care Services. MC 604 IPS – Additional Income and Property Information Needed for Medi-Cal

What to Gather Before You Start

The form asks about income, expenses, and property for your entire household. Pulling the paperwork together first prevents the back-and-forth requests that slow a case down. Have the following ready:

  • Social Security numbers and dates of birth for each household member.
  • Current statements for every checking and savings account, showing balances.
  • Recent pay stubs, pension statements, disability benefit letters, veterans’ benefit notices, and any child support documentation.
  • Statements for stocks, mutual funds, IRAs, 401(k)s, annuities, and other investment or retirement accounts.
  • Life insurance policies showing any cash surrender value.
  • Year, make, and model of every vehicle, boat, RV, or trailer in the household.
  • Addresses and approximate values for any real property you own, including land or buildings outside California.
  • Policy numbers and carrier names for any private health insurance or Medicare coverage.
  • Documentation of burial plots, burial insurance, prepaid funeral contracts, or designated burial funds.
  • Profit and loss statements if you are self-employed or own a business.
  • Records of any judgments, settlements, support orders, promissory notes, prenuptial or postnuptial agreements, or trusts.

Use actual paperwork rather than estimates. The county cross-references your answers against state databases, and mismatches trigger follow-up requests that push back your decision date.

What Counts as Property and What’s Exempt

Effective January 1, 2026, California reinstated asset limits for most Non-MAGI Medi-Cal programs. The limits are $130,000 for one person and $195,000 for a couple, plus $65,000 for each additional household member up to ten people. New applicants must meet the limits to qualify, and existing beneficiaries are reviewed at their first annual renewal in 2026.3Department of Health Care Services. All County Welfare Directors Letter 25-18

Not everything you own counts against the limit. The following are exempt:

  • The home you live in.
  • One vehicle.
  • Personal belongings and household furnishings.
  • Burial plots, a prepaid irrevocable burial plan, and up to $1,500 in designated burial funds.
  • Balances in an IRA, KEOGH, 401(k), 457 plan, or work-related pension if you receive regular payments from them. Only the income is counted. If the account belongs to a household member who isn’t applying for Medi-Cal, the balance doesn’t count either way.
  • Checking account deposits that were already counted as income in the month received.
4Department of Health Care Services. Non-MAGI Medi-Cal PUB 10

Everything else counts: savings accounts, stocks, mutual funds, bonds, CDs, cash, second vehicles, real estate other than your home, and retirement accounts that aren’t in payout status.

Filling Out the Form Section by Section

The form runs about seven pages. Page one has fields for your case name, case number, eligibility worker’s name, and a return-by date. If the county mailed it to you, most of that is already filled in. On a blank download, write your case number (it appears on any prior Medi-Cal correspondence) and your full name.

Household Status

Page one asks about specific living situations: whether anyone is legally married but living apart from their spouse, whether a step-parent lives in the home, and whether a child is being cared for by a relative other than a parent. These affect how income and household size are calculated under Non-MAGI rules. If none apply, leave the boxes blank and move on.

Income and Expenses

Page two lists income types with yes/no checkboxes: disability benefits, veterans’ benefits, child support received, and gifts. Check “yes” for every type that applies, and attach proof (award letters, bank deposits showing payments, or court orders). The section below asks about deductible expenses, including child support you pay out, health insurance premiums, Medicare premiums, childcare, adult care, and educational costs. These deductions can lower your countable income, so don’t leave them off.

Property and Possessions

Pages three through six are the heart of the form. Each item is a numbered yes/no question:

  • Cash and uncashed checks on hand, plus every checking and savings account with its current balance.
  • Whether the household owns more than one car, motorcycle, or truck, or any boats, RVs, or trailers. One vehicle is exempt, so the form is asking about additional ones.
  • Stocks, mutual funds, bonds, and certificates of deposit.
  • IRAs, KEOGHs, 401(k)s, 457 plans, and work-related pensions. If you take regular distributions, note that so the balance is treated as exempt.
  • Annuities, life insurance with cash value, burial plots, burial insurance, burial trusts, and prepaid contracts.
  • Trusts, blocked accounts, judgments, settlement agreements, support orders, prenuptial or postnuptial agreements, promissory notes, and mortgages or deeds of trust you hold.
  • Any piece of jewelry worth more than $100.
  • Accounts and assets tied to a business you own.
  • Your home (with questions about whether you live there and whether you intend to return if you’ve moved) and any other real property.

For every “yes,” fill in the details the form asks for (account numbers, current values, property addresses) and attach the supporting statement. Circle “no” rather than leaving a question blank. A blank can be treated as incomplete and bounced back for clarification.

Property Transfers

The final pages ask whether you or anyone in the household gave away, sold below market value, or otherwise transferred property. Answer honestly on every line.

These questions matter most if you’re applying for long-term care Medi-Cal, meaning coverage for a nursing facility. A 30-month look-back applies to transfers made on or after January 1, 2026; transfers from 2024 and 2025 are excluded, and the review window is measured from the asset limit reinstatement date. Counties don’t follow up when records show the transferred amount was less than the average private pay rate for nursing facility care, and transfers of exempt property (your home, one vehicle, burial assets) don’t trigger a penalty. If a penalty is proposed, the county has to review for undue hardship first, and no period of ineligibility takes effect without approval from the DHCS Medi-Cal Eligibility Division. The maximum penalty period is 30 months from the date of the transfer.3Department of Health Care Services. All County Welfare Directors Letter 25-18 If you aren’t seeking nursing-home-level care, the transfer review doesn’t apply to you.

How to Submit the Completed Form

You have three ways to return the MC 604 IPS to your county social services office:

  • Mail it to the address on the cover letter. A postmark on or before the return-by date protects you if delivery takes a few days.
  • Upload it through BenefitsCal. Log into BenefitsCal.com, click “Upload a Document,” enter the document details, select and upload your scanned or photographed pages as a single file, and save the confirmation receipt as proof of your submission date.5BenefitsCal. BenefitsCal Reporting Features Awareness Update
  • Drop it off in person at the county social services building. Put it in a sealed envelope with your name and case number, and note the date you delivered it.

Keep a copy of everything you submit. County offices process large volumes of paperwork, and your own copy is what resolves a “we never received it” dispute.

What Happens After You Submit

An eligibility worker reviews your reported income and assets against electronic verification sources. Federal rules require the Medi-Cal decision within 45 calendar days of your original application, or within 90 days if eligibility depends on a disability determination. The clock runs from your application date, not the date you send the supplement, so returning the form quickly matters.6eCFR. 42 CFR 435.912 – Timely Determination of Eligibility

The county sends its decision as a written Notice of Action, telling you whether you’ve been approved, denied, or assigned a share of cost. An unfavorable notice must explain the reason and the law behind it, and it must describe your right to a state hearing.7New York Codes, Rules and Regulations. 22 CCR 50179 – Notice of Action, Medi-Cal-Only Determinations If the worker needs more documentation, respond right away; the county can deny an application when the applicant fails to provide the information needed to complete the determination.6eCFR. 42 CFR 435.912 – Timely Determination of Eligibility

If You’re Denied

You have 90 days from the date the Notice of Action is mailed to request a state fair hearing. For redetermination-related actions (such as a termination of eligibility or an increase in your share of cost), DHCS has temporarily extended the deadline to 120 days. You can file online through the CDSS State Hearings portal, by phone at (800) 743-8525, or in writing to the State Hearings Division at P.O. Box 944243, Mail Station 9-17-442, Sacramento, CA 94244-2430.8California Department of Social Services. State Hearing Requests

If you already have Medi-Cal and your benefits are being cut or terminated, ask for “aid paid pending” when you request the hearing. That keeps your current benefits in place until the decision is issued. Request it before benefits stop; reinstating them after the fact is more complicated than preventing the cutoff in the first place.