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New Form To Request Medi-Cal Expenses Subject to Recovery

One of the most frequent complaints from Medi-Cal beneficiaries has been the inability to find out exactly how much in benefits have been paid on their behalf. In the past, beneficiaries or their representatives were required to complete a form DHCS 6236 – Request for Access to Protected Health Information – pay $25 and send it in to EDS Communications at the Department and hope they might receive some answer within 30 days. The new form, DHCS Form 4017 is a bit easier to complete; is for living beneficiaries only; still costs $25 – but is sent directly to the DHCS Estate Recovery Section.

To download a copy of the form, just search for DHCS 4017 or Click here.


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