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Income Documentation and Deductions

If your Social Security Number (SSN) or Individual Tax Payer identification Number (ITIN) is provided, your income will be electronically verified using the State and Federal systems. If you cannot provide a SSN/ITIN for each person in your federal tax household, show either your last year’s gross income or current gross income. Include a copy of the proof along with your application.

Proof of last year’s income:

1040 Federal Income Tax return from previous year; or
Documents to show self-employed or other income for each person in your federal tax household.

Proof of current income:

  1. Paycheck or unemployment stub for each person in your federal tax household

  2. Letter from Employer for each person in your federal tax household

    The following must be included in the letter or it will not be accepted:

    1. Letterhead identifying business name, address and phone number.
    2. Date of the employer letter.
    3. Employee's name.
    4. Employee's current gross monthly income for a period ending 45 days from when the program receives the document.
    5. Statement: "Information provided is true and correct to the best of the signer's knowledge."
    6. Signature and job title of authorized personnel.

    Click here for a sample employer letter.
  3. Other Income

    Documents to show other income.

  4. Medi-Cal Notice of Action (NOA)

    The NOA issued after 1/1/14 must include the MAGI income amount or a budget worksheet (may be separate), and must be issued within two months of the date of your application and after 1/1/14, showing that you do not qualify for no-cost Medi-Cal based on MAGI limits.

  5. Income deductions

    If you cannot provide a SSN/ITIN, provide documents on federal income tax deductions claimed for alimony paid, student loan interest paid or other federal income deduction taken. These deductions will be subtracted from your MAGI to see if you qualify for the MCAP. Send proof for each deduction that is taken by your federal tax household.

Apply for MCAP