Any personal information collected on and through this form is confidential pursuant to the California Information Practices Act, California Civil Code § 1798, et seq. DHCS needs this information to send email and SMS text messages regarding information about Medi-Cal eligibility relating to the continuous coverage unwinding period. DHCS will not use or share the information for other purposes except with your permission or as permitted by law. You should provide all information requested on this form. If you do not provide all information requested, DHCS may not be able to send email and SMS text messages regarding information about Medi-Cal eligibility relating to the continuous coverage unwinding period. In most instances, the individual(s) to whom this information pertains has the right to access it.
The collection, retention, and use of personal information collected on this webpage or volunteered by a user are governed by federal and state law, including, but not limited to, the California Information Practices Act of 1977 (Civil Code §1798 et seq.), the Public Records Act (Government Code §§ 6250 et seq.), Government Code Sections 11015.5 and 11019.9, and the federal Privacy Act of 1974. This privacy notice provided is required by California Civil Code § 1798.17.