Medi-Cal Letter Templates

1. Carve-Out Template (English)

    Last Updated: 10/18/17
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2. Carve-Out Template (Spanish)

    Last Updated: 10/18/17
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3. Member Authorization Letter

    Last Updated: 11/16/17
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4. Notice of Action Taken - Denied (English)

    Last Updated: 10/18/17 
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5. Notice of Action Taken - Denied (Spanish)

    Last Updated: 10/18/17 
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6. Notice of Action Taken - Modified (English)

    Last Updated: 10/18/17 
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7. Notice of Action Taken - Modified (Spanish)

    Last Updated: 10/18/17 
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8. Notice of Action Taken - Terminated (English)

    Last Updated: 10/18/17 
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9. Notice of Action Taken - Terminated (Spanish)

    Last Updated: 10/18/17 
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