Fill out Form MC 604 IPS Online in 2026

Form MC 604 IPS, Additional Income and Property Information Needed for Medi-Cal, is a California Department of Health Care Services document that county eligibility workers send to applicants and beneficiaries when the case file needs more details about household income or property. People fill it out so the county can finish a Medi-Cal eligibility decision, an annual renewal, or a redetermination triggered by a reported change. The answers go straight into the official Medi-Cal case record.

MC 604 IPS lets a Medi-Cal applicant or beneficiary give the county the income and property details a worker still needs to finish reviewing a case. Households use it to:

• List wages, self-employment, retirement, and other income sources
• Report bank accounts, vehicles, real estate, and other property
• Update household composition and tax filing status
• Provide proof for newly reported income or asset changes

1. Enter the case name, case number, county, and date at the top.

2. List every household member with relationship, date of birth, and Social Security number.

3. Report wages, self-employment, retirement, disability, and any other income.

4. List bank accounts, vehicles, real estate, life insurance, and other property.

5. Attach paystubs, account statements, or other proof of the entries.

6. Review every required field for accuracy before sharing the completed form.

Medi-Cal applicants and active beneficiaries fill out MC 604 IPS when their county eligibility worker requests more income or property information. The request often comes during the initial application, an annual renewal, or after the household reports a change such as a new job, a closed bank account, or a property sale.

After the form is returned, the county worker reviews the answers, compares them with verification documents, and updates the Medi-Cal case file. The information feeds into the eligibility decision, the share of cost, and any Modified Adjusted Gross Income or non-MAGI determination tied to the case.

Medi-Cal applicants whose county worker has not asked for more income or property details do not fill out MC 604 IPS on their own. Households whose only Medi-Cal program has fully covered eligibility through Modified Adjusted Gross Income data also skip it. Anyone applying for non-Medi-Cal benefits, such as CalFresh on its own, uses a different income reporting form for that program.

The deadline for MC 604 IPS is set by the county worker in the request notice and usually falls within 10 to 30 calendar days of the date on the letter. Returning the form on time keeps the application moving, prevents a delay in coverage, and avoids a denial or termination for failing to provide requested information. Late returns may need a written explanation.

The California Department of Health Care Services issues MC 604 IPS through the Medi-Cal forms library, and counties send a copy along with the request notice. If yours is misplaced, our editor keeps a blank ready for you to fill and download — the signed form still goes back to the county Medi-Cal office that sent the request.

MC 604 IPS must be signed by hand in ink, since the California Department of Health Care Services keeps the household's wet signature on the original Medi-Cal case file. After you fill the form on our platform, download the completed file, print it, and sign and date it with a pen before sending. Checking the latest county Medi-Cal guidance is a good idea before submitting.

Once your MC 604 IPS is signed, return it to the county Medi-Cal office handling your case, by mail to the address on the request notice, in person at the local office, by fax, or through a county online portal such as BenefitsCal where one is offered. Confirm the preferred channel with your county eligibility worker before sending.