The Newborn Referral Form (MC 330) is used to assist a Medi-Cal eligible mom to report the birth of her child(ren) to Medi-Cal.
Who can complete the form?
The form can be completed by the parent(s) of the newborn as well as hospitals, clinics, urgent care centers, independent nurse-midwives, outreach workers, Women, Infants and Children (WIC) groups, and others acting on mother’s behalf.
Newborn Referral Form Facts
- The Newborn Referral Form is not an application for Medi-Cal. However, by completing the information on the form you help the county confirm the eligibility of the newborn.
- Any changes to the household must be reported to the county, so this information should be turned in quickly.
- The mother may also report the birth by phone to her eligibility technician.
- If you are acting on behalf of the mother and are not a spouse, relative, or guardian, then you must complete and sign Section C of the Newborn Referral Form.
- For additional information you can call the Newborn Referral Information Line toll free at 1-800-281-9799
Where/How do I send the form?
The form can be submitted by fax or US mail.
- The Newborn Referral Form (MC 330) can be mailed to the county at:
Social Services Agency
P.O. Box 70003
Anaheim, CA 92825-9922
- The Newborn Referral Form (MC 330) can be faxed to the county Social Services Agency at 714-645-3482
- For additional information you can call the Newborn Referral Information Line toll free at 1-800-281-9799.
Links to the Form