state of california health and human services agency ...2 (209)754-6872 06 -----121312 06 colusa...

State of California—Health and Human Services Agency

Department of Health Care Services

RICHARD FIGUEROA GAVIN NEWSOM ACTING DIRECTOR GOVERNOR

DATE:

TO:

October 10, 2019

Medi-Cal Eligibility Division Information Letter No.: I 19-22

ALL COUNTY WELFARE DIRECTORS ALL COUNTY MEDI-CAL PROGRAM SPECIALISTS/LIAISONS ALL COUNTY ADMINISTRATIVE OFFICERS

SUBJECT: Pickle Tickler Type 52 Notice of Action Address Database

The purpose of this Medi-Cal Eligibility Division Information Letter is to provide counties with the current Pickle Tickler Type 52 Notice of Action (NOA) address database and to request county updates.

Pursuant to the Lynch v. Rank lawsuit, the Pickle Tickler Type 52 NOA is mailed annually to the home address of individuals who currently receive Title II Retirement, Survivors, and Disability Insurance payments, and were determined ineligible for the Pickle Program, immediately following discontinuance from Supplemental Security Income/State Supplementary Payment programs.

In December of each year, the Department of Health Care Services mails Type 52 NOAs as described above. The county contact information listed on the bottom of the NOA aids potential Pickle Program eligible individuals in requesting county assistance to apply for the Pickle Program. In conducting your review and/or updates, please be mindful of the fact this contact information is widely distributed. To avoid errors with county contact information, please provide your county updates to the attached list, in writing, no later than Friday, November 1, 2019 by email to [email protected].

If you have any questions or if we can provide further information, please contact Sara McDonald at (916) 345-8061 or by email at [email protected]

Original Signed by

Linda Nguyen, Chief Policy Development Branch Medi-Cal Eligibility Division

Enclosure

Medi-Cal Eligibility Division 1501 Capitol Avenue, MS 4607

P.O. Box 997413, Sacramento, CA 95899-7413 (916) 552-9200 phone • (916) 552-9477 fax

Internet Address: www.dhcs.ca.gov

TO: ALL COUNTY WELFARE DIRECTORS, ALL COUNTY MEDI-CAL PROGRAM SPECIALISTS/LIAISONS, ALL COUNTY ADMINISTRATIVE OFFICERS

mailto:[email protected]

mailto:[email protected]

http://www.dhcs.ca.gov/

1

PICKLE TYPE 52 ADDRESS

01 *------------------------121312* 01

Alameda County

Social Services Agency

24100 Amador St.

Hayward, CA 94544

Attn: Medi-Cal Program Specialist

(510) 670-5770

02 *------------------------052507* 02

Alpine County

Health & Human Services

75 A Diamond Valley Rd

Markleeville, CA 96120

530-694-1335

03 *------------------------121312* 03

Amador County

Department of Social Services

10877 Conductor Blvd, Suite 200

Sutter Creek, CA 95685

Attn: Bethany Cammisa

(209) 223-6550

04 *------------------------121312* 04

Butte County DESS

P.O. Box 1649

Oroville, CA 95965

Attn: Mickey Mrakuzic

(530) 879-3550

05 *------------------------121312* 05

Calaveras Health and

Human Services Agency

509 E St. Charles Street

San Andreas, CA 95249

Attn: Brian Galicia

2

(209) 754-6872

06 *------------------------121312* 06

Colusa County

Department of Health & Human Services

251 E Webster St

Colusa, CA 95932

Attn: Alexandra Elguez

(530) 458-0262

07 *------------------------010599* 07

Contra Costa County

Employment & Human Services Dept.

40 Douglas Drive

Martinez, CA 94553

(925) 608-4939

Attn: Medi-Cal Program Analyst

08 *------------------------121312* 08

Del Norte County

Pickle Coordinator

880 Northcrest Dr.

Crescent City, CA 95531

707-464-3191

Attn: Pickle Coordinator

09 *------------------------121312* 09

El Dorado County

Health and Human Services Agency

3368 Lake Tahoe Blvd. Suite 100

South Lake Tahoe, Ca 96150

(530) 573-3230

Attn: Jill Johnston

10 *------------------------052507* 10

County of Fresno


P.O. Box 1912

3

Fresno, CA 93718

(559) 600-1377

11 *------------------------121312* 11

Glenn County


PO Box 611/420 E Laurel St

Willows, CA 95988

Attn: Amanda Castillo

530-934-1403

[email protected]

12 *------------------------121312* 12

Humboldt County

Dept. of Health & Human Svcs.

Social Services Branch

929 Koster St

Eureka, CA 95501

877-410-8809

13 *------------------------121312* 13

Imperial County

Dept. of Soc. Svcs.

2995 S. 4th St., Ste.105

El Centro, CA 92243

Attn: Alex Gamboa

(760) 337-7422

14 *------------------------121108* 14

Inyo County

Social Services

920 N Main St

Bishop, CA 93514

Attn: Yvonne Freeman

(760) 872-1394

4

15 *------------------------121312* 15

Kern County

Department of Human Services

P. O. Box 511

Bakersfield, CA 93302

Attn: Applications

661-631-6807 Application Line

877-410-8812 Customer Assistance Tele-Center

16 *------------------------121211* 16

Kings County

Human Service Agency

1440 W. Lacey Blvd., Bldg. #8

Hanford, CA 93230

Attn: Amalia Cabadas

(559) 852-2279

17 *------------------------121312* 17

Lake County Department of

Social Services

P.O. Box 9000

Lower Lake, CA 95457

Rachael Dillman

(707) 995-4290

18 *------------------------010599* 18

Lassen County

Community of Social Services

P.O. Box 1359

Susanville, CA 96130-9902

530-251-8152

19 *------------------------121312* 19

Los Angeles County DPSS

Medi-Cal Program Section

17171 East Gale Ave

5

City of Industry, CA 91745


1-866-613-3777

20 *------------------------121211* 20

Madera County

Dept. of Social Services

720 E. Yosemite Ave.

Madera, CA 93638

559-675-2300

21 *------------------------121312* 21

Marin County

Dept. of Health & Human SVS

P.O. Box 4160

San Rafael, CA 94903

Attn: Laura Hettwer

877-410-8817

22 *------------------------121211* 22

Mariposa County

H

5362 Lemee Lane

Mariposa, CA 95338

(209) 966-2000

23 *------------------------121312* 23

Mendocino County HHSA

737 S. State St.

Ukiah, CA 95482

Attn: Medi-Cal Specialist

(707) 463-7809

24 *------------------------121312* 24

Merced County


P.O. Box 112

6

Merced, CA 95341


(209) 385-3000

25 *------------------------121312* 25

Modoc County


120 North Main Street

Alturas, CA 96101

530-233-6501 ext. 1324

Attn: Karena Nield

26 *------------------------121108* 26

Mono County


PO Box 2969

Mammoth Lakes, CA 93546

760-924-1789

27 *------------------------011211* 27

Monterey County, DSES

1000 South Main St, Suite 208

Salinas, CA 93901

Attn: Mary Hiebner

(831) 755-4406

28 *------------------------121312* 28

Napa County

Health & Human Services Agency

2751 Napa Valley Corporate Dr.

Napa, CA 94558

Attn: Barbara Colt

(707) 253-3818

29 *------------------------052507* 29

Nevada County Human Services

7

Social Services Department

P. O. Box 1210

950 Maidu Avenue

Nevada City, CA 95959

530-265-1340

30 *------------------------121211* 30

Orange Co. Social Svcs. Agency

Santa Ana Regional Center

Lobby B

1928 South Grand Ave

Santa Ana, CA 92705

(800) 281-9799

31 *------------------------121312* 31

Placer County

Human Services

Medi-Cal Program Specialist

PO Box 20400

Auburn, CA 95604-0400

(888) 385-5160

32 *------------------------121312* 32

Plumas County


270 County Hospital Rd Suite 207

Quincy, CA 95971

Attn: Suzanne Wilson

530-283-6441

33 *------------------------121312* 33

Riverside Co. DPSS

4060 County Circle Drive

Riverside, CA 92503


(800)274-2050

34 *------------------------011211* 34

8

Sacramento County

Department of Human Assistance

P.O. Box 487

Sacramento, CA 95812-9874


(916) 874-3100

35 *------------------------121312* 35

San Benito County


1111 San Felipe Rd Suite 206

Hollister, CA 95023


831-630-5126

36 *------------------------121312* 36

San Bernardino County

Transitional Assistance Dept

825 E Hospitality Ln, 2nd Floor

San Bernardino, CA 92415-0079

(877) 410-8829


37 *------------------------011211* 37

County of San Diego


Document Processing Center

P.O. Box 85023

San Diego, CA 92186-5023

(866) 262-9881

38 *------------------------121211* 38

San Francisco County

SF Human Svcs Agency/DAAS

2 Gough Street

San Francisco, CA 94103

415-557-6555

9

39 *------------------------121312* 39

San Joaquin County


P.O. Box 201056

Stockton, CA 95201

Attn: Neil Stambaugh

(209) 468-1153

40 *------------------------121211* 40

San Luis Obispo County


P.O. Box 8119

San Luis Obispo, CA 93403-8119

(805) 781-1893

Attn: Pati Garcia

41 *--------------------011211* 41

San Mateo County


400 Harbor Blvd., Bldg. B

Belmont, CA 94002

(800) 223-8383

42 *------------------------052507* 42

Santa Barbara County


2125 S Centerpointe Pkwy

Santa Maria, CA 93455

Attn: Lilia Ramirez

(805) 346-7388

43 *------------------------121312* 43

County of Santa Clara

Social Services Agency

PO Box 11018

San Jose, CA 95103-1018

10

Attn: Benefits Service Center

1-877-962-3633 or (408) 758-3600

44 *------------------------121312* 44

Santa Cruz County

Human Services Dept.

P.O. Box 1320

Santa Cruz, CA 95061

Attn.: Maria Bauer, MC Analyst

Customer Phone Service Center

1-888-421-8080

45 *------------------------121312* 45

Shasta County Health & Human

Svcs. Agency, Regional Svc. Cntr.

P.O. Box 496005

Redding, CA 96049-6005


(877) 652-0731

46 *------------------------121312* 46

Sierra County Welfare Dept.

P.O. Box 1019

Loyalton, CA 96118

Attn: Lori McGee

(530) 993-6725

47 *------------------------121312* 47

Siskiyou County Health and Human Services Agency

818 S Main St

Yreka, CA 96097

Attn: Alix Byrd

(530) 841-2717

48 *------------------------121312* 48

Solano County

Health & Social Services

P.O. Box 12000 MS 7-100

Vallejo, CA 94590

11

(707) 784-3809

Attn: Kelly Campbell

49 *------------------------121312* 49

Sonoma County

Human Services Department

PO Box 1539

Santa Rosa, CA 95403-1539


1-877-699-6868

50 *------------------------121312* 50

Stanislaus County

Community Services Agency

P.O. Box 42

Modesto, CA 95353-0042

251 E Hackett Rd

Modesto, Ca 95358

877-652-0734

51 *------------------------052507* 51

Sutter County

Health and Human Services

P.O. Box 1535

190 Garden Highway

Yuba City, CA 95992-1535

1-877-652-0735

52 *------------------------011211* 52

Tehama County


P.O. Box 1515

Red Bluff, CA 96080

Attn: Medi-Cal Pickle Coord.

(530) 527-1911

12

53 *------------------------121312* 53

Trinity County

Health and Human Services

P.O. Box 1470

Weaverville, CA 96093-1470

Attn: Tabatha Albers

(530) 623-8245

54 *------------------------112905* 54

Tulare County/Health & Human SVS

TulareWORKs Division

PO Box 671

6330 S. Mooney Blvd, Ste. 106

Visalia, CA 93277

800-540-6880

55 *------------------------082593* 55

Tuolumne County


20075 Cedar Rd. North

Sonora, CA 95370

209-533-5711

56 *------------------------121312* 56

Ventura County


855 Partridge Dr.

Ventura, CA 93003

Attn: Irma Reynoso

(805) 477-5405

57 *------------------------121312* 57

Yolo County

Health & Human Services Agency

25 North Cottonwood St

Woodland, CA 95695

Attn: Sophia Sandoval

13

530-661-2744

58 *------------------------121312* 58

Yuba County Health and

Human Services Dept.

PO Box 2320

Marysville, CA 95901-9987

Attn: Alejandro Rodriguez

530-749-6386

*------------------------------*

state of california health and human services agency ...2 (209)754-6872 06 *-----121312* 06 colusa...

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