IMPORTANT: Are you enrolled in Medi-Cal? Has your contact information changed in the past two years? Give your county office your updated contact information so you can stay enrolled. Go to or call the Los Angeles County Department of Public Social Services at 1-866-613-3777

Trans Health Provider Form

Thank you for your interest in becoming an L.A. Care Health Plan network provider. This form is necessary to perform an initial assessment to confirm your eligibility for participation.

More information

  • Files must be less than 25 MB.
  • Allowed file types: pdf doc docx xls xlsx.