Answer what you can — no field is required, and we will follow up if we need anything else.
How to reach you Text messages (optional)
Optional: check this box to receive informational text messages and calls from Medicaid Meals (Vista Verde Homes) at the phone number provided, using automated and artificial voice technology, about your eligibility screening, referrals, application status, and available services. Consent is not a condition of service. You can submit this form without checking it. Consent is not required to submit this form or to receive services.
Optional: check this box to receive text messages and calls about my screening, referrals, application status, and available services. (optional) SMS consent is optional. You can leave this box unchecked and still submit this form and get help; we will reach you by email instead, or you can email info@medicaidmeals.org. Consent is not a condition of service. These are informational messages, not marketing. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for help. Privacy Policy and Terms and Conditions .
Another phone number (optional)
Email
I do not have an email address
Where you live We are taking applications from the Bronx (ZIP codes 10451–10475) and from anywhere in California (Medi-Cal). Colorado opens later; email info@medicaidmeals.org and we will tell you when we reach you.
Street address
Apartment or unit (optional)
ZIP code
County The California county you live in. Your Medi-Cal plan and the services available depend on your county.
Choose one Alameda Alpine Amador Butte Calaveras Colusa Contra Costa Del Norte El Dorado Fresno Glenn Humboldt Imperial Inyo Kern Kings Lake Lassen Los Angeles Madera Marin Mariposa Mendocino Merced Modoc Mono Monterey Napa Nevada Orange Placer Plumas Riverside Sacramento San Benito San Bernardino San Diego San Francisco San Joaquin San Luis Obispo San Mateo Santa Barbara Santa Clara Santa Cruz Shasta Sierra Siskiyou Solano Sonoma Stanislaus Sutter Tehama Trinity Tulare Tuolumne Ventura Yolo Yuba Delivery notes (optional)
Your consent The referral authorization below is needed to send your answers. Agreeing to text messages, calls, or email is optional. Consent to text messages is not a condition of service.
I authorize Vista Verde Homes (Medicaid Meals) to use the information I provide, including my Medicaid Client ID, to identify programs I may qualify for and to share my information with Medicaid Managed Care Plans, Social Care Networks, and authorized service providers for eligibility review and referral purposes. I understand that participation is voluntary, I may withdraw at any time, and completing this form does not guarantee eligibility or services.
By submitting this form, you confirm that the information you provide is accurate to the best of your knowledge. You authorize Vista Verde Homes to use your responses to evaluate potential program eligibility. You consent to the limited sharing of your contact and qualification information with appropriate government, nonprofit, or community-based service providers for the purpose of facilitating referrals. You understand that participation is voluntary and that you may decline or withdraw from the referral process at any time. You acknowledge that Vista Verde Homes is not a healthcare provider, insurer, or government agency and does not guarantee acceptance into any program. I agree to the eligibility screening and referral authorization above.
You agree to receive emails about your eligibility screening, referrals, and application status. You can unsubscribe at any time.
I agree to receive emails about my screening and referrals. (optional)
Participation is voluntary. You can withdraw at any time. Completing this form does not guarantee eligibility or services.
Text messages are optional. Consent is not a condition of service. You can send this form without checking the text-message box.