Click on the image to the right to fill out the the sliding
 fee application online. Once you have completed the
 application please mail your Medi-Cal denial and proof
 of income to the following address for review.

MACT Health Board, Inc.   Attn: Billing Department   Po Box 939   Angels Camp, CA 95222-0939

 If you prefer you can also fax your Medi-Cal denial and
 proof of income to (866) 205-8079, Attn: Billing.

 If you need any assistance or have any questions
 regarding this application, please contact our billing
 department during normal business hours at:

   (209) 754-6240 or (866) 894-1902

 You must have Adobe Reader 8.0 or higher installed in
 order to view the application online. To download the
 newest version of adobe click here....