Proof of Non-Incarcerated Status

Documents You Can Submit

You can send us a copy of one of the following documents as proof that you are not incarcerated.

Note: Covered California is not currently asking members to provide proof of non-incarceration status. If you received a notice requesting this document, contact us at (800) 300-1506 before submitting anything.

Official Release Papers

Documentation from the institution or Department of Corrections confirming your release.

Parole Documents

Parole papers confirming your current status.

Non-Incarceration Attestation Form

Download the Non-Incarceration Attestation Form (PDF) and fill out the following four sections on the form:

• Case number
• Your printed name
• Your signature
• Today's date

Written Attestation Letter

You may write your own letter instead of using the form. The letter must include:

• Your full name and address — the same address on your enrollment application
• Your case number, if available
• The following statements:

  • "I, [your full name] am not incarcerated (in jail, prison, correctional facility, or similar penal institution) for the entire period during which I am seeking coverage through Covered California."
  • "I declare under the penalty of perjury, under the laws of the State of California, that what I stated in this letter is true and correct."
• Your signature and today's date

Once complete, submit your form or letter by uploading it to your online account, or by fax or mail using the contact information on the form.