Family PACT Program
Eligibility
Eligibility Requirements
1. I am currently able to get pregnant or cause a pregnancy.
2. I currently have a California address.
3. I do not currently have Medi-Cal benefits covering family planning services.
3a. l have Medical benefits through my parents or spouse, but I would like my family
planning services kept confidential.
3b. I have Medi-Cal that covers family planning services, but I cannot afford the deductible
or share of cost.
4. I do not have insurance that covers family planning services.
4a. I have insurance that covers family planning services, but I cannot afford the deductible
or share of cost. (Does not include co-pays)
4b. I have insurance that covers family planning services, through my parents or spouse,
but I would like my family planning services kept confidential.
5. I meet the income guidelines shown below to qualify for the Family PACT Program.
If you checked all of the above, fill out a CEC form and we can electronically enroll you today so that
your family planning services you are about to have can be free.
Income Guidelines
Family Size
Gross Monthly Income
Gross Annual Income
1
$1,962
$23,540
2
$2,655
$31,860
3
$3,348
$40,180
4
$4,042
$48,500
5
$4,735
$56,820
6
$5,428
$65,140
7
$6,122
$73,460
8
$6,815
$81,780
9
$7,508
$90,096
10
$8,201
$98,412
*Family Size = self, legal spouse and
any legally dependent children.
*Gross = An individual's total personal income before taking taxes or
deductions into account.
Revised April 2015