Healthy Families Transition Survey Question Title * 1. Please identify if you are: The parent of a child/children in Healthy Families/Medi-Cal Other family member Other (please specify) Question Title * 2. County of residence: 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 Other (please specify) Question Title * 3. How many children in your family are on Healthy Families/Medi-Cal? 1 2 3 4 5 6+ Question Title * 4. Which Health Plan covers your child/children? Kaiser Health Net Anthem Blue CalViva Molina Care 1st Health Plan of San Joaquin San Francisco Health Plan Community Health Group Inland Empire Health Plan LA Care Health Plan Kern Family Health Care Contra Costa Health Plan Alameda Alliance for Health Partnership HealthPlan Other (please specify) Question Title * 5. If you pay premiums, are you up to date with these payments? Yes No I don't know Other (please specify) Next