(b) An application shall include both of the following:

1. (1) A justification of the amount of grant funds requested, including both of the following:

   1. (A) The cost of uncompensated abortion and contraceptive services the applicant provided to patients with household incomes at or below 400 percent of the federal poverty level in the previous 12 months.
   2. (B) The anticipated cost of uncompensated abortion and contraception services to be provided to patients with household incomes at or below 400 percent of the federal poverty level in the upcoming 12 months.
2. (2) Other pertinent information that the department requires.

(d) For purposes of subdivision (b), the cost of uncompensated abortion and contraception services shall:

1. (1) Be calculated based on the amount the provider would expect to receive for providing these services to a patient enrolled in the Medi-Cal program.
2. (2) Include those services provided through prescription, including laboratory and pharmaceutical, as well as services that are the result of complications related to services provided pursuant to this chapter, to the extent they would be covered pursuant to Section 14132 of the Welfare and Institutions Code.