South Carolina Medicaid Eligibility Forms



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South Carolina Medicaid Eligibility Forms

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Application for Medicaid and Affordable Health … – SCDHHS.gov

www.scdhhs.gov

DHHS Form 3400 (June 2016). Page 2 of 15. Application for Medicaid and
Affordable Health Coverage. Get help with this application. • Online: SCDHHS.
gov. • Phone: Call our Help … The South Carolina Department of Health and
Human Services (SCDHHS) complies with applicable Federal civil rights laws
and does not …

Application for Medicaid and Affordable Health … – SCDHHS.gov

www.scdhhs.gov

DHHS Form 3400 (June 2016). Page 1 of 13. Application for Medicaid and
Affordable Health Coverage things to know. South Carolina Department of Health
and Human Services. Use this application to see what coverage choices you
qualify for. • Affordable private health insurance plans that offer comprehensive
coverage …

Annual Review Form – SCDHHS.gov

www.scdhhs.gov

In person: Visit an SCDHHS county eligibility office in your area. Annual Review
Form. Household #:. Notification Date: You have 30 days from the date listed
above to com- plete and return this form. If you do not, you may lose Medicaid
benefits. Send to: SCDHHS-Central Mail. PO Box 100101. Columbia, SC 29202-
3101 …

South Carolina Medicaid Program Annual Review Form – Providers

www1.scdhhs.gov

South Carolina Medicaid Program. Annual Review Form. This form is used to
review your Medicaid coverage. •. If you do not return this form, your Medicaid will
stop. This could affect the amount of your … Date Received: If an Authorized
Representative is completing this application, please complete the following:
Name: …

Application for Medicaid Family Planning Coverage – SCDHHS.gov

www.scdhhs.gov

TTY users should call 1-888-842-3620. DHHS Form 400 (April 2017). Page 1 of 6
. Application for Medicaid and Affordable Health Coverage things to know. South
Carolina Department of Health and Human Services. About this program. • This
application is used to apply for Medicaid for Family Planning coverage only.

Additional Information for Select Medicaid Programs – SCDHHS.gov

www.scdhhs.gov

DHHS Form 3400-A (June 2016). Page 1 of 2. Additional Information for Select
Medicaid. Programs. You recently applied for Medicaid with the State of South
Carolina. Please complete and return this form so we can process your
application. We need more information to see if you may be eligible for one or
more of the …

South Carolina Medicaid Program Annual Review Form – Providers

www1.scdhhs.gov

HH #:. Case Name: South Carolina Medicaid Program. Annual Review Form.
This form is used to review your Medicaid coverage. You must return this form to
us by … If an Authorized Representative is completing this application, please
complete the following: … Return to: SCDHHS, PO Box 100101, Columbia, SC
29202 …

South Carolina Department of Health and Human … – SCDHHS.gov

www.scdhhs.gov

DHHS Form 3401 (June 2016) … This application is used to apply for Nursing
Home, Waiver Services, or Optional State Supplementation (OSS) at the South
Carolina … Federal law requires that anyone who applies for Medicaid for
themselves must tell us about their citizenship or immigration status and provide
or apply.

South Carolina Department of Health and Human … – SCDHHS.gov

www.scdhhs.gov

DHHS Form 3401 (October 2013). Page 1 of 9. This application is used to apply
for Nursing Home, Waiver Services, or OSS at the South Carolina Department of
Health and Human Services. (SCDHHS). Please answer all questions as
completely as possible as they apply to you or the persons for whom you are
applying.

Residential Care/Assisted Living Compendium: South Carolina

aspe.hhs.gov

SC-1. Compendium of Residential Care and Assisted Living Regulations and
Policy: 2015 Edition. SOUTH CAROLINA. Licensure Terms. Community …
disease are required to disclose the form of care and treatment provided that ….
Facilities that serve Medicaideligible residents must contract with a licensed
nurse.

Application for Disability Insurance Benefits – Social Security

www.ssa.gov

Form SSA-16 (03-2017) UF. Discontinue prior editions. Social Security … eligible
under Title II and Part A of Title XVIII of the Social Security Act, as presently
amended. (Do not write in this ….. To State audit agencies for auditing State
supplementation payments and Medicaid eligibility considerations; and. 2. To the
Social …

Premium Assistance Under Medicaid and the Children's Health …

www.dol.gov

If you or your children are eligible for Medicaid or CHIP and you're eligible for
health coverage from your employer, your state may have a … eligible for these
premium assistance programs but you may be able to buy individual insurance
coverage through the Health …. NEVADA – Medicaid. SOUTH CAROLINA
Medicaid.

Appeal Request Form – Individual A – HealthCare.gov

www.healthcare.gov

Marketplace Eligibility Appeal Request. 09/2017. Form Approved. OMB No. 0938
-1213. Appeal Request Form – Individual A. Use the right form to request an …
South Carolina. South Dakota. Texas. Utah. Virginia. Wisconsin. • Visit
HealthCare.gov/marketplace-appeals to: • Get an appeal request form for other
states.

2017 Instructions for Forms 1094-B and 1095-B – IRS.gov

www.irs.gov

Form 1095-B is used to report certain information to the. IRS and to taxpayers
about individuals who are covered by minimum essential coverage and therefore
aren't liable for the individual shared responsibility payment. Minimum essential
coverage includes government-sponsored programs, eligible employer-
sponsored …

SC INSPIRED The State of South Carolina's Race to the Top – U.S. …

www2.ed.gov

SC INSPIRED. The State of South Carolina's Race to the Top Application. Table
of Contents. Page. PDF. Page. Application Part III: Race to the Top Application
Assurances. 2. Application Part III cont'd: … With respect to the certification
regarding lobbying in Department Form 80-0013, no Federal appropriated funds
have …

RETROACTIVE MEDICAID APPLICATION

www.michigan.gov

RETROACTIVE MEDICAID APPLICATION. 1. My family has unpaid medical bills
for the month(s) of: First. Month. Year …. I CERTIFY THAT ALL INFORMATION I
HAVE WRITTEN ON THIS FORM IS TRUE TO THE BEST OF MY KNOWLEDGE.
Signature. Date. Department of Human Services (DHS) will not discriminate …

What is a Medicaid Spend Down and how does it work

www.oms.nysed.gov

income. Some of these people may qualify for Medicaid if they spend the excess
income on medical bills. This is called a spend down. For example, a person over
65 is denied Medicaid because her monthly income is $50 more than the limit for
Medicaid eligibility. If she incurs medical bills of $50 per month, the rest of her.

Exemption Information If Your State Didn't Expand Medicaid

www.treasury.gov

South Carolina. • South Dakota. • Tennessee. • Texas. • Utah. • Virginia. •
Wisconsin. • Wyoming. So who qualifies for the Medicaid exemption? In addition
to other eligibility criteria, you may qualify to claim this exemption if your
household income was below a certain level for your family size, and at any time
during the year, …