State form 55390: Fill out & sign online

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to quickly redact Indiana state form 55390 online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Dochub is a perfect editor for modifying your paperwork online. Follow this simple guideline edit Indiana state form 55390 in PDF format online at no cost:

Sign up and log in. Create a free account, set a strong password, and proceed with email verification to start managing your forms.
Upload a document. Click on New Document and select the file importing option: add Indiana state form 55390 from your device, the cloud, or a protected link.
Make adjustments to the sample. Use the top and left panel tools to edit Indiana state form 55390. Insert and customize text, images, and fillable areas, whiteout unnecessary details, highlight the important ones, and provide comments on your updates.
Get your documentation completed. Send the form to other individuals via email, create a link for quicker file sharing, export the sample to the cloud, or save it on your device in the current version or with Audit Trail added.

Discover all the advantages of our editor today!

See more indiana state form 55390 versions

We've got more versions of the indiana state form 55390 form. Select the right indiana state form 55390 version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (146 Votes)
2017	4.1 Satisfied (52 Votes)
2013	4.4 Satisfied (418 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Contact us

What is the fax number for SNAP benefits in Indiana?

Fax: 800-403-0864 or deliver or mail to your local county office.

How do I report a change to Medicaid in Indiana?

Click here or call 800-403-0864 to report a change to your SNAP (food assistance), TANF (cash assistance) or Medicaid (health coverage) case; such as income, household member changes, home address, employment status, etc.

What are the income limits for Indiana Medicaid?

Income Asset Limits for Eligibility 2023 Indiana Medicaid Long-Term Care Eligibility for SeniorsType of MedicaidSingleMarried (both spouses applying)Income LimitAsset LimitInstitutional / Nursing Home Medicaid$2,742 / month*$3,000Medicaid Waivers / Home and Community Based Services$2,742 / month$3,0001 more row Feb 27, 2023

How do I contact Medicaid in Indiana?

Call us at 1-877-822-7196 or in the Indianapolis area 317-822-7196. There are representatives that can help you.

Does Indiana Medicaid automatically renew?

By law, all HIP members must have their eligibility renewed every 12 months. This annual process is used by the state to determine if members remain eligible for HIP for another year of coverage. The redetermination period is also one of the periods when a HIP Basic member can move to HIP Plus.

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

Where do I send my Indiana FSSA authorized rep form?

The form needs to be signed by you and the person you authorize as your representative. It should then be filed with the state by fax to 800-403-0864 or delivered by mail or in person to your local county office.

How do I report a change to the Healthy Indiana Plan?

You can call 1-800-403-0864. Or, you can visit your local Division of Family Resources (DFR) office to report a change. When you report the change, you may be able to request a recalculation of your payments for Healthy Indiana Plan or CHIP. You can download a copy of the Report of Change Form on Member Forms.

What does Indiana Family and Social Services do?

The eight care divisions in FSSA administer services to more than 1.5 million Hoosiers. FSSAs mission is to compassionately serve our diverse community of Hoosiers by dismantling long-standing, persistent inequity through deliberate human services system improvement.

Get the up-to-date indiana state form 55390 2024 now

Here's how it works

How to quickly redact Indiana state form 55390 online

See more indiana state form 55390 versions

Complete this form in 5 minutes or less

Got questions?

What is the fax number for SNAP benefits in Indiana?

How do I report a change to Medicaid in Indiana?

What are the income limits for Indiana Medicaid?

How do I contact Medicaid in Indiana?

Does Indiana Medicaid automatically renew?

Complete this form in 5 minutes or less

People also ask

Where do I send my Indiana FSSA authorized rep form?

How do I report a change to the Healthy Indiana Plan?

What does Indiana Family and Social Services do?

Related links

Try more PDF tools

Get the up-to-date indiana state form 55390 2024 now

Here's how it works

How to quickly redact Indiana state form 55390 online

See more indiana state form 55390 versions

Complete this form in 5 minutes or less

Got questions?

What is the fax number for SNAP benefits in Indiana?

How do I report a change to Medicaid in Indiana?

What are the income limits for Indiana Medicaid?

How do I contact Medicaid in Indiana?

Does Indiana Medicaid automatically renew?

Related Searches

Related forms

Complete this form in 5 minutes or less

People also ask

Where do I send my Indiana FSSA authorized rep form?

How do I report a change to the Healthy Indiana Plan?

What does Indiana Family and Social Services do?

Related links

Try more PDF tools