Doh 5178a 2026

1. Click ‘Get Form’ to open the doh 5178a in the editor.
2. Begin with Section A, where you will enter the applicant and spouse information. Fill in legal names, marital status, social security numbers, and dates of birth. If applicable, indicate if the applicant is chronically ill or certified blind.
3. Proceed to Section B to specify what care and services you are applying for. Check the appropriate box based on your needs for Medicaid coverage.
4. In Section C, list all resources and assets owned by you or your spouse. Ensure to include current balances and any closed accounts from the past 60 months.
5. Complete Sections D through G as required, providing details about homestead ownership, asset transfers, and tax returns filed in the last four years.
6. Finally, review all entries for accuracy before signing in Section I to certify that the information provided is correct.

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