Recertification medical assistance form 2026

1. Click ‘Get Form’ to open the recertification medical assistance form in the editor.
2. Begin by filling out the recipient's information section. Ensure you print clearly and provide accurate details such as name, date of birth, and social security number.
3. Next, complete the spouse’s information if applicable. Indicate whether your spouse is applying or receiving assistance and provide their details accordingly.
4. Proceed to list any resources that the recipient may have. This includes bank accounts, real estate, and other assets. Be honest about values and account numbers.
5. Fill in the income section for both the recipient and any dependent family members. Include all sources of income like Social Security, pensions, or employment earnings.
6. Complete the health insurance section by indicating coverage details for the recipient and their family members. Provide policy numbers and premium amounts.
7. Finally, review all sections for accuracy before signing on the back page. Return the completed form to the address listed at the top.

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