1157 form-2026

1. Click ‘Get Form’ to open the 1157 form in the editor.
2. Begin by entering the name of the potentially disabled person, along with their case number and beneficiary identification number in the designated fields.
3. Carefully read each question and provide answers in the applicant’s own words. This ensures that the information accurately reflects their situation.
4. Once completed, check item A to certify that all information is true, or select item B if you choose not to complete the form.
5. Initial item C to acknowledge understanding of potential changes to health plan enrollment if a disability is confirmed for one year or more.
6. Initial item D to confirm awareness of asset evaluations for Medicaid eligibility following a disability determination.
7. If someone else is completing the form on behalf of the applicant, they must sign, date, and explain why assistance was needed.

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