2011 bhsf facility hcbs fillable-2026

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The document is a Louisiana Medicaid Program application form for SSI recipients seeking long-term facility care, Home and Community Based Services (HCBS), or the Program of All-Inclusive Care for the Elderly (PACE). It collects personal information about the applicant, their financial status, and any relevant legal arrangements. Additionally, it includes rights and responsibilities related to Medicaid eligibility and a section for voter registration.

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Click ‘Get Form’ to open the 2011 bhsf facility hcbs fillable in the editor.
Begin by filling in the applicant's name, Social Security number, and date of birth in the designated fields. Ensure accuracy as this information is crucial for processing.
Indicate marital status and veteran status by selecting the appropriate checkboxes. This helps determine eligibility for specific services.
Provide residence and mailing addresses. If they differ, ensure both are clearly filled out to avoid any communication issues.
Complete sections regarding income and assets. Be thorough when detailing any additional income sources or properties owned, as this impacts eligibility.
Review all entries for accuracy before submitting. Utilize our platform’s features to save your progress and make edits as needed.

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2011	4.8 Satisfied (160 Votes)

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