2011 bhsf facility hcbs fillable-2025

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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 voter registration declaration.

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2011	4.8 Satisfied (160 Votes)

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