470-3118S Medicaid Review Spanish - dhs iowa 2026

1. Click ‘Get Form’ to open the 470-3118S Medicaid Review Spanish form in the editor.
2. Begin by filling in your county number, worker's name, case number, and worker's phone number at the top of the form.
3. In the 'Información Acerca de su Familia' section, list yourself and all household members. Include their names, relationships, ages, and Social Security numbers.
4. Provide your current mailing address and residential address. If you have a guardian or representative, include their names.
5. In the 'Gastos' section, detail your medical expenses and any ongoing medical bills for household members not covered by Medicaid.
6. List all sources of income for everyone in your household in the 'Ingreso' section. Be sure to include proof of income from the last 30 days.
7. Complete the 'Activos' section by listing all vehicles owned or being purchased by anyone in your household along with their values and debts.
8. Finally, sign on page 4 where indicated and ensure you submit any required documentation along with your completed form.

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