REQUEST FOR MEDICAID HOME AND COMMUNITY-BASED 2025

1. Click ‘Get Form’ to open the REQUEST FOR MEDICAID HOME AND COMMUNITY-BASED application in the editor.
2. Begin by entering the applicant’s name and contact information in the designated fields. Ensure accuracy as this information is crucial for processing.
3. Fill out the sections regarding the applicant's current residence, including whether they are at home, in a hospital, or a nursing facility. Provide dates of admission and discharge where applicable.
4. Complete the health care insurance section by indicating if the applicant has Medi-Cal or Medicare, and provide relevant policy numbers.
5. Identify the applicant’s medical needs by checking appropriate boxes and providing additional details in the spaces provided. This includes any special equipment needs or treatments required.
6. If someone else is submitting on behalf of the applicant, ensure to fill out their details in the legal authority section.
7. Review all entered information for accuracy before saving your changes. Once complete, you can download or share your application directly from our platform.

Start filling out your REQUEST FOR MEDICAID HOME AND COMMUNITY-BASED application today for free using our editor!