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Click ‘Get Form’ to open the Form 3400 Application in our platform.
Begin by entering your personal information in Step 1. Fill in your name, address, and contact details accurately. Ensure you include all family members who live with you.
Proceed to provide income information for each person listed. This includes employer details and any other sources of income. Use the editor's features to easily input and adjust this data.
In Step 2, indicate if any family members are American Indian or Alaska Native by checking the appropriate box. If yes, complete the additional form provided.
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What documents and information do you need for your Medicaid application? Your name and date of birth. Your Social Security number. Your monthly payment amounts for rent, mortgage, or utilities. Proof of citizenship or immigration status. Proof of income, like paystubs or W-2s.
What the most you can make to qualify for Medicaid?
For most states, the Medicaid income limit is $2,901 per month for a single applicant and $5,802 per month for married applicants, typically set at 300% of the Federal Benefit Rate (FBR).
What documents are required for Medicaid in the US?
Your Medicaid office may ask you to show the following: Proof of date of birth (e.g., birth certificate) Proof U.S. citizenship or lawful residence (e.g., passport, drivers license, birth certificate, green card, employment authorization card)
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Application for Medicaid and Affordable Health Coverage
If someone is helping you fill out this application, you may need to complete the Authorized Representative Form. (1282), which can be downloaded at SCDHHS.gov.
Form 3400 CA. Date. Signature of Enrollee. I authorize any payroll deduction that may be required towards the cost of this coverage. I docHub that the above
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