Illinois form hfs 3654-2025

Show details

4.9 out of 5

250 votes

The document is a financial information form for long-term care applicants in Illinois, issued by the Department of Healthcare and Family Services. It requires detailed personal and financial information from applicants to assess their eligibility for medical assistance. The form includes questions about income, previous residences, financial management assistance, marital status, insurance policies, inheritances, joint resources, annuities, and any transfers of money or property within the last 60 months. Applicants must certify the accuracy of their information and consent to investigations related to their financial status.

Here's how it works

01. Edit your hfs 3654 online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send 3654 form via email, link, or fax. You can also download it, export it or print it out.

How to modify Illinois form hfs 3654 online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

With DocHub, making changes to your documentation requires just a few simple clicks. Follow these quick steps to modify the PDF Illinois form hfs 3654 online free of charge:

Sign up and log in to your account. Log in to the editor with your credentials or click on Create free account to test the tool’s features.
Add the Illinois form hfs 3654 for redacting. Click on the New Document button above, then drag and drop the sample to the upload area, import it from the cloud, or using a link.
Alter your file. Make any changes required: insert text and pictures to your Illinois form hfs 3654, underline details that matter, remove sections of content and replace them with new ones, and insert icons, checkmarks, and areas for filling out.
Finish redacting the template. Save the modified document on your device, export it to the cloud, print it right from the editor, or share it with all the people involved.

Our editor is super user-friendly and effective. Try it out now!

See more illinois form hfs 3654 versions

We've got more versions of the illinois form hfs 3654 form. Select the right illinois form hfs 3654 version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2012	4.9 Satisfied (250 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What are the four types of Medicaid in Illinois?

In Illinois, Medicaid is commonly referred to as All Kids or the medical card. Within Medicaid, there are different coverage groups for different populations including: All Kids, FamilyCare, Affordable Care Act (ACA) Adults, Moms and Babies, Former Foster Care, and Aid to Aged, Blind and Disabled (AABD) medical.

Who qualifies for medical assistance in Illinois?

In Illinois, Medicaid is available to people who are: Children 18 years and younger, Parents and caregivers responsible for a child 18 years or younger, Low-income adults ages 19 to 64 years, Over 65 years, Disabled, Blind, Pregnant, and. Young adults under age 26 who were formerly in foster care.

Does anxiety qualify for a medical card in Illinois?

Anxiety is not a qualifying condition for medical marijuana in Illinois. In May 2015, the Medical Cannabis Advisory Board rejected a petition to include it as a qualifying condition. The Board also dismissed diabetes as a debilitating illness treatable with cannabis.

How to get a free medical card in Illinois?

You can request a temporary medical card in any of the following ways: Call the All Kids Unit toll free at 1-877-805-5312 (TTY: 1-877-204-1012). Contact your local office in person. Write to P.O. Box 19138, Springfield, IL 62794 or the office where you applied. By telephone to the office where you applied.

How much does it cost to get a medical card in Illinois?

Illinois Medical Marijuana Card Fees It charges $50 for a MMJ card valid for 1 year, $100 for a card with a validity period of 2 years, and $125 for a card that must be renewed every 3 years. These fees apply to both minors and adult patients applying to the Program.

hfs 3654 pdf

Illinois form hfs 3654 pdf Illinois form hfs 3654 pdf download Illinois form hfs 3654 printable HFS 3654 pdf HFS 2378dr Form pdf When is a 3654 form completed Illinois form hfs 3654 download Illinois Medicaid Forms PDF

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

What qualifies you for a medical card in Illinois?

What Are The Qualifying Conditions To Get A Medical Card In Illinois? PTSD Terminal Illnesses. Acquired Immunodeficiency Syndrome (AIDS) Agitation of Alzheimers disease. Fibrous dysplasia. Glaucoma. Hepatitis C. Osteoarthritis. Parkinsons disease. Polycystic Kidney Disease.

What is form 3654 Illinois?

HFS 3654 is a form for healthcare providers to report incidents of abuse or neglect of residents in long-term care facilities in the state of Illinois. Therefore, healthcare providers who work in long-term care facilities and are aware of incidents of abuse or neglect are required to file HFS 3654.

Who is eligible for Medicaid long term care in Illinois?

In 2025, a single Nursing Home Medicaid applicant must meet the following criteria: 1) Income under $1,304.17 / month 2) Assets under $17,500 3) Require a Nursing Home Level of Care.

Illinois form hfs 3654-2025

Here's how it works

How to modify Illinois form hfs 3654 online

See more illinois form hfs 3654 versions

Complete this form in 5 minutes or less

Got questions?

What are the four types of Medicaid in Illinois?

Who qualifies for medical assistance in Illinois?

Does anxiety qualify for a medical card in Illinois?

How to get a free medical card in Illinois?

How much does it cost to get a medical card in Illinois?

Complete this form in 5 minutes or less

People also ask

What qualifies you for a medical card in Illinois?

What is form 3654 Illinois?

Who is eligible for Medicaid long term care in Illinois?

hfs 3654 form

Try more PDF tools