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Patient 1st application Revised Sep2009 doc Form used for making an application with the alabama Cri

Patient 1st application Revised Sep2009 doc Form used for making an application with the alabama Cri 2025

Patient 1st application Revised Sep2009 doc Form used for making an application with the alabama Cri Preview on Page 1

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The document outlines the enrollment process and requirements for healthcare providers wishing to participate in Alabama's Patient 1st Program under Medicaid. It includes sections on general information, participation details, provider agreements, case management fees, and responsibilities of both the primary medical providers (PMPs) and the Alabama Medicaid Agency. Key components include application procedures, patient care coordination, after-hours coverage requirements, and compliance with federal and state regulations.

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How to use or fill out Patient 1st application Revised Sep2009 doc Form used for making an application with the Alabama Cri

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Click ‘Get Form’ to open it in the editor.
Begin with Section I – General Information. Fill in whether you are enrolling as an individual, group/practice, FQHC, or RHC. Provide your name and NPI numbers where applicable.
In Section II – Participation Details, specify your distance from patients and the number of patients you wish to enroll. Indicate if you want to be published on the Patient 1st List.
Complete Section III if applying as a group or clinic by listing all members along with their NPI numbers and hours worked per week.
Review all sections for accuracy before signing at the end of the form. Ensure that all required attachments are included.

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What is the income limit for Alabama Medicaid for seniors?

Home and Community Based Waivers: The income limits for these waivers are as follows: Elderly and Disabled Waiver is $2,901 per month. Independent Living Waiver is $2,901 per month. Persons with Intellectual Disabilities Waiver is $2,901per month.

How to claim Medicaid in Alabama for seniors?

A variety of online and paper forms are available to applicants, recipients and sponsors. For help in applying for Medicaid, call the Recipient Call Center (toll-free) at (800) 362-1504, Monday through Friday, 8:00 a.m. until 4:30 p.m. Or print out a paper copy to fill out.

What does it take for an elderly person to qualify for Medicaid?

Seniors and individuals with disabilities whose income exceeds the SSI limit but is below the federal poverty level (FPL, $1,304 for an individual in 2025). States can also choose to apply an asset limit to this pathway, usually $2,000 for an individual.

How to apply for Medicaid in Alabama for elderly?

Forms for Medicaid Applicants and Recipients A variety of online and paper forms are available to applicants, recipients and sponsors. For help in applying for Medicaid, call the Recipient Call Center (toll-free) at (800) 362-1504, Monday through Friday, 8:00 a.m. until 4:30 p.m. Or print out a paper copy to fill out. Forms for Applicants and Recipients - Alabama Medicaid Alabama Medicaid (.gov) 9.4FormsLibrary 9.4 Alabama Medicaid (.gov) 9.4FormsLibrary 9.4