Ohio medicaid application pdf 2025

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  1. Click ‘Get Form’ to open the Ohio Medicaid Application PDF in the editor.
  2. Begin by entering your personal information in the designated fields, including your name, address, and contact details. Ensure accuracy as this information is crucial for processing your application.
  3. Next, provide details about your household members. List their names, relationships, social security numbers, and income sources. Remember to indicate if any member is disabled or a U.S. citizen.
  4. In the income section, specify your total gross household income for the last 12 months. Attach necessary documentation as proof of income to avoid delays.
  5. Complete the heating source section by selecting your main source of heat and providing relevant account information from your utility bills.
  6. Finally, review all entered information for completeness and accuracy before signing the application at the bottom. Once satisfied, submit it through our platform for processing.

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Contact Us Medicaid ConsumersMedicaid Providers Call the Consumer Hotline 1-800-324-8680 Visit the Provider Page Apply for Medicaid Call the Integrated Helpdesk 1-800-686-1516 Check status of your application Assistance with PNM Module Where is my card? Assistance with Behavioral Health Redesign1 more row
Attach copies of your proof of income, resources (such as cash, savings, checking, real property, stocks, bonds, etc.), proof of citizenship or alien status, pregnancy if applicable, and other insurance you may have.
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.
Your state Medicaid agency may ask for: 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. A verification of what other government benefits you receive.
Proof of identity, like a photo ID, birth certificate or passport. Social Security card, or proof that you have applied for one. Proof of your immigration status if you are not a citizen. Documents showing all income sources, like pay stubs or your SSI award letter, and your assets, like bank statements and your car
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