Doh 5178a 2026

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The document is a Supplement to the Access NY Health Care Application (DOH-4220) that must be completed by individuals applying for Medicaid coverage who are 65 or older, certified blind or disabled, chronically ill, or institutionalized. It outlines the necessary sections to fill out regarding personal information, care services being applied for, resources and assets, asset transfers, tax returns, and important information about Medicaid eligibility and requirements. The document emphasizes the need for documentation of resources and provides instructions for applicants.

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