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Click ‘Get Form’ to open the DHS 1100B in the editor.
Begin by entering your case number and personal information at the top of the form, including your name, address, and contact details.
Review section A carefully. Attach copies of your last month’s income, assets, and private health insurance documentation as required.
For each question in sections 1 through 11, select 'YES' or 'NO' as applicable. If you answer 'YES', provide detailed explanations in the space provided.
In section 12, ensure you sign and date the form. This certifies that all information is accurate.
Finally, save your completed form and choose to either mail, fax, or deliver it to the designated office by the specified deadline.

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What is the highest income to be eligible for Medicaid?

Parents of Dependent Children: Income limits for 2025 are reported as a percentage of the federal poverty level (FPL). The 2025 FPL for a family of three is $26,650. Other Adults: Eligibility limits for other adults are presented as a percentage of the 2025 FPL for an individual is $15,650.

How do I speak with someone at DHS?

Contact Information for DHS Headquarters Operator Number: 202-282-8000. Comment Line: 202-282-8495. TTY: Use the Federal Relay Service for either number above. DHS Mailing Address.

What is the income limit for Medicaid in Hawaii?

DEPARTMENT OF HUMAN SERVICES. .

What is DHS in Hawaii?

By Phone Call the DHS Help Line at 1-800-843-6154; 1-866-324-5553 TTY. Available Monday - Friday, 8:30 AM - 4:30 PM. Closed State holidays. Follow the prompts for SNAP, Cash and Medical benefits to speak to a Customer Service Agent.

What is the income to qualify for Medicaid in Hawaii?

Qualify for the Community Health Coverage Program (CHCP) Household/Family SizeMonthly Household Income no more than*:Annual Household Income no more than*: 1 $4,497 $53,970 2 $6,080 $72,960 3 $7,662 $91,950 4 $9,245 $110,9402 more rows

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