3871b 2026

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The document is a Maryland Medical Assistance Eligibility Review Form (#3871B) used to assess eligibility for various medical services, including nursing facilities and waivers. It includes sections for service requests, client demographics, mental health assessments, diagnoses, skilled services required, functional assessments, and certification by healthcare professionals. The form aims to gather comprehensive information about the client's medical needs and conditions to determine appropriate care.

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Click ‘Get Form’ to open the 3871b document in the editor.
Begin with Part A, entering the requested eligibility date and admission date. Select the appropriate service type by checking one of the options provided.
In Part B, fill in the client’s name, current address, and contact information. Ensure all details are accurate for proper identification.
Proceed to Part C and answer the questions regarding mental health status. Check 'Yes' or 'No' as applicable, providing additional details where necessary.
Complete Parts D through G by detailing diagnoses, skilled services required, functional assessments, and certifications. Make sure to sign and date where indicated.

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Does Medicaid pay for assisted living in MD?

Level 3 programs provide all Level 2 and 3 services and also ongoing access to and coordination of comprehensive health services and interventions; comprehensive and frequent assistance with ADLs; monitoring and providing ongoing therapeutic intervention or intensive supervision to manage chronic behaviors that might

What is a 3871?

What is a 3871? A form used to determine the need for nursing home care (Form 3871) is then sent to the Delmarva Foundation for a determination of medical eligibility.

maryland 3871b

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