DHS-3340-ENG (Asset Assessment for Medical Assistance for Long-Term-Care Services (MA-LTC)). Form is used by a married person who expects to receive at least 30 consecutive days of long-term care services. Information provided on the form-2026

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The document DHS-3340-ENG 6-16 outlines the Asset Assessment process for married individuals seeking Medical Assistance for Long-Term-Care Services (MA-LTC) in Minnesota. It provides guidance on how to determine which assets a spouse can retain and what needs to be spent before eligibility for MA-LTC is granted. The form is intended for those expecting 30 days of uninterrupted long-term care services and includes instructions on completing the assessment, required proofs of asset values, and contact information for assistance.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in your personal information, including your first name, last name, date of birth, and social security number. Ensure accuracy as this information is crucial for processing.
Next, provide details about your spouse using the same fields. If your spouse has a different address, include that as well.
Proceed to the asset section. Answer each question regarding cash, bank accounts, investments, real estate, vehicles, and other assets. If you need more space for any answer, note the question number on a separate piece of paper.
Attach required proofs of asset values as specified on Page A of the form. This may include bank statements or property tax documents.
Review all entries for completeness and accuracy before signing the form along with your spouse's signature.
Finally, submit the completed form to your county agency either by mail or in person.

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2016	4.8 Satisfied (208 Votes)

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