Dhhs form 3400-2026

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  2. Begin by entering your personal information in the designated fields, including your name, address, and contact details. Ensure accuracy for seamless processing.
  3. Next, navigate to the section regarding your eligibility criteria. Carefully read each statement and select the appropriate options that apply to your situation.
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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.
An Income Trust is a special trust that an applicant/beneficiary funds by depositing their income each month. Income that flows through the Income Trust does not count toward the Medicaid Cap but is used to pay toward the cost of their Long Term Care Services.
Retroactive coverage means that Medicaid may cover your medical bills dating back to three months before your application date. Provide information for anyone in your household who has medical bills in the three months prior to your application date.
For most states, the Medicaid income limit is $2,901 per month for a single applicant and $5,802 per month for married applicants, typically set at 300% of the Federal Benefit Rate (FBR).
Your Medicaid office may ask you to show the following: Proof of date of birth (e.g., birth certificate) Proof U.S. citizenship or lawful residence (e.g., passport, drivers license, birth certificate, green card, employment authorization card)

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