DHS Search Results
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BadgerCare Plus: Forms, Guides, and Publications
… Plus . ACCESS website BadgerCare Plus Application Packet, F-10182 (paper form) They want someone to act on their behalf . This can be a person or an organization. Learn more from the … Plus. ACCESS website Information Change Report, F-10183 (paper form) They need to allow someone to see information about their eligibility . Use the Release of Confidential Information … -
Medicaid: Forms and Publications
… for the Elderly, Blind, or Disabled Application Packet, F-10101 Online using ACCESS They want someone to act on their behalf . This can be a person or an organization. Learn more from the … having a child. Paper— Medicaid Change Report, F-10137 Online using ACCESS They need to allow someone to see information about their eligibility . Use the Release of Confidential Information … -
Suspension of Benefits for Incarcerated Members: Frequently Asked Questions
… they had to complete the full application again to regain health care coverage. When someone's BadgerCare Plus or Wisconsin Medicaid coverage is suspended, their suspension can be … that should not have been covered during the time they should have been suspended. When someone is suspended and remains part of a household, does that person still count as a member of … -
BadgerCare Plus Application Packet
… Numbers are used only for the direct administration of the BadgerCare Plus programs. If someone in your household is not applying for BadgerCare Plus, you do not need to provide a … proof, contact your agency and ask for help. OTHER PROGRAMS Medicare Savings Program If you or someone in your home is receiving Medicare Parts A and/or B, they may be able to get help paying … No Are you on active duty in the U.S. military or an honorably discharged veteran, married to someone on active duty or an honorably discharged veteran, the surviving spouse of a veteran, or … -
Information Change Report
… than 10 days after the change has occurred: • You move to a new address or out of state. • Someone moves in or out of your home, becomes pregnant, or gives birth. • Your living arrangement … or you go into a nursing home or other institution). • You get married or divorced. • Someone in your home has a change in health insurance. • Someone in your home has a change in expected tax filing status or tax dependents or no longer … -
Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet
… Security Numbers are used only for the direct administration of the Medicaid program. If someone in your household is not applying for Medicaid, you do not need to provide Social … Services (USCIS) for people in your household who are not applying for assistance. If someone in your household is not applying for Medicaid, you do not need to answer this question … F-10137, of this application packet for future use. If you are completing this application for someone else, complete either the Appoint, Change, or Remove an Authorized Representative: Person … -
ForwardHealth Enrollment and Benefits Handbook
… rules. Fraud means getting benefits or assistance you know you should not get or helping someone else get benefits or assistance you know that person or their household should not get. … the amount you owe to an amount you can repay in three years. An authorized representative or someone who otherwise causes an overpayment or engages in trafficking may also be held … ForwardHealth card to get health care services or prescription drugs for yourself. • Let someone else use your ForwardHealth card to get health care services or prescription drugs. Page … -
BadgerCare Plus Application Packet, Spanish
… than 10 days after the change has occurred: • You move to a new address or out of state. • Someone moves in or out of your home, becomes pregnant, or gives birth. • Your living arrangement … or you go into a nursing home or other institution). • You get married or divorced. • Someone in your home has a change in health insurance. • Someone in your home has a change in expected tax filing status or tax dependents or no longer … -
BadgerCare Plus Employer-Sponsored Health Insurance
… Reasons). What does “Access to Employer-Sponsored Health Insurance” Mean? Access means you or someone in your home is able or has been able to sign up for health insurance through an employer. Past Access — You or someone in your home was able to sign up for health insurance through a current employer in the … health insurance coverage in the last 3 months from a past employer. Current Access — You or someone in your home can sign up for health insurance through an employer in the next month. You … -
Medicaid - Patient Liability
… not covered by Medicaid. • The actual amount you pay each month for support payments to someone else. • A job credit if you are employed. If, after we subtract all of the credits from … or call 1-800-362-3002. If you apply online, you may need to talk with someone who works at your local agency after you submit the application. In many cases, this can … -
FoodShare: A Recipe for Good Health
… any web links. Call your agency or ForwardHealth Member Services at 800-362-3002 if you think someone is trying to scam you. The Federal Trade Commission is the nation’s consumer protection … provided is in accordance with 8 C.F.R. 103, 212, 213, and 245. A “public charge” is someone who the government believes is likely to become dependent on the government for basic … -
What are the rules when getting free rides to appointments?
… Fraud means getting coverage or payments you know you should not get. It also means helping someone else get coverage or payments you know that person should not get. Anyone who commits … more benefits than you should. • Use another person’s card to get services for yourself. • Let someone else use your ForwardHealth card to get health care services or prescription drugs. If … -
SLMB+ Notice Example
… Your Reporting Rules Based on the benefits you are getting, you must report within 10 days if someone: - Has a new address - Has a change in where he or she is staying - Moves in or out of … -
Medicaid Change Report
… any other changes that may affect your Medicaid eligibility. Examples of other changes include someone getting or dropping health insurance, someone becoming disabled or recovering from a disability. A change could also be a change in … -
Appoint, Change, or Remove an Authorized Representative: Organization
… or conservator, that person must appoint an authorized representative for you if you want someone besides them to be your authorized representative. If you have an activated durable power … 3 — If you are appointing or changing an authorized representative, you will need to have someone besides your authorized representative watch you sign this form. This person is called a … -
Personal Care Screening Tool (PCST)
… setting With live-in paid caregiver(s); includes service in exchange for room and board Someone Else’s Home or Apartment Family Nonrelative 1-2 bed adult family home (certified) … Off Living Situation – Member (Own Home or Apartment): Off Living Situation – Member (Someone Else’s Home or Apartment): Off Living Situation – Member (Apartment with Services): Off … -
Instructions: Personal Care Screening Tool (PCST)
… is placed in front of the member. • Member is able to dress upper body independently but needs someone to choose appropriate clothes. B. Member is able to dress upper body by self, but … supervision or cueing: • Member can dress upper body independently but needs a reminder from someone to button the blouse and adjust the collar. • Member requires cueing/instructing to … solid foods. G. Member needs total feeding from another person. The member depends entirely on someone else for feeding. H. Member’s ability is age appropriate for a child age 3 or younger. … -
Appoint, Change, or Remove an Authorized Representative: Person
… or conservator, that person must appoint an authorized representative for you if you want someone besides them to be your authorized representative. If you have an activated durable power … 3 — If you are appointing or changing an authorized representative, you will need to have someone besides your authorized representative watch you sign this form. This person is called a … -
Medicaid: Contacts
… HMO (health maintenance organization) HMO enrollment specialist: 800-291-2002 HMO ombudsman (someone who can help you understand HMOs): 800-760-0001 Health care providers If you’re a health … -
Medicaid Disability Application
… by the applicant or his/her representative. If you are completing this application for someone else, complete the Medicaid/FoodShare Wisconsin Authorization of Representative (F-10126) … (Other than his / her name)? Yes No If the applicant cannot speak English, list the name of someone that may be contacted who speaks English and will give the applicant messages. Name …