Get Icama Certificate

Filling out the Icama Certificate online can be a straightforward process if you follow the provided guidance. This document is essential for ensuring Medicaid eligibility and requires accurate completion of various sections.

Follow the steps to successfully complete the Icama Certificate.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with section A, where you will input child information. Enter the child's legal name, birthdate, and social security number. Ensure to provide the required Social Security number, as it is necessary to open the Medicaid case. Specify the child's gender and select their race and ethnicity by checking all applicable boxes.
3. Continue in section A by completing the details for additional children if applicable (Child B and Child C). Repeat the same steps as for the first child, ensuring all required information is filled out accurately.
4. In section 2, input the names of the adoptive parent(s) or guardian(s). Make sure to include both parents' or guardians' names as required.
5. Provide the current address in section 3. Fill out the number and street, county, city, state, and telephone number, including the area code. An email address is also required in this section.
6. If applicable, complete section 4 with the previous address of the adoptive parent(s)/guardian(s). Include all necessary details just like in section 3.
7. In section 5, state the reason if the child is not residing with the adoptive parent(s)/guardian(s). Provide a clear explanation.
8. Move to section B to fill out referral information. Include the name, agency, mailing address, telephone number, fax number, and email address for both the sender and the recipient.
9. In section C, certification is required. Ensure the certifying person includes their signature, name, title, agency, and the city and state where it is signed, along with the date.
10. Finally, in the distribution section, follow the instructions for submitting the original document with the current Adoption Assistance or Guardianship agreement and ensure copies are distributed as mentioned.
11. Once you have completed filling out the form, save your changes, and choose to download, print, or share the document as necessary.

Take action now and complete your Icama Certificate online for efficient Medicaid processing.