Get Medicaid Change Of Address Online

Changing your address with Medicaid is a crucial step to ensure that you continue to receive benefits without interruption. This guide provides a clear, step-by-step approach to help you fill out the Medicaid Change Of Address Online form effectively.

Follow the steps to complete the Medicaid Change Of Address Online form:

1. Press the ‘Get Form’ button to access the form, opening it in the editor.
2. Fill in your name and Medicaid number in the designated fields at the top of the form.
3. Provide your new address and home phone number. Ensure that all details are accurate to prevent delays.
4. Indicate whether this is a new address by checking 'Yes' or 'No.' If 'Yes,' enter the date you moved.
5. Review the various categories for changes and check those that apply to you, such as marital status changes or family changes.
6. For marital status changes, fill in the date of the change and select your new marital status from the options provided.
7. If applicable, complete the section regarding your spouse's information, including their name, Social Security number, date of birth, and address.
8. Report any changes related to family members, such as new births or individuals moving in or out of your home, listing their names and relevant information.
9. Input any income changes, specifying your new income details, employer name, gross amount, and hours worked.
10. Indicate any changes to your expenses, such as starting or stopping payments for day/night care services.
11. Complete the insurance changes section by referring to the relevant form and instructions provided.
12. If applicable, provide information regarding the death of a recipient and any desire to close the Medicaid case.
13. In the 'Other Changes' section, briefly describe any additional changes not covered by the previous categories.
14. Sign and date the form. If someone assisted you in filling it out, include their information as well.
15. To submit your completed form, you may email it to the provided address or follow any outlined submission instructions.

Take the next step by completing the Medicaid Change Of Address Online form today.