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  • Dom-323, Disability Or Blindness Report And Instructions - Medicaid Ms

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FORMS AND INSTRUCTIONS. DOMl323 - DISABILITY OR BLINDNESS REPORT. M. PURPOSE & USE This form is used to record the applicant's condition and.

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The standard Medicaid ID card is blue, printed with the Medicaid logo and the beneficiary's name and ID number. Medicaid ID cards for members on the family planning waiver are yellow. Always remember to take your Medicaid ID card every time you go to get health services.

Qualifications: Placement in a facility or HCBS waiver program must be medically necessary and the individual must be income and resource eligible and must not have transferred assets within a five year look back period and any subsequent months in order to qualify for Medicaid.

Eligibility Policy and Procedures Manual Medicaid programs in each state must provide coverage to specified categories of needy individuals that include: Children, • Pregnant women, • Parents or caretaker relatives of dependent children, • Aged individuals and • Disabled or blind individuals.

You may also call Medicaid's toll-free telephone number at 1-800-421-2408.

To request a hearing: Contact the Medicaid regional office shown on your notice – in person, via mail, by telephone, or through other commonly accepted electronic means such as fax or e-mail. Tell us you want to appeal the action taken on your case. Tell us if you want a local or state hearing.

For those providers who do not have a touch-tone telephone, please contact the Provider and Beneficiary Services call center at 1-800-884-3222.

Call the Office of Eligibility toll-free at: 800-421-2408. Contact the regional office that serves your county of residence.

Mississippi Medicaid includes multiple health benefits programs administered by DOM: fee-for-service Medicaid, MississippiCAN and CHIP.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232