Get Fm 3290 Me Tefra Application 4-07doc

Filling out the FM 3290 ME TEFRA application online can be a straightforward process when you have the right guidance. This document serves to assist you in providing accurate information necessary for Medicaid coverage for children under the TEFRA program.

Follow the steps to successfully complete the FM 3290 ME TEFRA application online.

1. Click the ‘Get Form’ button to obtain the application and open it in the editor.
2. Begin by entering the name of the child applying for Medicaid. Fill in the last name, first name, middle initial, birth date, social security number, sex, telephone number, and place of birth (city, county, and state). Ensure that all personal details are accurate.
3. Provide the applicant's address, including street address, city, mailing address (if different), state, zip code, and county.
4. List the names of the parents or guardians of the applicant. Include their last name, first name, middle initial, and relationship to the applicant.
5. In Section 4(a), indicate whether the applicant has income from any of the specified sources by checking 'Yes' or 'No'. If yes, fill out the details in Section 4(b) about the income source, amount, and frequency of receipt.
6. In Section 5(a), indicate if the applicant has any assets/resources. Check 'Yes' or 'No' for each item listed. For any 'Yes' answers, provide detailed information in Section 5(b) regarding the item, value, ownership, and the location of the account.
7. Answer questions regarding additional assets/resources not previously mentioned, the existence of health insurance, and whether the applicant received medical services in the last three months.
8. Confirm if the applicant's income and resources have remained consistent over the last three months. If not, provide an explanation for changes.
9. Ensure the applicant has a South Carolina Partners for Health Medicaid card by selecting 'Yes' or 'No'.
10. Read through the Rights and Responsibilities section. Confirm understanding by checking the box and provide the signatures of the applicant, parent, or guardian along with the date.
11. Finally, review the completed application thoroughly. Save changes, download, print, or share the form as necessary.

Complete your FM 3290 ME TEFRA application online today to ensure timely processing and eligibility for Medicaid coverage.