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How to fill out the SD DSS-EA-240 online
The SD DSS-EA-240 form is an essential application for individuals seeking long-term care or related medical assistance in South Dakota. This guide will provide you with a clear, step-by-step approach to completing the form online, ensuring that you understand each section and completely fulfill the requirements.
Follow the steps to successfully complete your application.
- Press the 'Get Form' button to access the SD DSS-EA-240 form and open it in the designated online application tool.
- Begin by filling out your personal information in section 1. Provide your full name, current address, home address, and contact number. Ensure that this information is accurate and clearly printed.
- In section 1, also include optional details about race, ethnicity, birthdate, and marital status. While some fields are optional, filling them out may assist in the processing of your application.
- Proceed to section 2 if you have a spouse, and provide their full name, address, birthdate, and any relevant Social Security details.
- In section 3, detail any dependent children living with you, including their names, dates of birth, Social Security numbers, and gross income sources.
- Section 4 requires information about your living arrangements and any shelter costs, such as rent or utilities. If applicable, detail these expenses and attach required verification.
- Provide details on your medical history in section 5. This includes the name of your primary physician, any hospital visits in the last three months, and whether you're requesting retroactive assistance.
- If completing the form for someone else, fill out section 6 with your details as the authorized representative, and include a contact person for more information.
- Complete section 7 if applicable, to indicate whether there is a legal guardian or power of attorney, providing necessary names and contact details.
- In section 8, disclose your resources and assets. You must include all accounts and properties you or your spouse own, providing current values and bank details, verifying that the information is clear and accurate.
- Section 9 focuses on any transfers of assets. If you or your spouse have transferred any assets within the past 36 months, provide details of each transfer.
- Fill out section 10 regarding health insurance and any nursing home insurance. Indicate the company names, policy numbers, and type of coverage.
- In section 11, list all income sources for both you and your spouse, including Social Security benefits, pensions, and any other financial support.
- In section 12, certify your citizenship or alien status as required by law. This includes providing proof of status or explaining your situation if applicable.
- Finally, review the entire form for accuracy. Ensure all required sections are complete and attach any necessary verifications. Save, download, or print your completed application before submitting it.
Complete the SD DSS-EA-240 application online today to ensure you receive the assistance you need.
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While Medicaid provides extensive coverage, certain items and services are not covered under the SD DSS-EA-240 regulations. Generally, Medicaid does not cover cosmetic procedures, fertility treatments, or non-prescription drugs. Additionally, alternative therapies and routine dental care for adults may also be excluded. Knowing these limitations can help you plan your healthcare options effectively.
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