Get H1113 Form

The H1113 form is an essential document for people applying for prior Medicaid coverage. This guide will walk you through the online process of completing this form, ensuring you understand each component and can provide accurate information.

Follow the steps to complete the H1113 Form online effectively.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by answering the question on the first page regarding your need for assistance with medical bills for the specified months. If you respond 'Yes', provide the names and birthdates of everyone in your household during those months.
3. Proceed to the next question regarding ownership of items during the same period. If you indicate 'Yes', make a list of those items as instructed.
4. Answer the third question about receiving any income during the three months listed. If applicable, detail the sources of income, including amounts and the individuals who received them.
5. List any unpaid medical bills for services received during the specified months in the relevant section. Include the patient's name and the name and address of the providers you owe, such as hospitals or doctors.
6. Review the form for completeness and accuracy. Ensure all necessary fields are filled out correctly before proceeding.
7. Finally, save your changes. You can download, print, or share the filled-out form as needed.

Start completing your H1113 Form online today to secure your Medicaid coverage.