Get Mn Dhs-2128-eng 2020-2025

The MN DHS-2128-ENG form is essential for individuals seeking renewal for long-term care services under the Minnesota Health Care Programs (MHCP). This guide provides step-by-step instructions to help users complete the form online accurately.

Follow the steps to fill out the MN DHS-2128-ENG form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Read the Notice of Privacy Practices and Notice of Rights and Responsibilities included with the form. These documents contain critical information that you should understand before proceeding.
3. Fill in your personal information, including your name, date of birth, address, and phone number. Ensure all details are current and accurate.
4. Indicate whether you are currently in a long-term care facility. If yes, provide the facility's name and your previous address before moving.
5. Describe your living situation by selecting one of the provided options. Make sure to select the option that most accurately reflects your current living conditions.
6. Complete sections 2 through 22 regarding your finances, assets, employment status, and any changes in health insurance. Provide as much detail as possible, as these details will be used to determine your eligibility.
7. Attach any required proofs, such as financial statements or identification documents, as copies. Do not send original documents.
8. Review the completed form for accuracy and completeness. If there are questions requiring more explanation, use a separate piece of paper to provide your answers.
9. Sign and date the form. You can sign it as soon as you complete it, rather than waiting until the last day of the month.
10. Submit the completed form along with all attachments to your county or tribal agency immediately after filling it out. You can do this online, by fax for faster processing, or in person.

Complete your MN DHS-2128-ENG form online today to ensure your continued access to long-term care services.