Get West Virginia Olmstead Transition Diversion Program - Wvdhhr

Filling out the WEST VIRGINIA OLMSTEAD TRANSITION DIVERSION PROGRAM application can be an essential step for individuals with disabilities seeking to transition from facility settings to their homes. This guide offers clear and supportive instructions to help users complete the form accurately and efficiently.

Follow the steps to successfully complete your application for the program.

1. Click the ‘Get Form’ button to access the application form in your preferred document editor.
2. Begin by filling in the required personal information, including the applicant's first name, last name, and date of birth. Check the appropriate gender option.
3. In Section 1, indicate the current living or residential setting by checking the corresponding box that applies to the applicant's situation, including options such as nursing facility or their own home.
4. If applicable, provide the facility name and admission date in the designated fields. If the applicant resides in a private setting, proceed to complete Section 2.
5. In Section 2, check the appropriate statement that describes the applicant's imminent risk of facility placement and include any required documentation to support your claims.
6. In Section 3, list the applicant's diagnosis(es) and check any applicable conditions and high-risk factors that may influence eligibility.
7. Proceed to Section 4 to provide information regarding the applicant's income and services, including Medicaid and Medicare membership status.
8. In Section 5, indicate the applicant's status with related programs and include any denial letters if applicable.
9. For Section 6, provide details of any legal representative if the application is being submitted on behalf of the applicant.
10. In Section 7, describe the funding request, including the total amount and detailed vendor information required for processing.
11. Finally, complete Section 8 by signing the application to certify that the information provided is accurate. Ensure it is signed by the applicant or their legal representative.
12. After completing the form, save your changes and prepare it for submission either by printing, faxing, or emailing it to the designated Olmstead Coordinator.

Complete your application for the WEST VIRGINIA OLMSTEAD TRANSITION DIVERSION PROGRAM online today.