Get Oh Odm 10239 2019-2026

This guide provides step-by-step directions for completing the OH ODM 10239 form online. Designed for ease of use, it aims to help users navigate each section of the form to ensure accurate and complete submission.

Follow the steps to fill out the OH ODM 10239 form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the applicant's name, including last and first names, and provide the middle initial if applicable. Ensure that all details are spelled correctly.
3. Enter the applicant's Social Security Number, followed by their date of birth in the format mm/dd/yyyy.
4. Select the appropriate gender by checking either 'Male' or 'Female'.
5. Review the eligibility requirements carefully. Note that if you have transitioned through the HOME Choice program after July 2019, you may not be eligible to reapply.
6. Confirm that the applicant is at least 18 years old and has their needs supported in a home or community-based setting.
7. Provide the Medicaid ID number if currently approved for Medicaid.
8. Indicate the sources of income or support that apply by checking all relevant options, such as Social Security, SSDI,SSI, or others.
9. Confirm if the applicant is legally permitted to leave their long-term care facility.
10. Identify the type of long-term care facility where the applicant has resided for at least 90 consecutive days by checking the appropriate box.
11. Complete the sections about the current facility, including the name, contact information, and dates of admission.
12. Explain the circumstances that led to the applicant's stay in long-term care by checking the corresponding box.
13. Record what type of housing the applicant lived in prior to their long-term care.
14. Review any community services received by checking all that apply.
15. Answer the questions related to intentions of transitioning back to the community, including anticipated date and housing status.
16. Provide information about the support system the applicant has to transition to and after they move back to the community.
17. Confirm whether the applicant has previously received a Medicaid waiver.
18. Ensure all consent statements are checked to affirm understanding and agreement with program responsibilities.
19. If applicable, have the guardian or person completing the application also provide their information and signature.
20. Once all fields are filled, review the entire form for accuracy and completeness before submission.
21. Save changes, download, print, or share the form as needed.

Complete your documents online to ensure a smooth application process.