Get Al Form 204/205 2014-2025

Filling out the AL Form 204/205 is an essential step for individuals seeking Medicaid benefits for elderly and disabled programs. This guide offers a clear and structured approach to complete the form online, ensuring all necessary fields are accurately filled.

Follow the steps to effectively complete the AL Form 204/205 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the 'Apply for Medicaid' section. Indicate your choice by checking the appropriate box for the type of assistance you are seeking: Hospital, Nursing Facility, Home and Community Based Waiver Program, or SSI Related Programs.
3. In the 'Applicant' section, enter your full name, mailing address, home address, county of residence, Medicare number, date of birth, social security number, and contact information accurately.
4. Fill in your marital status by selecting the appropriate option that describes your situation, along with the date if applicable.
5. In the 'Living Arrangement' section, check the box that best describes your current living situation and provide details, including rent amounts if applicable.
6. Under 'Residency Information', confirm if you are a United States citizen and provide relevant dates and previous residences as necessary.
7. In the 'Income' section, list your sources of income, along with claim numbers and gross amounts, ensuring to provide verification documentation as specified.
8. Complete the 'Property' and 'Resources' sections, providing detailed information about your assets and verifying ownership.
9. For 'Life Insurance' and 'Burial Insurance', fill out the details about your policies and include the face value where required.
10. Read the 'Release of Information' section and ensure you understand the affirmations and responsibilities listed, then provide your signature and date.
11. Review all sections for accuracy. After ensuring all fields are complete, you can save your changes, download the filled form, print it, or share it as needed.

Start completing the AL Form 204/205 online for your Medicaid application today!