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A THE FOLLOWING PERSONS ARE INCLUDED FOR THE MONTH(S) SHOWN LINE NO. B MONTH & YEAR NAME MONTH MONTH MONTH & YEAR & YEAR & YEAR RETROACTIVE MEDICAL ASSISTANCE LINE NO. MONTH MONTH MONTH MONTH & YEAR & YEAR & YEAR & YEAR NAME MONTH & YEAR MONTH & YEAR MONTH & YEAR MONTH & YEAR CATEGORY CONTROL DIGIT RESOURCES RESOURCE LIMITATION GROSS MONTHLY INCOME NET MONTHLY INCOME INCURRED MEDICAL EXPENSES ELIGIBLE FOR RETROACTIVE MEDICAL ASSISTANCE ELIGIBLE WITH A PATIENT PAY LIABILITY OF.
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Sullivan FAQ
The MNO-MA asset limits are $2,400 for an individual and $3,200 for a couple. There is no additional asset disregard. 2) Asset Spend Down – Seniors who have assets over Medicaid's limit can still become asset-eligible by spending down extra assets on non-countable ones.
What is a PA 162 form used for? This is an application for Medical Assistance benefits. If you need help translating it, please contact your county assistance office, CAO.
In approximately half of the states, ABD Medicaid's income limit is $914 / month for a single applicant and $1,371 for a couple. In the remaining states, the income limit is generally $1,215 / month for a single applicant and $1,643 / month for a couple.
How long will it take for my application to be processed? It should not take longer than 45 days if all necessary documentation needed to determine your eligibility for the Medical Assistance program is given to the county assistance office. What must I verify?
Identity — Identity can be verified by a driver's license, state identification card or another piece of identification. Social Security Number (SSN) — A SSN must be provided for each person applying for Medical Assistance. County Assistance Office staff will help you apply for an SSN for anyone who does not have one.
Children aged 18 and under. Pregnant women. Parents and caretakers of children under 21. Adults ages 19-64 with incomes at or below 133 percent of the Federal Income Poverty Guidelines (FPIG)
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