Get Workers With Disabilities Medicaid Application For Assistance

This guide provides users with clear and detailed information on how to fill out the Workers With Disabilities Medicaid Application For Assistance online. It aims to support individuals who are navigating the application process, ensuring a thorough understanding of each section and its requirements.

Follow the steps to successfully complete your application online.

1. Press the ‘Get Form’ button to access the application form and open it in your preferred editor.
2. Begin by completing the applicant information section. This includes entering your last name, first name, middle initial, date of birth, and sex. Confirm your Medicare number, county of residence, home phone number, and address details.
3. Indicate whether you are a U.S. citizen and provide your Social Security number. If applicable, provide documentation of your alien status.
4. Answer the household section by listing every member of your household, including their names, Social Security numbers, race, sex, and relationship to you.
5. In the income section, complete each question regarding your income sources. Attach any necessary proof like pay stubs or tax returns and specify your gross income amount and frequency.
6. List vehicles owned in the vehicles section. Provide details such as the year, make, model, whether the vehicle is used for commuting, and its equity value.
7. For the assets section, list all personal assets owned by you and your spouse. This includes cash, bank accounts, and life insurance—be sure to provide verification.
8. Answer the property section to indicate whether you own your home and if it is your primary residence.
9. In the special approved account section, indicate if you are saving funds for special needs and provide necessary details.
10. Complete the health insurance section and disclose if you or your spouse have health insurance aside from Medicare and Medicaid.
11. Confirm whether you have any medical bills incurred within three months prior to this application.
12. Finally, read through the certification, ensuring all information is accurate, and provide your signature along with the date. Make sure to include contact details as necessary.
13. Review your filled application, then save changes, download, print, or share the completed form as needed.

Complete your application online today to access the support you need.