Get Ky Map-350 2009

The KY MAP-350 is an essential document for individuals seeking home and community-based waiver services. This guide provides a clear, step-by-step approach to help users complete the form accurately and efficiently online.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and access it in the online editor.
2. Begin by certifying your understanding of the home and community-based waiver for aged and disabled individuals. Indicate whether consideration for the program as an alternative to nursing facility placement is requested or not, and provide your signature along with the date.
3. Proceed to the section for individuals with mental retardation or developmental disabilities. Similar to the previous step, indicate whether you are requesting consideration for this waiver program. Sign and date accordingly.
4. Next, certify your understanding of the Model Waiver II program. Again, indicate your request status and sign with the current date.
5. Move on to the Acquired Brain Injury waiver section. Indicate your request status for this program and sign and date the form.
6. In the freedom of choice of provider section, certify your understanding that you may choose any Medicaid provider qualified to provide service. Sign and date this section.
7. Complete the resource assessment certification by indicating your understanding of the assessments available. Sign and date this section.
8. Fill out the recipient information, including the Medicaid recipient's name, address, phone number, and Medicaid number. Provide information for the responsible party or legal representative, including their address and phone number.
9. If someone assisted you in completing the form, have them sign and provide their title, agency or facility name, and address.
10. After ensuring all sections are completed accurately, save your changes, download, print, or share the form as needed.

Start completing the KY MAP-350 online now to ensure timely processing of your request.