Get Ocfs-8011a Notice Of Decision - Discontinuance From Waiver Program.dot. The Purpose Of This

The OCFS-8011A Notice Of Decision - Discontinuance From Waiver Program is an important document for individuals involved in the Bridges to Health Medicaid Waiver Program. Filling it out correctly is essential for a smooth transition and understanding of the reasons for discontinuance. This guide will provide step-by-step instructions to assist users in completing the form.

Follow the steps to complete the form accurately

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the child's name in the specified format: last name, first name, and middle initial. This should be placed in the designated field.
3. Provide the child's address, including city, state, ZIP code, and Medicaid identification number, ensuring all details are accurate.
4. Fill in the child's date of birth and sex, selecting 'Male' or 'Female' as appropriate.
5. Indicate the B2H waiver type by checking one box specifically: Serious Emotional Disturbance (SED), Developmental Disabilities (DD), or Medically Fragile (MedF).
6. Select the reason for discontinuance from the provided options by checking the appropriate box. If the reason is 'Other,' provide a brief explanation in the space provided.
7. Fill out the contact information for the Local Department of Social Services or Division of Juvenile Justice and Opportunities for Youth, ensuring to include the contact's name, signature, title, address, city, county, state, and ZIP code.
8. Review the rights to a conference and a fair hearing section to ensure all necessary information is understood. Check any boxes as needed regarding the continuing of benefits.
9. Finally, save your changes, download a copy for your records, or print the completed form as necessary.

Complete your documents online today for a seamless experience.