South Carolina Healthy Connections PO Box 100101 Columbia, SC 29202 (888) 5490820Date: BG#: HH#: Case Name:South Carolina Medicaid Program Annual Review Form This form is used to review your Medicaid.
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How to fill out the SC WKR001 online
The SC WKR001 is a vital form used to review your Medicaid coverage in South Carolina. Completing this form accurately ensures the continuation of your benefits and provides necessary information for your annual review.
Follow the steps to successfully complete the SC WKR001 online.
- Click the ‘Get Form’ button to access the SC WKR001 form and open it in the online editor.
- Enter your personal details. Fill in your last name, first name, middle initial, mailing address (including apartment or lot number), city, county, state, and zip code. Enter your street address if it's different from your mailing address. Provide your telephone number, including area codes.
- If an authorized representative is assisting you, complete their details, including name, phone number, address, and relationship to you.
- List the individuals living with you. Start with yourself and provide their names, Social Security numbers, and dates of birth. Indicate if they are US citizens, disabled, or pregnant, alongside your relationship to each individual.
- Provide information on family members who have moved out of your home in the past year and enter details for any who have moved into your home, including their names and Social Security numbers.
- Indicate whether anyone in your family is employed. For each employed individual, provide the gross pay before taxes, employer details, and employment frequency.
- Detail any income received by your household members in the past four weeks, such as child support, alimony, or social security income. Ensure you attach proof for each income source.
- Disclose any assets or resources owned by your family. Provide values and details for checking and savings accounts, properties, vehicles, and more. Attach proof of value.
- Answer questions regarding any adults in the household who are not currently working, any changes to private health insurance, and whether anyone pays for childcare to attend work or school.
- Before finalizing, review the rights and responsibilities section. Sign and date the form. Ensure that all necessary documentation is attached.
- Once completed, save the changes, and download or print the form as needed for submission.
Complete the SC WKR001 online today to ensure your Medicaid coverage remains uninterrupted.
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