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  2. Application for Medicaid and Affordable Health Coverage - SC DHHS

    www.scdhhs.gov/sites/default/files/FM 3400.pdf

    Use this application to see what coverage choices you qualify for • Affordable private health insurance plans that offer comprehensive coverage to help you stay well. • A new tax credit that can immediately help pay your premium for health coverage. • Free or low-cost insurance from Medicaid or the Children’s Health Insurance Program ...

  3. Application for Medicaid and Affordable Health Coverage ...

    www.scdhhs.gov/sites/default/files/Form3405...

    HealthCare.gov. premium for health coverage. • Free or low-cost insurance from Medicaid or the Children’s Health Insurance Program (CHIP). Apply faster online. What you may need to apply. Why do we ask for this information? let you know what coverage you qualify for and how to get any help paying for it. We.

  4. Forms - SCDHHS

    www.scdhhs.gov/members/forms

    Now you can submit requested info, report a change in income, return an annual review or submit other documents online using SCDHHS' Document Upload tool. SCDHHS will use the info you give to match your uploaded documents with your Medicaid application, if you have one.

  5. Application for Health Coverage & Help Paying Costs

    www.medicaid.gov/state-resource-center/mac...

    Application for Health Coverage & Help Paying Costs. Use this application to see what coverage you qualify for. • Afordable private health insurance plans that ofer comprehensive coverage to help you stay well. • A new tax credit that can immediately help pay your premiums for health coverage.

  6. 2020 Income Limits & LTC Spousal Impoverishment Standard Changes Eff. 01-17-2020 (PDF) Affidavit of Identity for Medicaid Applicants/Recipients Residing in an Institution (PDF) Appendix D: ABD, LTC Application (PDF) (PDF) Appendix D: ABD, LTC Application (Spanish) (PDF) (PDF) Appendix E: Medically Needy Spenddown (Spanish) (PDF)

  7. Social Services - SC DHHS

    apply.scdhhs.gov/CitizenPortal

    Apply for Medicaid. Start a new application now. Submit Annual Review. If you received notice that it is time for your annual review, you can submit it online here. View Existing Account. See your pending applications, resume an application, submit changes, or view notices. Check Status/Update Information

  8. Health Insurance - New York State Department of Health

    www.health.ny.gov/forms/doh-4220.pdf

    This application can be used to apply for Medicaid, the Family Planning Benefit Program, or for assistance paying your health insurance premiums. You can apply for yourself and/or immediate family members living with you.

  9. Form H1200, Application for Assistance – Your Texas Benefits

    www.hhs.texas.gov/regulations/forms/1000-1999/...

    English PDF: Form H1200. Spanish PDF: Form H1200-S. Instructions. English and Spanish forms can be found under the title "Form to apply for Medicaid for the Elderly and People with Disabilities or Medicare Savings Program" under section "Forms to apply for benefits".

  10. How To Apply for NC Medicaid

    medicaid.ncdhhs.gov/apply

    Download and fill out a printable application to apply by: Mail, email or fax; In person (to fill out the form ahead of time) Download Printable Application (PDF) If you are a single adult with no dependents or health care coverage from your employer, use the “short form” application (DHB-5201-ia).

  11. SC DHHS

    tools.apply.scdhhs.gov/quick-tools/uploadfilepage

    This online tool is a way to give info to South Carolina Healthy Connections Medicaid. With this tool you can: Provide requested information, Report a change in income, Return an annual review, or; Submit other documents.