Sc Medicaid Application Form Printable

The south carolina department of health and human services scdhhs complies with applicable federal civil.

Sc medicaid application form printable. Form 943 information release form form 3400 b additional information for nursing homes and in home care form 3400 dhec healthy connections application dhec form 1716 request for medicaid id number infant form wkr002 magi annual review form form 1282 authorization for release of information and appointment of authorized representative. Even if youre not able to find the best program that suits your needs apply for the program anyway. Civil rights discrimination complaint if you have questions about this form call scdhhs at 803898 2605. Other forms additional person in household electronic application rights and responsibilities your rights and responsibilities from the applyscdhhsgov application.

The programs are exclusive that makes them easy to understand. Form 3400 dhec june 2016 page of step 1 primary contact person we need one adult in the family to be the contact person for your application. Large print braille audio accessible electronic formats other formats. First name middle name last name and suffix 2.

Using the phone number or qr code below you can send us a text message and we will respond as soon as possible. Office for civil rights scdhhs po. Home address leave blank if you dont have one 3. South carolina medicaid application information.

Dhhs form 910 may 2010 page 1 of 6 south carolina department of health and human services application for the south carolina medicaid program this application is developed s pecifically for aged blind or disabled adults. Scdhhs is offering health care programs for the children adults pregnant women senior citizens blind and people with disabilities. Apartment or suite number 4. You only need to tell us the social security number and answer the questions about being a us citizen for the.

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