You are welcome to use these materials to promote the programs in your own community.If you have the resources and want to customize any of these materials to promote your local CHIP/Children’s Medicaid efforts, please e-mail The following printed materials are available for download. Arkansas Medicaid program helps needy individuals pay for basic and necessary medical services living in Arkansas and meeting the program eligibility guidelines.
Application for Medicaid Coverage of COVID-19 Uninsured Eligibility Group Testing Costs. Complete this application to get help paying for certain coronavirus (COVID-19) testing costs. Also use this form to apply for help paying for health insurance through the Health Insurance Marketplace.If you have more than four people in your home, use these pages to tell us about them.Use this form to apply for assistance with your Medicare premium.Use this application for persons who are planning to live or now live in a nursing facility, group home, or developmental center in Louisiana or who have been offered an opportunity for Waiver or PACE in Louisiana. Cover Virginia Additional Person Supplement (Spanish) (PDF) Cover Virginia Application for Health Coverage and Help Paying Costs (PDF) Cover Virginia Application for Health Coverage and Help Paying Costs (Spanish) (PDF) Medicaid Funded Long-term Care Service Authorization (PDF) Notification of …
For additional information about applying for Medicaid, click here to visit Right from the Start Medicaid or to apply for Medicaid please visit. You are welcome to use these materials to promote the programs in your own community. Spanish Vietnamese. No one should complete this application who is not seeking coverage for COVID-19 tests, or who already has health care benefits and services. Before using these logos, please refer to the Download and save the editable PowerPoint flyer to your computer and customize it for your organization. There are many effective outreach materials that promote CHIP/Children’s Medicaid.
No one should complete this application who is not seeking coverage for COVID-19 tests, or who already has health care benefits and services. Complete this application to get help paying for certain coronavirus (COVID-19) testing costs. Texans can dial 2-1-1 (option 6) for information on COVID-19 and local community resources on health care, utilities, food, housing and more.
Apply in person.
There are many effective outreach materials that promote CHIP/Children’s Medicaid.
All materials are bilingual unless otherwise stated.
... To download the application form for Medicaid in Spanish, please follow this link. Apply for health coverage or renew existing coverageUse this form to apply for or renew coverage for all Louisiana Medicaid programs. Spanish PDF: Form H1200-S Instructions. The following logos are designed for use by health plans, community and faith-based organizations, and other contractors involved in promotion of CHIP and Children's Medicaid. 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". If you get insurance through someone's job or if you can get insurance through a job, get your employer to fill out this form so you can tell us about it. You can download the resources below or order printed copies of CHIP/Children’s outreach materials. Additional information can also be found in the Understanding Medicaid booklet. Paper applications in English and Spanish can also be … If you have the resources and want to customize any of these materials to promote your local CHIP/Children’s Medicaid efforts, please e-mail HHS Communications.
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