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Department of Health & Human Services N E B R A S K A Division of Medicaid and Long-Term Care Medicaid & Long-Term Care Use Only Nebraska Service Provider Agreement Community Treatment Aide Addendum
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How to Fill Out Medicaid & Long-Term Care:

01
Gather necessary documents and information, such as identification, income verification, asset details, and medical records.
02
Start by contacting your local Medicaid office or visiting their website to obtain the application form.
03
Carefully read all instructions provided on the application form before filling it out.
04
Begin with personal information like your name, address, contact details, and social security number.
05
Provide detailed information about your household, including the number of people living with you and their relationship to you.
06
Document your income sources and amounts accurately, including any wages, public assistance, retirement benefits, etc.
07
As you fill out the application, be sure to disclose any assets you own, such as property, vehicles, savings accounts, investments, and other valuable possessions.
08
Next, answer the questions related to long-term care, indicating whether you require assistance with activities of daily living or have any specific medical conditions.
09
If you have a spouse, include the necessary information about them as well.
10
Double-check all sections of the form to ensure accuracy and completeness before submitting it to the Medicaid office.
11
Keep copies of all the documents you provided as proof for future reference if needed.

Who Needs Medicaid & Long-Term Care?

01
Individuals with limited income and resources who require assistance with medical costs and long-term care services may be eligible for Medicaid.
02
Elderly individuals who have difficulty performing activities of daily living, such as bathing, dressing, eating, or using the bathroom, often require long-term care.
03
Disabled individuals or those with chronic illnesses who need ongoing medical care and assistance may also benefit from Medicaid and long-term care services.
04
Medicaid and long-term care can help individuals who cannot afford the high costs of nursing homes, assisted living facilities, or in-home care services on their own.
05
Low-income families with children who have special healthcare needs may also qualify for Medicaid and long-term care programs.
06
Each state may have specific eligibility criteria, so it is important to check with your local Medicaid office to determine if you or your loved ones qualify for these services.
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Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Long-term care services help people with chronic illnesses or disabilities maintain their quality of life.
Individuals who meet the eligibility requirements for Medicaid and require long-term care services are required to file for Medicaid and long-term care.
To fill out Medicaid and long-term care applications, individuals can contact their local Medicaid office or visit the official website to access the necessary forms and instructions.
The purpose of Medicaid and long-term care is to provide financial assistance and support for individuals who require ongoing medical care and assistance with daily activities due to chronic illnesses or disabilities.
Information such as medical history, financial status, proof of income, and documentation of the need for long-term care services must be reported on Medicaid and long-term care applications.
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