Get the free DHS 1139 Medicaid Application and Change Request Form

STATE OF HAWAIIDEPARTMENT OF HUMAN SERVICES Request Division Health Care Services Branch 601 Kamila Boulevard, Room 506A Cupola, Hawaii 96707Dear Applicant: The Affordable Care Act (ACA) required

How to fill out dhs 1139 medicaid application

How to fill out dhs 1139 medicaid application

1. Step 1: Start by downloading the DHS 1139 Medicaid application form from the official website or request a copy from your local Department of Human Services office.
2. Step 2: Read through the instructions and gather all the required documents, such as proof of income, identification, and residency.
3. Step 3: Complete the personal information section, including your name, address, social security number, and contact information.
4. Step 4: Provide detailed information about your household members, including their names, ages, relationships, and income sources.
5. Step 5: Answer all the financial questions accurately, providing information about your income, assets, and expenses.
6. Step 6: If applicable, provide information about any health insurance coverage you currently have.
7. Step 7: Sign and date the application form.
8. Step 8: Make a copy of the completed application for your records.
9. Step 9: Submit the DHS 1139 Medicaid application either in person at your local Department of Human Services office or by mail.
10. Step 10: Wait for the Department of Human Services to review your application and notify you of the decision.

Who needs dhs 1139 medicaid application?

1. Anyone who meets the eligibility criteria for Medicaid and requires healthcare coverage can use the DHS 1139 Medicaid application.

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What is dhs 1139 medicaid application?

The dhs 1139 medicaid application is a form used to apply for Medicaid benefits.

Who is required to file dhs 1139 medicaid application?

Individuals who are in need of Medicaid benefits are required to file the dhs 1139 medicaid application.

How to fill out dhs 1139 medicaid application?

To fill out the dhs 1139 medicaid application, you need to provide personal information, income details, and any other requested information.

What is the purpose of dhs 1139 medicaid application?

The purpose of the dhs 1139 medicaid application is to determine eligibility for Medicaid benefits.

What information must be reported on dhs 1139 medicaid application?

The dhs 1139 medicaid application requires information such as personal details, income, assets, and household composition.