NH DHHS DFA Form 800MA 2018 free printable template

Signature Date mm/dd/yyyy STEP 6 Mail completed application. Mail your signed application to CMU 129 Pleasant Street Concord NH 03301 Fax your signed application to CMU Call in your application to Client Services 603 271-8604 603 271-9700 or toll free 1-800-852-3345 ext. 9700 If you are filling out DFA Form 800MA Insert you must send all pages of this application including the insert to your local District Office. NH Department of Health and Human Services DHHS Division of Family Assistance...

How to fill out NH DHHS DFA Form 800MA

How to fill out NH DHHS DFA Form 800MA

1. Download the NH DHHS DFA Form 800MA from the official website.
2. Read the instructions carefully before starting to fill out the form.
3. Provide your personal information, including your full name, address, and date of birth.
4. Indicate your household size by listing all members living with you.
5. Fill out your income information, including wages, benefits, and any other sources of income.
6. Report your expenses, such as housing costs, utilities, and medical expenses.
7. If applicable, provide information about any assets you own, like bank accounts or property.
8. Review the form to ensure all information is accurate and complete.
9. Sign and date the form at the bottom.
10. Submit the completed form to the appropriate NH DHHS office.

Who needs NH DHHS DFA Form 800MA?

1. The NH DHHS DFA Form 800MA is needed by individuals and families applying for financial assistance or Medicaid services in New Hampshire.

People Also Ask about

How do I verify my NH Medicaid eligibility?

Contact the DHHS Customer Service Center toll-free at 1-844-ASK-DHHS (1-844-275-3447) (TDD Relay Access: 1-800-735-2964), Monday through Friday, 8:00 a.m. to 4:00 p.m. ET. Contact your local District Office. Visit Related Resources for additional eligibility information.

How much do you get for cash assistance in NH?

The amount depends upon the family's income, resources, and living arrangements but is tied to 60 percent of the poverty line. Currently, a family of three with no income may receive up to $1,086 per month in cash benefit — the most generous of any state.

What is NH Dhhs Division of Family Assistance?

The Bureau of Family Assistance (BFA) administers programs and services for eligible NH residents by providing financial, medical, food & nutritional assistance, help with child care costs and emergency help to obtain and keep safe housing.

What is NH Medicaid fax number?

Print and complete the form, and either mail it to the address at the bottom of the form or fax the form to 1-866-446-3318.

What is my NH Medicaid provider number?

Checking Eligibility for Medicaid Recipients If providers have questions after checking the MMIS online portal, please contact the state's Medicaid Provider Service Center at 1-866-291-1674.

What is Medicaid called in New Hampshire?

NH Healthy Families provides health care coverage for NH Medicaid and Granite Advantage Health Care Program (Granite Advantage). The Department of Health and Human Services (DHHS) decides who is eligible for this program.

Who qualifies for NH cash assistance?

To be eligible for New Hampshire Family Assistance, you must be a resident of New Hampshire, and a U.S. citizen, legal alien or qualified alien. You must be unemployed or underemployed and have low or very low income. You must also be one of the following: Have a child 18 years of age or younger, or.

How do I contact NH Dhhs?

Contact the DHHS Customer Service Center toll-free at 1-844-ASK-DHHS (1-844-275-3447) (TDD Relay Access: 1-800-735-2964), Monday through Friday, 8:00 a.m. to 4:00 p.m. ET. Contact your local District Office.

Who is the director of NH Dhhs?

Patricia Tilley - Director, Division of Public Health Services - NH Department of Health and Human Services (DHHS) | LinkedIn.

What does Dhhs stand for?

U.S. Department of Health and Human Services.

What does the New Hampshire Department of Health and Human Services do?

The New Hampshire Department of Health and Human Services is the largest agency in the state government and is responsible for the health, safety and wellbeing of citizens statewide. It provides services for individuals, children, families and seniors, administering a wide array of programs.

How does NH cash assistance work?

Cash is distributed to help people pay for basic living expenses, like rent and housing, food, medical costs, and utilities. Other benefits that can be offered to parents of families who are eligible for FANF cash assistance include Medicaid, general social services or Healthy Kids Gold medical coverage.

What is NH MMIS?

The NH Health Enterprise Medicaid Management Information System (MMIS) is a secure access system that is provided only for authorized use in support of the NH Medicaid Program. Use of this system is subject to audit and monitoring, and users have no implicit or explicit expectation of privacy.

Who qualifies for welfare in NH?

To be eligible for New Hampshire Family Assistance, you must be a resident of New Hampshire, and a U.S. citizen, legal alien or qualified alien. You must be unemployed or underemployed and have low or very low income. You must also be one of the following: Have a child 18 years of age or younger, or.

Is NH health families Medicaid?

NH Healthy Families offers Medicaid Care Management health insurance coverage to tens of thousands of low-income residents in New Hampshire, including women, children, people with disabilities, and foster children.

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What is NH DHHS DFA Form 800MA?

NH DHHS DFA Form 800MA is a document used by the New Hampshire Department of Health and Human Services to collect information related to an individual's Medicaid eligibility.

Who is required to file NH DHHS DFA Form 800MA?

Individuals seeking Medicaid benefits or those who have been requested to provide additional information regarding their Medicaid eligibility are required to file NH DHHS DFA Form 800MA.

How to fill out NH DHHS DFA Form 800MA?

To fill out NH DHHS DFA Form 800MA, individuals must carefully complete all sections of the form, providing accurate personal information, income details, and any supporting documentation as required.

What is the purpose of NH DHHS DFA Form 800MA?

The purpose of NH DHHS DFA Form 800MA is to determine an individual's eligibility for Medicaid services and to ensure accurate information is obtained for the assessment process.

What information must be reported on NH DHHS DFA Form 800MA?

The information that must be reported on NH DHHS DFA Form 800MA includes personal identification details, income sources and amounts, household composition, and any other relevant financial information.