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State of CaliforniaHealth and Human Services Agency California Department of Public Health KAREN L. SMITH, MD, MPH Director and State Public Health OfficerEDMUND G. BROWN JR. GovernorOFFICE OF AIDS
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How to fill out medi-cal waiver program section

01
To fill out the Medi-Cal waiver program section, follow these steps:
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Begin by providing your personal information, including your name, address, and contact information.
03
Next, indicate your eligibility for the Medi-Cal waiver program by providing necessary documentation and proof of income.
04
Fill out the section related to your medical history, including any current or past conditions, medications, or treatments.
05
Provide information about your primary care physician and any specialists you may be seeing.
06
If applicable, complete the section regarding any supportive services you require, such as in-home assistance or medical equipment.
07
Review your application for accuracy and completeness before submitting it.
08
Submit the completed application form to the appropriate Medi-Cal office or online portal.
09
Make sure to keep a copy of the application for your records.
10
Await a response from Medi-Cal regarding your eligibility for the waiver program.

Who needs medi-cal waiver program section?

01
The Medi-Cal waiver program section is needed by individuals who meet certain criteria, including:
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- Individuals with disabilities who require long-term supports and services
03
- Elderly individuals who need assistance with activities of daily living
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- Individuals who wish to receive care and services in their own homes or communities instead of institutional settings
05
- Individuals who meet the income and asset requirements set by the program
06
It is important to review the specific eligibility criteria for the Medi-Cal waiver program in your state to determine if you or someone you know needs to fill out this section.
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Medi-Cal waiver program section is a program that allows individuals to receive long-term care services at home or in a community-based setting instead of in a nursing home.
Individuals who are seeking long-term care services through the Medi-Cal waiver program are required to file the program section.
To fill out the Medi-Cal waiver program section, individuals need to provide detailed information about their medical condition, living situation, and need for long-term care services.
The purpose of the Medi-Cal waiver program section is to enable individuals to receive care in their preferred setting, promoting independence and quality of life.
Information on medical history, current health status, living arrangements, support needed, and caregiver information must be reported on the Medi-Cal waiver program section.
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