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PRINTED: 12/17/2020 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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01
Gather all the necessary documents and information required for the Medicaid program initial core.
02
Start by providing personal information such as your name, address, and contact details.
03
Fill out the sections related to your household composition and income details. Provide accurate information about all the members of your household and their sources of income.
04
If applicable, include information about any additional expenses or deductions that you may be eligible for.
05
Answer the questions related to your current health insurance coverage, if any.
06
Fill out the sections specific to your state's Medicaid program. Each state may have different requirements and additional forms that need to be completed.
07
Review all the information provided to ensure accuracy and completeness.
08
Sign and date the form.
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Submit the completed Medicaid program initial core form as directed by your state's Medicaid office.

Who needs medicaid program initial core?

01
Individuals who meet the income and eligibility requirements of their state's Medicaid program.
02
Low-income individuals and families who cannot afford private health insurance.
03
Pregnant women and children from low-income households.
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Individuals with disabilities who require healthcare services.
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Senior citizens who meet the age and income criteria.
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Individuals who need long-term care services and support.
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Individuals who require financial assistance for medical expenses.
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The Medicaid Program Initial Core refers to the foundational set of data and information that states must report to the Centers for Medicare & Medicaid Services (CMS) to establish their Medicaid programs and comply with federal requirements.
States that wish to receive federal funding for their Medicaid programs are required to file the Medicaid Program Initial Core.
To fill out the Medicaid Program Initial Core, states must gather required information about their program structure, eligibility criteria, services provided, and financial management systems, and submit it through the designated CMS portal or system.
The purpose of the Medicaid Program Initial Core is to ensure that state Medicaid programs are compliant with federal laws and regulations, and to provide a framework for the evaluation of program effectiveness and accountability.
Information that must be reported includes details about program administration, eligibility standards, benefits offered, cost-sharing provisions, and compliance with federal regulations.
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