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Application for 1915(c) HUBS Waiver: SC.0676. R00.03 – Mar 01, 2011 (as of Mar 01, 2011) Page 1 of 148 Application for a 1915 Home and CommunityBased Services Waiver PURPOSE OF THE HUBS WAIVER PROGRAM

How to fill out application for a 1915c

To fill out an application for a 1915c, follow these steps:

1. Obtain the application form from the appropriate source, such as the state or local government agency responsible for administering the 1915c program.
2. Carefully read all the instructions and requirements provided with the application form to ensure you understand what information is needed.
3. Begin by providing your personal information, including your name, address, contact details, and any identification numbers required.
4. Next, provide information about your healthcare needs or the needs of the individual for whom you are completing the application. This may include details about medical conditions, disabilities, and any other relevant information.
5. Indicate the specific services or supports you are seeking through the 1915c program. This could include specific types of medical care, therapies, or assistance with activities of daily living.
6. If applicable, provide any additional documentation or supporting evidence that may be required to demonstrate eligibility for the program. This could include medical records, evaluations, or confirmation from healthcare professionals.
7. Review the completed application form to ensure all sections are filled out accurately and completely. Double-check for any errors or missing information.
8. Sign and date the application form as required, and follow any instructions for submitting the application. This may involve mailing it to a specific address or submitting it online.
9. Keep a copy of the completed application for your records.

Anyone who requires the healthcare services or supports provided through the 1915c program may need to complete this application. This could include individuals with disabilities, chronic illnesses, or other medical conditions that require specialized care. It is important to check the specific eligibility criteria for the 1915c program in your state or locality to determine if you qualify for this assistance.

For pdfFiller’s FAQs

What is application for a 1915c?

An application for a 1915c is a form used to request a waiver from the Centers for Medicare & Medicaid Services (CMS) to provide home and community-based services under Medicaid.

Who is required to file application for a 1915c?

The state agencies responsible for administering Medicaid programs are required to file an application for a 1915c waiver.

How to fill out application for a 1915c?

The application for a 1915c waiver must be filled out with detailed information about the proposed home and community-based services program, including the target population, services to be provided, and funding sources.

What is the purpose of application for a 1915c?

The purpose of the application for a 1915c waiver is to seek CMS approval to provide home and community-based services to individuals who would otherwise require institutional care.

What information must be reported on application for a 1915c?

The application for a 1915c waiver requires reporting information on the proposed program design, service types, eligibility criteria, budget, and the expected impact on the target population.

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