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Get the free Medicaid- One Time Parent Consent Form Updated 03.26.13

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PARENT/GUARDIAN TO DISCLOSE STUDENT INFORMATION TO MICHIGAN DEPARTMENT OF COMMUNITY HEALTH Student Name: Birth Date: School District: The Medicaid School-Based Services Program in Michigan: Provides
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Medicaid - one time parent is a program that provides temporary assistance to parents or guardians who are in need of medical coverage for themselves or their children.
Parents or guardians who meet the eligibility requirements for the medicaid- one time parent program are required to file.
You can fill out the medicaid- one time parent application online through the state's medicaid website or by visiting a local medicaid office.
The purpose of medicaid - one time parent is to provide temporary medical coverage to parents or guardians who are in need.
You must report your household income, number of dependents, and any other relevant financial information on the medicaid - one time parent application.
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