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Home and Community Based Waiver Services Provider Enrollment Information Form STEP 1: Choose the Waiver/Program(s) that you are enrolling for. ACT 150Community HealthChoicesOBRASTEP 2: Choose the

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How to fill out home and community based

01

Determine the eligibility criteria for home and community based services.

02

Fill out the application form with accurate personal information.

03

Provide any required documentation to support the application.

04

Submit the completed form and documentation to the appropriate agency or organization.

05

Wait for a response regarding the approval or denial of the home and community based services.

Who needs home and community based?

01

Individuals who require assistance with daily activities due to age or disability.

02

People who prefer to receive care and support in their own home or community rather than in a facility.

03

Families who are seeking additional help in caring for a loved one at home.

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What is home and community based?

Home and community based services provide support for individuals who require assistance with daily activities in order to remain living in their own homes or communities.

Who is required to file home and community based?

Individuals who are in need of assistance with daily activities and wish to receive support in their own homes or communities are required to file for home and community based services.

How to fill out home and community based?

To fill out home and community based services, individuals can contact their local social services agency or Medicaid office for assistance with the application process.

What is the purpose of home and community based?

The purpose of home and community based services is to help individuals maintain their independence and continue living in their own homes or communities, rather than in a nursing home or other institutional setting.

What information must be reported on home and community based?

Information required for home and community based services may include medical history, financial information, and the level of assistance needed with daily activities.

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