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Application for 1915(c) HUBS Waiver: MS.0366. R03.00 Jul 01, 2015Page 1 of 141Application for a 1915© Home and Community Based Services Waiver PURPOSE OF THE HUBS WAIVER PROGRAM The Medicaid Home
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How to fill out based services waiver
How to fill out based services waiver
01
Obtain a copy of the based services waiver form from the appropriate agency or organization.
02
Carefully read through the entire waiver form to understand all the requirements and limitations.
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Fill out all sections of the waiver form accurately and completely.
04
Provide any necessary documentation or information to support your eligibility for the based services waiver.
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Sign and date the waiver form before submitting it to the designated department or individual.
Who needs based services waiver?
01
Individuals who require additional support and services due to a physical or developmental disability.
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People who are eligible for government-funded assistance programs and need help with daily activities.
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Those who qualify for specific based services and need access to specialized resources and care.
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What is based services waiver?
Based services waiver is a request for exemption from certain services or requirements based on specific circumstances.
Who is required to file based services waiver?
Individuals or entities who believe they qualify for an exemption from certain services or requirements.
How to fill out based services waiver?
Based services waiver can typically be filled out online or through a paper form provided by the relevant authority.
What is the purpose of based services waiver?
The purpose of based services waiver is to provide individuals or entities with the opportunity to request exemptions in specific situations.
What information must be reported on based services waiver?
The information that must be reported on a based services waiver varies depending on the specific circumstances of the exemption being requested.
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