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Complete the 1915(i) Member Discharge Form for Medicaid services including Care Coordination, Housing Support, and more. Submit by April 2024.

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What is 1915i member discharge form?

The 1915i member discharge form is a document used to formally discharge a member from a specific Medicaid program under section 1915(i) of the Social Security Act.

Who is required to file 1915i member discharge form?

Providers or agencies responsible for managing a member's Medicaid services are required to file the 1915i member discharge form when a member is being discharged from the program.

How to fill out 1915i member discharge form?

To fill out the 1915i member discharge form, provide the member's personal information, the reason for discharge, the effective date of discharge, and any other required information as specified by your state Medicaid agency.

What is the purpose of 1915i member discharge form?

The purpose of the 1915i member discharge form is to document and formalize the discontinuation of Medicaid services for a member, ensuring proper record-keeping and compliance with Medicaid regulations.

What information must be reported on 1915i member discharge form?

The form must include the member's name, identification number, discharge date, reason for discharge, and the signature of the authorized individual completing the form.

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