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Form 1003D Acknowledgement: Presumptive Medicaid Eligibility Choice for Independence (Home and Community Based Care Program) - New Hampshire
What Is Form 1003D?
This is a legal form that was released by the New Hampshire Department of Health and Human Services - a government authority operating within New Hampshire. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 1003D?
A: Form 1003D is an acknowledgement form for Presumptive Medicaid Eligibility Choice for Independence (Home and Community Based Care Program) in New Hampshire.
Q: What is Presumptive Medicaid Eligibility?
A: Presumptive Medicaid Eligibility is a temporary Medicaid coverage which allows individuals to receive certain healthcare services while their regular Medicaid application is being processed.
Q: What is the Choice for Independence (Home and Community Based Care Program)?
A: Choice for Independence is a program in New Hampshire that provides home and community-based services to elderly and disabled individuals.
Q: Who should complete Form 1003D?
A: Individuals who are applying for Presumptive Medicaid Eligibility Choice for Independence in New Hampshire should complete Form 1003D.
Q: What is the purpose of Form 1003D?
A: The purpose of Form 1003D is to acknowledge the individual's choice to receive Presumptive Medicaid Eligibility services under the Choice for Independence program.
Q: Is the completion of Form 1003D mandatory?
A: Yes, completing Form 1003D is mandatory in order to receive Presumptive Medicaid Eligibility services under the Choice for Independence program.
Q: What happens after I complete Form 1003D?
A: After you complete Form 1003D, your eligibility for Presumptive Medicaid services will be determined, and you will receive a notice regarding the status of your application.
Q: Can I apply for regular Medicaid while receiving Presumptive Medicaid Eligibility?
A: Yes, you can still apply for regular Medicaid while receiving Presumptive Medicaid Eligibility under the Choice for Independence program.
Q: Can I choose not to receive Presumptive Medicaid Eligibility services?
A: Yes, individuals have the choice to refuse Presumptive Medicaid Eligibility services and only apply for regular Medicaid.
Form Details:
- The latest edition provided by the New Hampshire Department of Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form 1003D by clicking the link below or browse more documents and templates provided by the New Hampshire Department of Health and Human Services.
