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Instructions for Form AL-6 Assisted Living / Adult Family Care (Al / Afc) Referral for the Managed Long Term Services and Supports (Mltss) Medicaid Waiver - New Jersey
This document contains official instructions for Form AL-6 , Assisted Living/Adult Long Term Services and Supports (Mltss) Medicaid Waiver - a form released and collected by the New Jersey Department of Human Services. An up-to-date fillable Form AL-6 is available for download through this link.
FAQ
Q: What is Form AL-6?
A: Form AL-6 is a referral form for Assisted Living/Adult Family Care (AL/AFC) under the Managed Long Term Services and Supports (MLTSS) Medicaid Waiver in New Jersey.
Q: What is Assisted Living/Adult Family Care (AL/AFC)?
A: AL/AFC is a type of long-term care where individuals receive assistance with daily activities in a residential setting.
Q: What is the Managed Long Term Services and Supports (MLTSS) Medicaid Waiver in New Jersey?
A: MLTSS is a program that helps New Jersey residents access long-term care services and supports in their own homes or in community-based settings.
Q: Who can use Form AL-6?
A: Form AL-6 can be used by individuals or their authorized representatives to request a referral for AL/AFC services under the MLTSS Medicaid Waiver.
Q: What information is required on Form AL-6?
A: Form AL-6 requires information such as the individual's name, contact information, medical history, and functional limitations.
Q: How can I submit Form AL-6?
A: Form AL-6 can be submitted by mail or fax to the MLTSS Enrollment Broker.
Q: Is there a deadline for submitting Form AL-6?
A: There is no specific deadline for submitting Form AL-6, but it is recommended to submit it as soon as possible.
Q: What happens after submitting Form AL-6?
A: After submitting Form AL-6, the MLTSS Enrollment Broker will review the referral and determine eligibility for AL/AFC services.
Instruction Details:
- This 1-page document is available for download in PDF;
- Actual and applicable for the current year;
- Complete, printable, and free.
Download your copy of the instructions by clicking the link below or browse hundreds of other forms in our library of forms released by the New Jersey Department of Human Services.
