Form 821 Application for Medicaid Presumptive Eligibility (Pe) - New Hampshire

What Is DFA Form 821?

This is a legal form that was released by the New Hampshire Department of Health and Human Services - Division of Family Assistance - 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 821?
A: Form 821 is the Application for Medicaid Presumptive Eligibility (Pe) in New Hampshire.

Q: Who is this form for?
A: This form is for individuals in New Hampshire who are applying for Medicaid Presumptive Eligibility (Pe).

Q: What is Medicaid Presumptive Eligibility (Pe)?
A: Medicaid Presumptive Eligibility (Pe) provides temporary health coverage to eligible individuals while their full Medicaid application is being processed.

Q: How do I apply for Medicaid Presumptive Eligibility?
A: You can apply for Medicaid Presumptive Eligibility by filling out Form 821.

Q: What information is required on Form 821?
A: Form 821 requires information about your household, income, and assets.

Q: Is there an income limit for Medicaid Presumptive Eligibility?
A: Yes, there is an income limit for Medicaid Presumptive Eligibility. The specific limit depends on your household size.

Q: How long does Medicaid Presumptive Eligibility coverage last?
A: Medicaid Presumptive Eligibility coverage lasts for up to 60 days or until a determination is made on your full Medicaid application.

Q: What happens after I submit Form 821?
A: After you submit Form 821, your eligibility for Medicaid Presumptive Eligibility will be determined. You will also need to complete a full Medicaid application.

Q: Can I apply for regular Medicaid while on Presumptive Eligibility?
A: Yes, you should also submit a full Medicaid application while on Medicaid Presumptive Eligibility to ensure continuous coverage if you qualify.