Form 5872 Long Term Dignity Savings Affidavit - Missouri

What Is Form 5872?

This is a legal form that was released by the Missouri Department of Revenue - a government authority operating within Missouri. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 5872?
A: Form 5872 is the Long Term Dignity Savings Affidavit used in Missouri.

Q: What is the purpose of Form 5872?
A: The purpose of Form 5872 is to provide documentation for individuals in Missouri seeking Medicaid coverage for long-term care services.

Q: Who needs to complete Form 5872?
A: Individuals in Missouri who are applying for Medicaid and are seeking coverage for long-term care services need to complete Form 5872.

Q: Are there any eligibility requirements to complete Form 5872?
A: Yes, individuals must meet certain eligibility requirements to complete Form 5872. These requirements include being at least 65 years old, having a medical or functional need for long-term care services, and meeting income and asset limits set by Missouri Medicaid.

Q: Are there any fees associated with submitting Form 5872?
A: No, there are no fees associated with submitting Form 5872.

Q: What should I do with the completed Form 5872?
A: The completed Form 5872 should be submitted to the Missouri Department of Social Services along with the Medicaid application.

Q: What happens after I submit Form 5872?
A: After submitting Form 5872, the Missouri Department of Social Services will review the form and determine the individual's eligibility for Medicaid coverage for long-term care services.

Q: Can I get assistance in completing Form 5872?
A: Yes, individuals can seek assistance from various organizations and agencies that provide support with completing Form 5872.

Q: Is Form 5872 specific to Missouri?
A: Yes, Form 5872 is specific to Missouri and is used for Medicaid applications for long-term care services in the state.