Medicaid Forms/Applications - Virginia Department of Social …
Medicaid Forms/Applications. People Who May Be Eligible For Medical Assistance. Adults Aged 19 - 64 ... Appendix D: ABD, LTC Application (PDF) (PDF) Appendix D: ABD, LTC Application (Spanish) (PDF) (PDF) ... Cover Virginia Additional Person Supplement (English) (PDF) Cover Virginia Additional Person Supplement (Spanish) (PDF) (PDF)
Forms - Virginia Department of Social Services
Title IV-E Foster Care and Medicaid Evaluation (PDF) Virginia Birth Father Registry: Registration Form (PDF) Virginia Birth Father Registry: ... Application Forms by Category Children Under Age 19. Apply Online Through CommonHelp; Other Ways to Apply for Medical Assistance (PDF)
Applying for Medicaid - Virginia Medicaid
Information on how to apply for Medicaid in Virginia. Call the Cover Virginia Call Center Monday through Friday, 8 a.m. to 7 p.m. and Saturday 9 a.m. to 12 p.m. at 833-5CALLVA (TDD: 1-888-221-1590). Mail or drop off a paper application to your local Department of Social Services (DSS) ( [PDF] English application [PDF] Spanish application).
Medicaid Forms/Applications - Virginia Department of Social …
The mission of the Virginia Department of Social Services (VDSS) is to promote self-reliance, prevention, and protection by serving as a catalyst for healthy families and communities.
Mar 1, 2024 · Apply faster online at commonhelp.virginia.gov. For more information about Medicaid, FAMIS and Plan First visit coverva.dmas.virginia.gov. What you may need to apply • Social Security numbers (or document numbers for any eligible immigrants who need insurance) • Employer and income information for everyone in your family (for example, from
Applications | CoverVA
Applying for Medicaid for adults over age 19 with disabilities, or who are 65 or older, or for anyone who needs long-term care. You must complete the ABD-LTC Application – Appendix D and the Application for Health Coverage & Help Paying Costs. Order online [PDF] ABD-LTC Application – Appendix D (English)
You can also request a paper Medicaid application be mailed to you. • Apply Online at: https://www.commonhelp.virginia.gov/ • Call Cover Virginia at 1-855-242-8282 to apply on the phone Monday-Friday 8:00 AM-7:00 PM and Saturday 9:00 AM-12:00 PM • Applications are also available Online at http:// www.dss.virginia.gov/benefit/medical_a ...
How can I get a form? To apply for Medical Assistance using a paper application form, you can download and print the form and supplements below. You can also call your local department of social services (DSS) and ask for a form to be mailed to you or pick one up at your local DSS office. You can find the address and phone number for your local ...
MES Forms Library | MES - Virginia
Most of the DMAS/MES forms in our library are in PDF format and can be viewed either in your browser or downloaded to your computer. We’re still working to make your experience here better. Our published forms are currently under review, and going forward we plan on a better way to categorize the forms, making it easier to find the form you need.
Feb 1, 2021 · Use this application to apply for anyone in your family. Apply even if you or your child already has health coverage. You could be eligible for lower-cost or free coverage. Families that include immigrants can apply. You can apply for your child even if …