№ files_lp_3_process_9_52129
Administrative intake form used to collect personal, financial, and benefits information regarding Medicaid eligibility issues for individuals with intellectual or developmental disabilities in New Jersey.
Organization: The Arc of New Jersey
Program: Mainstreaming Medical Care Program
Document Type: Medicaid eligibility problem report form
Region: New Jersey, United States
Subject: Medicaid eligibility and benefits review for individuals with intellectual or developmental disabilities (I/DD)
Related Agencies: NJ Division of Medical Assistance and Health Services; Division of Developmental Disabilities (DDD)
Target Group: Individuals with intellectual or developmental disabilities and their families or representatives
Required Information: Personal identification data, financial assets, SSI history, Medicaid history, Social Security Disability benefits, Medicare status, parental employment status, individual employment and income details
Contact Persons: Beverly Roberts; Victoria Ramkissoon
Submission Method: Email or fax
Website: www.mainstreamingmedicalcare.org
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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