Form DHS-3887-ENG Hospital Presumptive Eligibility Applicant Assurance Statement - Minnesota

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Form DHS-3887-ENG Hospital Presumptive Eligibility Applicant Assurance Statement - Minnesota

What Is Form DHS-3887-ENG?

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

FAQ

Q: What is DHS-3887-ENG?A: DHS-3887-ENG is a form for Hospital Presumptive Eligibility Applicant Assurance Statement.

Q: What is Hospital Presumptive Eligibility?A: Hospital Presumptive Eligibility is a temporary Medicaid coverage for individuals who qualify based on their hospital stay or emergency medical condition.

Q: Who needs to complete the form?A: Minnesota residents who are applying for Hospital Presumptive Eligibility need to complete the DHS-3887-ENG form.

Q: What does the form require?A: The form requires applicants to provide their personal information, income, household size, and other relevant details.

Q: Is the form available in languages other than English?A: Yes, the form is available in languages other than English, including Spanish and Somali.

Q: What is the purpose of the form?A: The purpose of the form is to collect necessary information to determine an applicant's eligibility for Hospital Presumptive Eligibility.

Q: How long does the coverage last?A: Hospital Presumptive Eligibility coverage lasts for 60 days.

Q: Can I apply for other Medicaid programs while on Hospital Presumptive Eligibility?A: Yes, individuals can apply for other Medicaid programs while on Hospital Presumptive Eligibility.

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Form Details:

  • Released on August 1, 2014;
  • The latest edition provided by the Minnesota Department of Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DHS-3887-ENG by clicking the link below{class="scroll_to"} or browse more documents and templates provided by the Minnesota Department of Human Services.

Download Form DHS-3887-ENG Hospital Presumptive Eligibility Applicant Assurance Statement - Minnesota

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