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Form DOH-4220 Medicaid Application for Non-magi Eligibility Group - New York
What Is Form DOH-4220?
This is a legal form that was released by the New York State Department of Health - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DOH-4220?A: DOH-4220 is the Medicaid Application for Non-magi Eligibility Group.
Q: Who can use DOH-4220?A: DOH-4220 can be used by individuals who are applying for Medicaid under the Non-magi Eligibility Group.
Q: What is the Non-magi Eligibility Group?A: The Non-magi Eligibility Group includes individuals who do not qualify for Medicaid based on Modified Adjusted Gross Income (MAGI) guidelines.
Q: What information is required on DOH-4220?A: DOH-4220 requires personal and financial information, such as income, assets, household composition, and medical expenses.
Q: Is there a fee to submit DOH-4220?A: No, there is no fee to submit DOH-4220.
Q: What happens after submitting DOH-4220?A: After submitting DOH-4220, your application will be reviewed by the Medicaid agency and you will be notified of your eligibility status.
Form Details:
- Released on August 1, 2021;
- The latest edition provided by the New York State Department of Health;
- Easy to use and ready to print;
- Available in Haitian Creole;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form DOH-4220 by clicking the link below or browse more documents and templates provided by the New York State Department of Health.
Download Form DOH-4220 Medicaid Application for Non-magi Eligibility Group - New York
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