Retro Eligibility Attestation Form for Long Term Care Services and Supports - Washington, D.C.

Retro Eligibility Attestation Form for Long Term Care Services and Supports - Washington, D.C.

Retro Eligibility Attestation Form for Care Services and Supports is a legal document that was released by the Washington DC Department of Health Care Finance - a government authority operating within Washington, D.C..

FAQ

Q: What is the Retro Eligibility Attestation Form?A: The Retro Eligibility Attestation Form is a form used for long term care services and supports in Washington, D.C.

Q: Who needs to fill out the Retro Eligibility Attestation Form?A: The Retro Eligibility Attestation Form needs to be filled out by individuals who are seeking retroactive Medicaid eligibility for long term care services and supports in Washington, D.C.

Q: What is retroactive Medicaid eligibility?A: Retroactive Medicaid eligibility allows individuals to receive Medicaid coverage for long term care services and supports for a certain period of time before they applied for Medicaid.

Q: What information do I need to provide on the Retro Eligibility Attestation Form?A: You will need to provide your personal information, including your name, address, social security number, and Medicaid identification number, as well as information about your long term care services and supports.

Q: Is there a deadline for submitting the Retro Eligibility Attestation Form?A: Yes, there is a deadline for submitting the Retro Eligibility Attestation Form. The form must be submitted within 90 days from the date of the long term care services and supports eligibility determination.

Q: What happens after I submit the Retro Eligibility Attestation Form?A: After you submit the Retro Eligibility Attestation Form, the Washington, D.C. Department of Health Care Finance (DHCF) will review your form and determine your retroactive Medicaid eligibility for long term care services and supports.

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Form Details:

  • Released on August 1, 2022;
  • The latest edition currently provided by the Washington DC Department of Health Care Finance;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Washington DC Department of Health Care Finance.

Download Retro Eligibility Attestation Form for Long Term Care Services and Supports - Washington, D.C.

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