OHIP 0001 - Notice of Decision on your Request for Undue Hardship (Transfer of Assets Penalty) Read more about OHIP 0001 - Notice of Decision on your Request for Undue Hardship (Transfer of Assets Penalty)
DOH 5224 - Medicaid Presumptive Eligibility for Pregnant Women Screening Checklist Read more about DOH 5224 - Medicaid Presumptive Eligibility for Pregnant Women Screening Checklist
UU3, U0264 - Medicaid to FPBP Due to Excess Income (S/CC Parents/Caretaker Relatives age 19 & 20 Living Alone or with Parents Children 1-18) Read more about UU3, U0264 - Medicaid to FPBP Due to Excess Income (S/CC Parents/Caretaker Relatives age 19 & 20 Living Alone or with Parents Children 1-18)
T14, S0035 - Over 65 Request to Apply for Medicare Used for backlog & for monthly process Upstate Read more about T14, S0035 - Over 65 Request to Apply for Medicare Used for backlog & for monthly process Upstate
C46, U0295 - Pre-Release Notice - Upstate (30 Days Prior to Release) Read more about C46, U0295 - Pre-Release Notice - Upstate (30 Days Prior to Release)
S20AF, X0007 - Accept Excess Inc/Res Resource Spenddown Met Read more about S20AF, X0007 - Accept Excess Inc/Res Resource Spenddown Met
S20AD, X0003 - Accept Excess Resources Spenddown Met Read more about S20AD, X0003 - Accept Excess Resources Spenddown Met
H3W, Y0102 - Authorize Medicaid Coverage Immediate Referral from NYSoH cover letter Read more about H3W, Y0102 - Authorize Medicaid Coverage Immediate Referral from NYSoH cover letter
H2W, Y0136 - Renewal Letter Individual Transferred from New York State of Health (NYSoH) FORM QUESTIONS Read more about H2W, Y0136 - Renewal Letter Individual Transferred from New York State of Health (NYSoH) FORM QUESTIONS
UU2, U0265 - Family Planning Benefit Program (Post-Partum Extension) to Family Planning Extension Program Due Excess Income Read more about UU2, U0265 - Family Planning Benefit Program (Post-Partum Extension) to Family Planning Extension Program Due Excess Income