OHIP 0002 - Notice of Action on Application-Benefit for Medical Assistance Payment of Medicare Premiums (NYC Spanish) Read more about OHIP 0002 - Notice of Action on Application-Benefit for Medical Assistance Payment of Medicare Premiums (NYC Spanish)
OHIP 0001 - Notice of Decision on your Request for Undue Hardship (Transfer of Assets Penalty) (Spanish) Read more about OHIP 0001 - Notice of Decision on your Request for Undue Hardship (Transfer of Assets Penalty) (Spanish)
LDSS 939 - Medical Assistance Questionnaire - Responsible Relative (Spanish) Read more about LDSS 939 - Medical Assistance Questionnaire - Responsible Relative (Spanish)
LDSS 4807 - Health Care Programs for New Yorkers (Spanish) Read more about LDSS 4807 - Health Care Programs for New Yorkers (Spanish)
LDSS 4578 - Notice of Intent to Change Medical Assistance to Transitional Medical Assistance Coverage (Spanish) Read more about LDSS 4578 - Notice of Intent to Change Medical Assistance to Transitional Medical Assistance Coverage (Spanish)
LDSS 4294 - Explanation of the Effect of Transfer of Asset(s) on Medical Assistance Eligibility (Spanish) Read more about LDSS 4294 - Explanation of the Effect of Transfer of Asset(s) on Medical Assistance Eligibility (Spanish)
LDSS 3827 - Burial Fund Acknowledgment (Spanish) Read more about LDSS 3827 - Burial Fund Acknowledgment (Spanish)
LDSS 2400 - Child-Teen Health Program Services (Spanish) Read more about LDSS 2400 - Child-Teen Health Program Services (Spanish)
DOH 4443 - Standardized Financial Maintenance Requirements for Medicaid Applicants-Recipients Form (Spanish) Read more about DOH 4443 - Standardized Financial Maintenance Requirements for Medicaid Applicants-Recipients Form (Spanish)
DOH 5247 - Medicaid Authorized Representative Designation-Change Request (Spanish) Read more about DOH 5247 - Medicaid Authorized Representative Designation-Change Request (Spanish)