HI DHS 1139 2014-2025 free printable template

Ohanahealthplan.com 1-888-980-8728 or www. uhccommunityplan.com For more information click here AN EQUAL OPPORTUNITY AGENCY Department Of Human Services MEDICAID APPLICATION / CHANGE REQUEST FORM Group Individual PART A Provider is currently credentialed with attach credentialing documents with proof of 500 payment CHIP FROM ANOTHER STATE State Abbreviation MEDICARE Y/N MEDICAID FROM ANOTHER STATE State Abbreviation Medicaid Application type 1 NEW 5 YEAR RE-VALIDATION 3 CHANGE REQUEST If...

How to fill out dhs 1139 form

How to fill out HI DHS 1139

1. Obtain the HI DHS 1139 form from the appropriate agency's website or office.
2. Fill out your personal information at the top of the form, including your name, address, and contact details.
3. Provide information about your household members, including their names and dates of birth.
4. Specify the type of assistance you are applying for, if applicable.
5. Complete any additional sections related to income, expenses, or specific programs.
6. Review all entered information for accuracy and completeness.
7. Sign and date the form at the designated area.
8. Submit the form according to the instructions provided, either online, via mail, or in person.

Who needs HI DHS 1139?

1. Individuals or families residing in Hawaii who are seeking assistance through the Department of Human Services.
2. People who need to report changes in their circumstances or apply for specific benefits.

People Also Ask about dhs1139

What is the highest income to qualify for Medicaid?

Federal Poverty Level thresholds to qualify for Medicaid In 2023 these limits are: $14,580 for a single adult person, $30,000 for a family of four and $50,560 for a family of eight. To calculate for larger households, you need to add $5,140 for each additional person in families with nine or more members.

Is Medquest the same as Medicaid?

In Hawaii, the Medicaid program is called Med-QUEST. While this is a state and federally funded program, the state administers the program under federally set parameters. The Hawaii Department of Human Services is the administering agency.

What is the income limit for Med-Quest Hawaii?

Income Limits In dollar terms, for March 2022-February 2023, an applicant cannot have more than $1,303 per month ($15,636 per year) in income. Married couples, with both spouses applying for benefits, are able to have income up to $2,606 per month ($31,272 per year). These amounts are readjusted annually in March.

What is Medicaid called in Hawaii?

Hawaii's Medicaid/CHIP is called Med-QUEST (QUEST stands for Quality care, Universal access, Efficient utilization, Stabilizing costs, and Transforming the way health care is provided to recipients).

How does someone qualify for Medicaid quest Hawaii?

If income is greater than 100% of the FPL and assets up $2,000 for a single person household or up to $3,000 for a household of two, may be eligible for medical assistance under the Medically Needy Spenddown program, provided he or she has medical expenses greater than the determined spenddown amount.

What is the highest income to qualify for Medicaid in Hawaii?

Income & Asset Limits for Eligibility March 2023 – February 2024 Hawaii Medicaid Long-Term Care Eligibility for SeniorsType of MedicaidSingleMarried (both spouses applying)Income LimitAsset LimitInstitutional / Nursing Home MedicaidNo hard income limit*$3,000Home and Community Based Services$1,398 / month†$3,0001 more row • Feb 27, 2023

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What is HI DHS 1139?

HI DHS 1139 is a specific form or document that is used for reporting certain information to the Department of Human Services in Hawaii.

Who is required to file HI DHS 1139?

Individuals or organizations that are involved in specific activities as defined by the Hawaii Department of Human Services are required to file HI DHS 1139.

How to fill out HI DHS 1139?

To fill out HI DHS 1139, you need to provide accurate information as requested in the form, adhere to the guidelines outlined by the Hawaii Department of Human Services, and ensure all required fields are completed before submission.

What is the purpose of HI DHS 1139?

The purpose of HI DHS 1139 is to collect data and information necessary for the oversight and regulation of services under the jurisdiction of the Hawaii Department of Human Services.

What information must be reported on HI DHS 1139?

The information that must be reported on HI DHS 1139 typically includes details about the individual or organization filing, type of services provided, and any relevant financial or operational data as specified by the form's instructions.