MATP ELIGIBILITY Quick Reference Guide
PM 81 Blind Disabled Adult Child w/Buy-In Y PM 84 Blind Pickle Indv Y PM 85 Blind Disable Emp Indv Y PM 86 Blind QDWI Indv N PMN 00 Blind Long Term Care (NMP) N PMN 66 Blind Long Term Care w/Buyin NMP N PMN 80 Blind Long Term Care w/Buyin NMP N PMW 00 Blind Waiver Program (NMP) Y
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Incident Report Form Template - Pennsylvania
matp.pa.govIncident Report Form Template . MATP I. NCIDENT . R. EPORT. N. AME OF INVOLVED PERSON _____ A. DDRESS
INSTRUCTIONS REQUIREMENTS - Pennsylvania
matp.pa.govCOMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE OFFICE OF MEDICAL ASSISTANCE PROGRAMS MEDICAL ASSISTANCE TRANSPORTATION PROGRAM INSTRUCTIONS REQUIREMENTS Prepared by the Division of Medical Assistance Transportation Programs
PA Department of Public Welfare Frequently Asked …
matp.pa.govPA Department of Public Welfare Frequently Asked Questions on Methadone Treatment in MA and MATP _____ heroin use.
COMMONWEALTH OF PENNSYLVANIA
matp.pa.govCOMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES OFFICE OF MEDICAL ASSISTANCE PROGRAMS MEDICAL ASSISTANCE TRANSPORTATION PROGRAM STANDARDS GUIDELINES Prepared by the Division of Medical Assistance Transportation Programs
Recipient Identification General Transportation …
matp.pa.govYes No Yes No Yes No Yes No I don't know; Yes No Yes No Yes No Yes No Yes No Yes No Do you live 1/4 mile or less from a bus route?
Mileage Reimbursement 2017-01-01 - Pennsylvania
matp.pa.govPhone #: Last Name: First Name: I hereby certify that to the best of my knowledge, the medical trip information listed on the back of this form is true, correct, and complete.
SeGOV User Guide - Pennsylvania
matp.pa.gov5 At the Keystone Key page (above), enter SeGov Username and Password. Click Login DPW USER AGREEMENT The Reset Password functionality verifies that the User Agreement is on file with Active Directory (AD) maintained by the …
Verification of Disability or Special Needs - …
matp.pa.govLimitations These Limitations Apply Status Indicate the tasks (below) related to using public transit that the individual listed above cannot do.
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dss.mo.govDisabled $860 Disabled Blind $1,012 Blind Elderly/Disabled $3,000 $6,000 Blind $3,000 Elderly/Disabled Blind $6,000 MO HealthNet for the Aged, Blind, and Disabled (MHABD) Spend down Incurred Medical Expenses reduce income to $860 for Elderly/Disabled or $1,012 for Blind Incurred Medical Expenses reduce income to $1,166 for Elderly/ Disabled or
Ohio
medicaid.ohio.govAged, Blind, or Disabled Individuals Medicare Premium Assistance Programs Medicaid Buy-ln ualified Medicare Specified Low-Income Medicaid for Aged, Beneficiary (QMB) 100% FPL $1,074 $1,452 $1,830 $2,209 $2,587 $2,965 $3,344 $3,722 $4,100 $4,857 $5,235 Qualified Individuals for Workers with Disabilities (MBIWD) 250% FPL $2,684 Medicare Beneficiary
Wisconsin Medicaid for the Elderly, Blind, or Disabled ...
www.dhs.wisconsin.govWISCONSIN MEDICAID FOR THE ELDERLY, BLIND OR DISABLED APPLICATION PACKET HOW TO APPLY This is an application for health care benefits for people who are 65 years of age or older, blind or have a disability. To apply for health care benefits, complete this application and return it to the following address or complete an application online at
Washington Apple Health Application
www.hca.wa.govfor Aged, Blind, Disabled/Long-Term Services and Supports Use this application to see what health care coverage you qualify for if: • You need to apply for Long-Term Services and Supports (LTSS) (nursing home care, assisted living facility, adult family home, in-home care programs, or Tailored Supports for Older Adults (TSOA))
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NJ FamilyCare Aged, Blind, Disabled Programs APPLICATION
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TENNESSEE WILDLIFE RESOURCES AGENCY • LICENSING …
www.tn.govType 197 - Resident Fishing License for the Blind TCA 70-2-104 (a) (1) provides for the issuance of a sport fishing license for a fee of $10.00 to those residents of Tennessee who are certified as being blind, having a visual acuity with maximum correc-tion, not exceeding 20/200 but accompanied by a limitation in the field