Download:
pdf |
pdfEligibility Results
Thank you for
your application
Review your
eligibility results
Send us the
information we need
Start using your
health coverage
✔
1
2
3
Your application tracking
number is: 987654321
1. Review your eligibility results
Please keep this number
for your records.
Anna Jackson
Download your application
to print or save a copy.
For now, you
qualify for
Medicaid health
coverage.
Your coverage started on January 1, 2016.
But, to keep
your coverage,
we need more
information.
You need to send us proof of your citizenship
by April 19, 2016 to keep your coverage.
The citizenship information on your
application does not match our records.
You will receive a Medicaid card in the mail.
For now, you can get health services using
your Medicaid ID number: 12345-9876
Questions? Call us at 866-987-1234 (TTY: 866-987-4321).
We’re here Monday to Friday, 8 a.m. to 8 p.m. The call is free!
Or go to sma.gov.
English | Español | Français
Go to Step 2
Scenario 5
You’re not done yet! Take these next steps.
Eligibility Results
Thank you for
your application
Review your
eligibility results
Send us the
information we need
Start using your
health coverage
✔
1
2
3
Your application tracking
number is: 987654321
Please keep this number
for your records.
Download your application
to print or save a copy.
2. Send us the information we need
You need to send us proof of your citizenship by April 19, 2016, or your health
coverage will end.
Your eligibility letter tells you what proof to send. It tells you how to send proof by mail,
by fax, or in person. You can also send proof online.
Your letter also tells you more about our decisions and how we made them.
You need to download your eligibility letter before you go to Step 3.
Download your eligibility letter
Back to Step 1
Questions? Call us at 866-987-1234 (TTY: 866-987-4321).
We’re here Monday to Friday, 8 a.m. to 8 p.m. The call is free!
Or go to sma.gov.
English | Español | Français
Go to Step 3
Scenario 5
You’re not done yet! Take these next steps.
Eligibility Results
Thank you for
your application
Review your
eligibility results
Send us the
information we need
Start using your
health coverage
✔
1
2
3
Your application tracking
number is: 987654321
Please keep this number
for your records.
Download your application
to print or save a copy.
2. Send us the information we need
You need to send us proof of your citizenship by April 19, 2016, or your health
coverage will end.
Your eligibility letter tells you what proof to send. It tells you how to send proof by mail,
by fax, or in person. You can also send proof online.
Your letter also tells you more about our decisions and how we made them.
You need to download your eligibility letter before you go to Step 3.
Download your eligibility letter
Back to Step 1
Questions? Call us at 866-987-1234 (TTY: 866-987-4321).
We’re here Monday to Friday, 8 a.m. to 8 p.m. The call is free!
Or go to sma.gov.
English | Español | Français
Go to Step 3
Scenario 5
You’re not done yet! Take these next steps.
Eligibility Results
Thank you for
your application
Review your
eligibility results
Send us the
information we need
Start using your
health coverage
✔
1
2
3
Your application tracking
number is: 987654321
Please keep this number
for your records.
Download your application
to print or save a copy.
2. Send us the information we need
You need to send us proof of your citizenship by April 19, 2016, or your health
coverage will end.
Your eligibility letter tells you what proof to send. It tells you how to send proof by mail,
by fax, or in person. You can also send proof online.
Your letter also tells you more about our decisions and how we made them.
You need to download your eligibility letter before you go to Step 3.
Download your eligibility letter
Back to Step 1
Questions? Call us at 866-987-1234 (TTY: 866-987-4321).
We’re here Monday to Friday, 8 a.m. to 8 p.m. The call is free!
Or go to sma.gov.
English | Español | Français
Go to Step 3
Scenario 5
You’re not done yet! Take these next steps.
Eligibility Results
Thank you for
your application
Review your
eligibility results
Send us the
information we need
Start using your
health coverage
✔
1
2
3
Your application tracking
number is: 987654321
Please keep this number
for your records.
Download your application
to print or save a copy.
3. Start using your health coverage
You are ready to start using your Medicaid health coverage. You can get health services
right away from any doctor, clinic or other health care provider who accepts Medicaid.
Find a provider online.
Remember, your health coverage will end on April 19, 2016 if you do not give us
proof of your citizenship.
Back to Step 2
Questions? Call us at 866-987-1234 (TTY: 866-987-4321).
We’re here Monday to Friday, 8 a.m. to 8 p.m. The call is free!
Or go to sma.gov.
English | Español | Français
Scenario 5
You’re not done yet! Take these next steps.
Eligibility Results
Thank you for
your application
Review your
eligibility results
Read your
eligibility letter
Finish
enrolling
✔
1
2
3
Your application tracking
number is: 987654321
1. Review your eligibility results
Please keep this number
for your records.
Anna Jackson
Peter Jackson
Download your application
to print or save a copy.
Tom Jackson
You qualify for
Medicaid health
coverage.
Your coverage started on January 1, 2016.
You will receive a Medicaid card in the mail.
For now, you can get health services using
your Medicaid ID number:
Anna Jackson: 12345-9876
Peter Jackson: 23451-8769
Tom Jackson: 34512-7689
Susan
Jackson
You do not
qualify for
Medicaid health
coverage.
You still might be able to get health
coverage – and help paying for it – through
the Marketplace.
Questions? Call us at 866-987-1234 (TTY: 866-987-4321).
We’re here Monday to Friday, 8 a.m. to 8 p.m. The call is free!
Or go to sma.gov.
English | Español | Français
Go to Step 2
Scenario 8a
You’re not done yet! Take these next steps.
Eligibility Results
Thank you for
your application
Review your
eligibility results
Read your
eligibility letter
Finish
enrolling
✔
1
2
3
Your application tracking
number is: 987654321
Please keep this number
for your records.
Download your application
to print or save a copy.
2. Read your eligibility letter
The letter tells you more about our decisions and how we made them. It tells you more
about your health coverage choices and what to do next. It explains what to do if you
think we made a mistake about your eligibility.
You need to download your eligibility letter before you go to Step 3.
Download your eligibility letter
Back to Step 1
Questions? Call us at 866-987-1234 (TTY: 866-987-4321).
We’re here Monday to Friday, 8 a.m. to 8 p.m. The call is free!
Or go to sma.gov.
English | Español | Français
Go to Step 3
Scenario 8a
You’re not done yet! Take these next steps.
Eligibility Results
Thank you for
your application
Review your
eligibility results
Read your
eligibility letter
Finish
enrolling
✔
1
2
3
Your application tracking
number is: 987654321
3. Finish enrolling
Please keep this number
for your records.
Anna Jackson
Download your application
to print or save a copy.
Tom Jackson
Peter Jackson
Choose a
Medicaid
plan.
To keep using your health coverage, you need to choose
a health plan by February 15, 2016.
You may choose the same plan for everyone or different
plans for each person.
Choose a Medicaid plan
Susan Jackson
Complete your
Marketplace
application.
We sent your information to the Marketplace. They
will start an application for you. They will send you a
letter asking for more information to complete your
application. They will see if you qualify for health
coverage – and help paying for it – through the
Marketplace.
If you do not want to wait for the letter, you can
start a new application now at Healthcare.gov.
You will need to:
Create a Marketplace user account if you don’t
have one
Re-enter the information you gave us already
Have your eligibility letter with you to answer
questions
Answer “yes” when asked if anyone has been
found not eligible for Medicaid in the past 90 days
After you complete your application, the Marketplace will tell you whether
you can get coverage now or have to wait. Most people can only get
coverage during a specific time of the year called the Open Enrollment
Period. But some people may get coverage now if they had certain life
changes such as getting married, having a baby or losing Medicaid or
other health coverage. This is called a Special Enrollment Period.
Questions? Call the Marketplace at 1-800-318-2596
(TTY: 1-855-889-4325).
Back to Step 2
Questions? Call us at 866-987-1234 (TTY: 866-987-4321).
We’re here Monday to Friday, 8 a.m. to 8 p.m. The call is free!
Or go to sma.gov.
English | Español | Français
Scenario 8a
You’re not done yet! Take these next steps.
| File Type | application/pdf |
| File Modified | 2016-06-03 |
| File Created | 2016-06-03 |