GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility

Documents and forms in this information collection

Document Name	Document Type
Form 1 Tribal Input GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form CMS-10434 #15 Designation and Authority GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form CMS-10434 #15 Intergovernmental Cooperation Act Waivers GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form CMS-10434 #15 Eligibility Determinations and Fair Hearings GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form CMS-10434 #15 Organization and Administration GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Single State Agency Assurances GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Submission Summary GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Medicaid State Plan GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Public Comment GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Other Comment GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 MAGI Based Methodologies GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 MAGI Based Methodologies – Territories GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Reasonable Classification of Children All GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Reasonable Classification of Children Limit GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Income Standard GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 AFDC Income Standards GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Income Standards – Poverty Level – Territories GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Income Standards - AFDC-related – Territories GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Presumptive Eligibility for Children under Age 19 GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Qualified Entities GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Financial Eligibility Requirements for Non-MAGI Groups GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Presumptive Eligibility by Hospitals GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Parents and Other Caretaker Relatives GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Presumptive Eligibility for Parents and Other Caretaker Relatives GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Pregnant Women GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Presumptive Eligibility for Pregnant Women GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Presumptive Eligibility for Pregnant Women GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Financial Eligibility Requirements for Non-MAGI Groups – Territories GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Optional Eligibility Groups GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Infants and Children under Age 19 GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Infants and Children under Age 19 – Territories GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Adult Group GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Adult Group - Presumptive Eligibility GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Adult Group - Presumptive Eligibility – Territories GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Former Foster Care Children GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Former Foster Care Children – Presumptive Eligibility GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 De-selected GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Mandatory Eligibility Groups GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Individuals above 133% FPL under Age 65 GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Individuals above 133% FPL under Age 65 - Presumptive Eligibility GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Optional Coverage of Parents and Other Caretaker Relatives GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Reasonable Classification of Individuals under Age 21 GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Children with Non IV-E Adoption Assistance GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Optional Targeted Low Income Children GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Individuals with Tuberculosis GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Independent Foster Care Adolescents GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Individuals Eligible for Family Planning Services GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Individuals Eligible for Family Planning Services - Presumptive Eligibility GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 State Residency GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Citizenship and Non-Citizenship GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Eligibility Process GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
Form 1 Application GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction
CMS-10434 #15 Designation and Authority QSSI-MACPro-PRA-A1.pdf	Form and Instruction
CMS-10434 #15 Intergovernmental Cooperation Act Waivers QSSI-MACPro-PRA-A2.pdf	Form and Instruction
CMS-10434 #15 Eligibility Determinations and Fair Hearings QSSI-MACPro-PRA-A3.pdf	Form and Instruction
CMS-10434 #15 Organization and Administration QSSI-MACPro-PRA-A4.pdf	Form and Instruction
1 Single State Agency Assurances QSSI-MACPro-PRA-A5.pdf	Form and Instruction
1 Submission Summary QSSI-MACPro-PRA-I1.pdf	Form and Instruction
1 Medicaid State Plan QSSI-MACPro-PRA-I2.pdf	Form and Instruction
1 Public Comment QSSI-MACPro-PRA-I3.pdf	Form and Instruction
1 Tribal Input QSSI-MACPro-PRA-I4.pdf	Form and Instruction
1 Other Comment QSSI-MACPro-PRA-I5.pdf	Form and Instruction
1 MAGI Based Methodologies QSSI-MACPro-PRA-S10.pdf	Form and Instruction
1 MAGI Based Methodologies – Territories QSSI-MACPro-PRA-S10T.pdf	Form and Instruction
1 Reasonable Classification of Children All QSSI-MACPro-PRA-S11.pdf	Form and Instruction
1 Reasonable Classification of Children Limit QSSI-MACPro-PRA-S11a.pdf	Form and Instruction
1 Income Standard QSSI-MACPro-PRA-S13a.pdf	Form and Instruction
1 AFDC Income Standards QSSI-MACPro-PRA-S14.pdf	Form and Instruction
1 Income Standards – Poverty Level – Territories QSSI-MACPro-PRA-S14a.pdf	Form and Instruction
1 Income Standards - AFDC-related – Territories QSSI-MACPro-PRA-S14T.pdf	Form and Instruction
1 Presumptive Eligibility for Children under Age 19 QSSI-MACPro-PRA-S16.pdf	Form and Instruction
1 Qualified Entities QSSI-MACPro-PRA-S17.pdf	Form and Instruction
1 Financial Eligibility Requirements for Non-MAGI Groups QSSI-MACPro-PRA-S2.pdf	Form and Instruction
1 Presumptive Eligibility by Hospitals QSSI-MACPro-PRA-S21.pdf	Form and Instruction
1 Parents and Other Caretaker Relatives QSSI-MACPro-PRA-S25.pdf	Form and Instruction
1 Presumptive Eligibility for Parents and Other Caretaker QSSI-MACPro-PRA-S25a.pdf	Form and Instruction
1 Pregnant Women QSSI-MACPro-PRA-S28.pdf	Form and Instruction
1 Presumptive Eligibility for Pregnant Women QSSI-MACPro-PRA-S28a.pdf	Form and Instruction
1 Presumptive Eligibility for Pregnant Women QSSI-MACPro-PRA-S28T.pdf	Form and Instruction
1 Financial Eligibility Requirements for Non-MAGI Groups – QSSI-MACPro-PRA-S2T.pdf	Form and Instruction
1 Optional Eligibility Groups QSSI-MACPro-PRA-S3.pdf	Form and Instruction
1 Infants and Children under Age 19 QSSI-MACPro-PRA-S30.pdf	Form and Instruction
1 Infants and Children under Age 19 – Territories QSSI-MACPro-PRA-S30T.pdf	Form and Instruction
1 Adult Group QSSI-MACPro-PRA-S32.pdf	Form and Instruction
1 Adult Group - Presumptive Eligibility QSSI-MACPro-PRA-S32a.pdf	Form and Instruction
1 Adult Group - Presumptive Eligibility – Territories QSSI-MACPro-PRA-S32T.pdf	Form and Instruction
1 Former Foster Care Children QSSI-MACPro-PRA-S33.pdf	Form and Instruction
1 Former Foster Care Children – Presumptive Eligibility QSSI-MACPro-PRA-S33a.pdf	Form and Instruction
1 De-selected QSSI-MACPro-PRA-S3a.pdf	Form and Instruction
1 Mandatory Eligibility Groups QSSI-MACPro-PRA-S4.pdf	Form and Instruction
1 Individuals above 133% FPL under Age 65 QSSI-MACPro-PRA-S50.pdf	Form and Instruction
1 Individuals above 133% FPL under Age 65 - Presumptive El QSSI-MACPro-PRA-S50a.pdf	Form and Instruction
1 Optional Coverage of Parents and Other Caretaker Relativ QSSI-MACPro-PRA-S51.pdf	Form and Instruction
1 Reasonable Classification of Individuals under Age 21 QSSI-MACPro-PRA-S52.pdf	Form and Instruction
1 Children with Non IV-E Adoption Assistance QSSI-MACPro-PRA-S53.pdf	Form and Instruction
1 Optional Targeted Low Income Children QSSI-MACPro-PRA-S54.pdf	Form and Instruction
1 Individuals with Tuberculosis QSSI-MACPro-PRA-S55.pdf	Form and Instruction
1 Independent Foster Care Adolescents QSSI-MACPro-PRA-S57.pdf	Form and Instruction
1 Individuals Eligible for Family Planning Services QSSI-MACPro-PRA-S59.pdf	Form and Instruction
1 Individuals Eligible for Family Planning Services - Pres QSSI-MACPro-PRA-S59a.pdf	Form and Instruction
1 State Residency QSSI-MACPro-PRA-S88.pdf	Form and Instruction
1 Citizenship and Non-Citizenship QSSI-MACPro-PRA-S89.pdf	Form and Instruction
1 Eligibility Process QSSI-MACPro-PRA-S94.pdf	Form and Instruction
1 Application QSSI-MACPro-PRA-S94a.pdf	Form and Instruction
GenIC 15 - Supporting Statement (rev 06-28-2019 by OSORA PRA).docx Supporting Statement	IC Document

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