Apply For Medicaid Form PDF Details

If you are in need of medical assistance, you may be wondering if you are eligible for Medicaid. The Medicaid application process can seem daunting, but our guide will help make it a little easier. We'll provide information on the eligibility requirements and what documentation you will need to submit with your application. Plus, we'll give tips on how to increase your chances of being approved. So whether you're just starting to explore your options or are ready to apply, keep reading for everything you need to know about Medicaid applications.

QuestionAnswer
Form NameApply For Medicaid Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesnevadans, medacade, nv, nevadahealthlink

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based health insurance. Nevada Health Link can help you find a plan that fits your needs and budgets. You cannot be denied due to a pre- existing medical condition.

Plan costs are based on the household’s taxable annual income, how many people are in the household, the place of residence and if anyone in the household uses tobacco. Applicants may be eligible for tax credits and other financial assistance with their selected plans.

To start the signup process, visit

www.NevadaHealthLink.com.

How to apply

A screener tool will help determine if you may be eligible for Medicaid/Nevada Check Up, or if you may be eligible to purchase coverage through Nevada Health Link. The tool will ask about household occupants, their ages and household income.

From there, you can either visit Access Nevada at www.dwss.nv.gov to apply for Medicaid or Nevada Check Up, or www.NevadaHealthLink. com to apply for a subsidized health plan.

Depending on program requirements, some documentation may be required. It would be helpful to have these documents available:

Proof of citizenship, such as a birth certificate or permanent residency ID card.

Proof of Nevada residence, such as a phone or power bill with physical address listed.

Social Security Card.

Proof of Income from prior year tax return and/or recent paycheck stubs.

Proof of membership of a federally recognized tribe.

Current health insurance, if applicable, with ID card.

Current employment information, including name, address, contact name and phone.

What happens next?

Upon submitting an application for Medicaid or Nevada Check Up, DWSS will send a confirmation letter. The case number and PIN will be included for use with the phone system or Access Nevada “Check My Benefits.” You will be able to get basic

information about your benefits.

When additional information is necessary to determine eligibility, DWSS will send you a letter outlining the required information and the date it must be received. If information is not received by the date requested, the application is denied.

A Notice of Determination letter will state if your application was approved or denied. If you disagree with the determination, the letter will provide contact information to appeal the decision.

If you’ve selected a health insurance plan through Nevada Health Link at HealthCare.gov, you will receive additional information from your insurance company about how to pay for and manage your plan.

Resources for medical assistance

Medicaid and Nevada Check Up

Website: www.dwss.nv.gov

Northern Nevada: 775-684-7200

Southern Nevada: 702-486-1646

Statewide: 877-543-7669

Nevada Health Link

Website:

www.NevadaHealthLink.com

Division of

Welfare and

Supportive

Services

Working for the welfare

of all Nevadans.

Peace of mind is just a click away

You can apply online through:

Access Nevada (www.dwss.nv.gov) for Medicaid or Nevada Check Up

Nevada Health Link (www. NevadaHealthLink.com) for subsidized health insurance

Enrollment can be completed quickly and easily from any computer with Internet access. Several organizations have computers that are free to the public.

DWSS Call Center

For locations and hours, call 702-486-1646 or 775-684-7200.

Online at www.dwss.nv.gov

click on “Resources & Upcoming Events.”

Which assistance programs are available?

Division of Welfare and Supportive

Services (DWSS) determines Medicaid and Nevada Check Up eligibility for low-income Nevadans. Online applications can be completed using Access Nevada at www.dwss.nv.gov.

101; Carson City, NV 89701

In urban areas of Clark and Washoe counties, Medicaid and Nevada Check Up services are provided through managed care organizations — Amerigroup and Health Plan of Nevada. In rural areas and for some coverage groups, the Division of Health Care Financing & Policy pays claims on a “fee for service” basis.

Nevada Medicaid (Fee for Service)

Carson City: 775-684-3651

Elko: 775-753-1191

Las Vegas: 702-668-4200

Reno: 775-687-1900 https://dhcfp.nv.gov

Amerigroup

Participant Services: 800-600-4441

AT&T Relay Service: 800-855-2880

AT&T Relay Service Spanish: 800-855-2884

www.myamerigroup.com

Health Plan of Nevada

Service Area: Clark and Washoe counties

Participant Services: 800-962-8074

www.healthplanofnevada.com

Other Access Nevada/DWSS Assistance Programs include:

The Supplemental Nutrition Assistance Program (SNAP) helps low-income Nevadans buy nutritious food from local retailers.

Temporary Assistance to Needy Families (TANF) is designed to help families achieve self-sufficiency by job preparation, work opportunities and support services.

Nevada Health Link

Nevada Health Link is the state’s

website where Nevadans can enroll in income-

Medicaid provides free health care coverage for low-income people, including:

Adults between 19-64 whose household income is at or below 138% of the Federal Poverty Level (FPL. See chart).

Children.

Pregnant Women whose household income is less than 165% of the FPL.

Parent Caretakers with income at or below 138% of the FPL.

Supplemental Security Income recipients.

Certain Medicare beneficiaries.

Nevada Check Up provides medical and dental benefits for children from birth to 18 years old. To qualify, your income must be at or below 205% of the Federal Poverty Level (See chart).

A small premium, on a quarterly basis, may be required. Send checks or money orders to: Nevada Check Up Premiums; 1100 E. William St., Suite

2014 Federal Poverty Level (FPL) Chart

If your monthly income falls within one of these ranges, you may be eligible for assistance.

 

Nevada Medicaid Monthly*

Nevada Check Up Monthly*

Nevada Health Link Monthly*

 

 

 

 

 

 

To qualify for Nevada Check Up,

To qualify for a subsidy

 

 

(help with your insurance cost),

Family

138% of FPL

your income should be below

your income must be below

Size:

 

205% of FPL

 

400% of FPL

 

 

 

138%

205%

400%

1

$1,342.08

$1,945.00

$3,890.00

2

$1,808.92

$2,621.67

$5,243.33

3

$2,275.83

$3,298.33

$6,596.67

4

$2,742.75

$3,975.00

$7,950.00

5

$3,209.67

$4,651.67

$9,303.33

6

$3,676.58

$5,328.33

$10,656.67

7

$4,143.42

$6,005.00

$12,010.00

8

$4,610.33

$6,681.67

$13,363.33

 

Nevada Medicaid – 0% to 138% of the FPL

 

 

 

*Monthly income was calculated by dividing

*Must not be eligible for Medicaid or

*Must not be eligible for Medicaid or

 

other health insurance plan.

other health insurance plan.

 

the poverty guidelines, which is an annual

 

 

 

 

figure by 12 months.