Application

Use

Face-to-Face
Interview Required?

• Medicaid for children, pregnant women and families

No

• Medicaid for older individuals or individuals who are blind or disabled
• This is also an application for cash, medical and/or food stamp assistance for all individuals
• This application explores eligibility for Disability Medical Assistance and Refugee Medical Assistance Programs

Yes

• Assists Medicare-eligible individuals who have limited income with paying their Medicare expenses

No

• This application explores eligibility for Home and Community-Based Services Waiver Programs

Please note: You must receive Medicaid to receive waiver services.

No

• Please use this addendum along with JFS 07200 and JFS 07236 to apply for the Medicaid Buy-In for Workers with Disabilities program

No