Name That Form Activity

<%@LANGUAGE="JAVASCRIPT" CODEPAGE="65001"%> Name That Form Activity

MA-LTC Basics

Processing MA-LTC Requests

Level of Care Requirement

LTC Screenings - Waivers

LTC Screenings - LTCF

Training Caseload

General MA Requirements

Community Spouse

Asset Requirements

General Asset Requirements

Homestead Exclusions

Third Party Liability

Home Equity Limit

Name That Form Activity

Can you determine the appropriate MA-LTC request form that must be used based on what you have learned so far? Complete the activity on the handout Name That Form! (PDF), and return to this page to check your answers.

Question 1.

The DHS-3543A, MHCP Request for Payment of Long-Term-Care Services (Families with Children and Adults), is used to request MA-LTC for current MA enrollees who do not have an asset limit.

Question 2.

Julia has had a break in MA-LTC services of over one calendar month and she will need to complete the DHS-3543, MHCP Request for Payment of Long-Term-Care Services. She has remained on MA but needs to request LTC services.

Question 3.

c. No form is needed. Review Rhonda’s income calculation for necessary changes.

Question 4.

a. Sweeny is an applicant for both MA and MA payment of LTC services and will use the DHS-3531, MHCP Application for Payment of Long-Term Care and Waiver Services.

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MA-LTC Forms

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Updated September 21, 2021.
Copyright © 2011 Health Care Eligibility and Access (HCEA).