Applications will be rejected if supporting documentation is not received within 14 days of request. If you qualify: If you are a resident of Vermont or New Hampshire, complete the application for Medicaid for the state you reside in. [...] Once the application for Medicaid has been processed, you will receive a Notice of Decision from the state. [...] The Notice of Decision and necessary documentation must be attached to the completed Patient Assistance application before it can be processed. [...] Copy of your Notice of Decision from the state 2. [...] Documentation of investment accounts from a broker or financial institution 5. [...] Documentation of child support and/or alimony paid or received Mail the completed application with proof of income and documentation to: NVRH Attention: PA PO Box 905 St. [...] Applicants with liquid assets of $50,000 or more will not be considered. [...] o Copy of current statement for investment accounts from broker or financial institution. [...] o Copy of Notice of Decision from the State of VT or NH o Copy of unemployment benefits statement, if applicable. [...] o Documentation of child support and/or alimony paid or received.
- Pages
- 8
- Published in
- United States of America
