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How do I fill this out?
To fill out this document, gather all necessary eligibility information beforehand. Carefully follow the outlined instructions for each section. Ensure all required fields are completed to avoid delays in processing.

How to fill out the Medicaid NC Health Choice COVID-19 Procedures?
1
Gather all necessary personal and eligibility information.
2
Follow the instructions in each section carefully.
3
Complete all required fields thoroughly.
4
Submit the document within the specified time frame.
5
Keep a copy of your submission for your records.
Who needs the Medicaid NC Health Choice COVID-19 Procedures?
1
Individuals applying for Medicaid to ensure they receive benefits.
2
Social Services caseworkers who assist applicants.
3
Families needing health coverage during COVID-19.
4
Healthcare providers requiring eligibility verification.
5
County Departments of Social Services managing Medicaid applications.
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What are the instructions for submitting this form?
To submit this form, ensure it is filled out completely and accurately. You can email your completed form to the designated county department email address or fax it to the specified number. Additionally, you may also choose to submit the form in person at your local social services office.
What are the important dates for this form in 2024 and 2025?
Key dates include August 31, 2020, for recertifications and ongoing evaluations during the COVID-19 public health emergency. Individuals should keep track of their recertification deadlines as outlined in the guidelines.

What is the purpose of this form?
The purpose of this form is to outline necessary procedures for Medicaid and NC Health Choice applications and recertifications amidst the ongoing pandemic. It serves as an essential guide for county departments to ensure eligible individuals continue receiving medical benefits. Timely completion of this document is crucial to maintain coverage and comply with regulatory requirements.

Tell me about this form and its components and fields line-by-line.

- 1. Personal Information: Includes name, contact information, and social security number.
- 2. Income Details: Information regarding all sources of income for the applicant.
- 3. Household Composition: Details about family members living in the same household.
- 4. Medicaid Program Selection: Selection of the specific Medicaid or NCHC program the applicant is applying for.
What happens if I fail to submit this form?
Failing to submit this form may result in a lapse of benefits and coverage interruptions. It is crucial to adhere to deadlines to ensure continuous coverage.
- Lapsed Coverage: Not submitting may lead to gaps in health coverage.
- Benefit Denial: Failure to meet the submission deadline could result in denial of benefits.
- Increased Financial Burden: Without coverage, individuals may face significant healthcare costs.
How do I know when to use this form?

- 1. Initial Application: Use the form when first applying for Medicaid or NC Health Choice.
- 2. Recertification: Necessary for renewing eligibility for ongoing benefits.
- 3. Change of Circumstances: Update eligibility based on changes like income or family size.
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