Public-dhhs.ne.gov

Federally Facilitated Marketplace (FFM)

WEBThe Account Transfer information is converted to a Healthcare Marketplace (HCMP) Electronic Application. The corresponding PDF will have the same look and feel of the …

Actived: 5 days ago

URL: https://public-dhhs.ne.gov/nfocus/HowDoI/howdoi/federally_facilitated_marketplace_%28ffm%29.htm

Frequently Asked Questions

WEBMLTC-OTH-54 11/2023 Q. What coverage is available through the marketplace, and how do I apply? A. Health coverage through the marketplace covers things like prescription …

Category:  Health Go Health

Heritage Health Adult Expansion

WEBHeritage Health Adult covers Nebraska residents, age 19 through 64, whose income is at or below 138 percent of the federal poverty level. For 2021, this is an annual income of …

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Application for Home and Community Based Service (HCBS) …

WEBFederal Regulations, 38 CFR 1.460-1.499, 42 CFR Part 2 and Part 431, Subpart F) which prohibit you from making any . further disclosure of it without the specific written consent …

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Department of Health and Human Services Disabled Persons …

WEBDepartment of Health and Human Services Disabled Persons & Family Support Program (DPFS) Service & Device Application - Self-Assessment DPF-3 Rev. 4/2021 - Page 2 of 11

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Application for Nebraska Medicaid for Aged and Disabled

WEBDivision of Medicaid & Long Term-Care. Application for Nebraska Medicaid for Aged and Disabled. This form is used by: • Those over age 65 • Those under age 65 who are …

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Division of Medicaid and Long-Term Care Service Provider …

WEB18. Is the provider, any facility, employee or contractor providing services under this Agreement identified on the OIG list of Excluded Individuals/Entities website as excluded …

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Application for Certified Copy of Birth Certificate

WEBHHS-88 6/21 The Office of Vital Records has been registering births for persons born in Nebraska since 1904. PLEASE TYPE OR PRINT LEGIBLY Full name at birth _____

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Division of Medicaid and Long-Term Care Designation of

WEBDivision of Medicaid and Long-Term Care Designation of Authorized Representative MLTC-35 (34535) 7/15 Client Name: _____ Client Date of Birth:

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Application for Certified Copy of Death Certificate

WEBHHS-92 6/21 This office has been registering deaths occurring in Nebraska since 1904. PLEASE TYPE OR PRINT LEGIBLY Full name of deceased _____ (If female, list …

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Nebraska Department of Health and Human Services Children …

WEBa.Provider understands that an inspection of the facility may involve a full walk-through of the building where care is provided to allow program administration to monitor for health …

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Application for Certified Copy of Marriage Certificate (Single’s …

WEBNebraska Department of Health and Human Services Application for Certified Copy of Marriage Certificate (Single’s Letter) This office has been registering marriages …

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Division of Medicaid and ongTerm Care / Division of Children …

WEBDivision of Medicaid and ongTerm Care / Division of Children and amily Services Eliiili Relese of Iformaio MTCEA3 /201 Client Name: _____ Client Date of Birth:

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Heritage Health Adult Expansion

WEBMLTC-OTH-27 Rev. 1/2022 A D U L T E X P A N S I O N I receive benefits or services through another DHHS program (such as EWM, Ryan White, Refugee, Disability, etc.). …

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Physical Examination Report

WEBFH-42 Rev. 11/21. Department of Health and Human Services . Physical Examination Report . Name of School (if desired) The school board shall require evidence of (a) a …

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Heritage Health Adult Medically Frail Attestation Form

WEBNebraska Department of Health and Human Services Heritage Health Adult Medically Frail Attestation Form MLTC-92 Rev. 2/2021 Purpose: Nebraska DHHS Medicaid and Long …

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