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Bureau of Health Services Financing (Medicaid)
Contact Us - LTC Recipient

Contact Us - LTC Recipient

Please provide the information below:

Which do you have a question about?

E-Mail Address

Your First Name

Your Last Name

Person ID #

Date of Birth

Are you in a facility? Yes
No

What is the name of the facility?

Do you receive waiver services? Yes
No

Which waiver services do you receive? Adult Day Health Care
Community Choices Waiver
New Opportunity Waiver (NOW)
Children's Choice
Residential Options Waiver (ROW)
Supports Waiver

Who is your waiver provider(s)?

What LTC coverage do you have?

Surgeon General Ralph L. Abraham, M.D.

Secretary Bruce D. Greenstein

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