Free Information for Medicaid Disability Applicants, HCF 10113 - Wisconsin


File Size: 536.4 kB
Pages: 1
File Format: PDF
State: Wisconsin
Category: Health Care
Author: DHFS
Word Count: 367 Words, 2,256 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://dhs.wisconsin.gov/forms/F1/F10113.pdf

Download Information for Medicaid Disability Applicants, HCF 10113 ( 536.4 kB)


Preview Information for Medicaid Disability Applicants, HCF 10113
DEPARTMENT OF HEALTH SERVICES Division of Health Care Access and Accountability F-10113 (07/08)

STATE OF WISCONSIN WI Statute 49.45

INFORMATION FOR MEDICAID DISABILITY APPLICANTS Your application for Medicaid Disability will be sent to the Wisconsin Department of Health and Family Services' Disability Determination Bureau (DDB) where a determination will be made. To be found disabled, you must have a disability or combination of disabilities which will last for at lease twelve consecutive months and will prevent you from doing any type of substantial gainful work. The DDB may send you other forms that ask for more information about the jobs you have had or about your daily activities. It is your responsibility to complete and return these forms as soon as possible. The additional information is needed to complete your application. If additional medical information is needed, the DDB may schedule a special examination for which the government will pay. It is your responsibility to attend the exam on time and on the date scheduled. If you see any new doctors, are scheduled for more medical tests, or are hospitalized after you complete your application, please write or call the DDB as soon as possible, so that any new medical records can be obtained for your claim. If you do not attend any special examinations scheduled for you or if you do not promptly furnish additional information requested, your claim may be denied for insufficient evidence. If you change your address or telephone number, write or call the DDB as soon as possible. Applications take an average of seven to eight weeks to complete. If your application is approved you will receive a notice from the local office where you applied. If your application is not approved, you will receive a letter explaining the reasons why and your appeal rights. The DDB also processes applications for Social Security Disability Insurance and Supplemental Security Income (SSI) Disability. The disability requirements for all three programs are the same. If you are also applying for Social Security or SSI, the DDB will try to coordinate handling the applications at the same time.

Disability Determination Bureau P.O. Box 7886 Madison, WI 53707-7886 Telephone 1-608-266-1565