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Wayne Michigan Form 966: What You Should Know

You may also qualify for Medicaid. You can learn more about eligibility, program requirements, and application procedures at Michigan health program website. Michigan Medicaid — Choice Waiver program. Complete the program. The form and its supporting documentation must show proof that the adult is receiving nursing home or long term care and the income verification is the current Medicaid income requirements. Submit the completed form and supporting documentation (i.e. application, insurance card, statement of income, etc) to: State of Michigan CMS-8 MS-CMS-8-3 Attn: CMS-8 1 West Washington Street Room 250 Harrison Township, MI 48034 Email MS-CMS-8 The form must indicate the type of nursing facility, the type of services provided, and the required payment by Medicaid. The requestor can also use the form for other health care coverage. State of Michigan MS-CMS-8-19 MS-CMS-8-20C MS-CMS-8-21 MS-DHS-22 State of Michigan Department for Community Health Services, 2nd Floor, 1050 S. Washington, Room 913 Lansing, MI 48 Contact the Michigan Department of Community Health Services. Michigan State Department of Community Health Services 1 State House Square Lansing, MI 48912 Telephone: or Contact them for program information. Contact the CHS for more details on the eligibility criteria. Michigan Social Services Administration Telephone information: Contact the SSA for more details on the eligibility criteria. State of Michigan CMS-8-821E MS-CMS-8-22 MS-CMS-8-43 MS-DHS-23 MS-CMS-8-22 Michigan's Medicaid Disenrollment Program for Children with Medicaid It is recommended that this individual is contacted by the Medicaid Disenrollment Program at a local social service agency and has it properly implemented. Once Medicaid eligibility for this individual has been established, she or he would be able to choose to be enrolled in the Michigan Health Plan (MHP) in the state of Michigan.

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