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CHILDRENS SPECIAL HEALTH CARE SERVICES PCP ATTESTATION FORM Provider Information First Name Middle Initial Last Name Suffix Street Address Suite City, State Zip Code Tax ID #: NPI #: PHP Provider.

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Children's Special Health Care Services (CSHCS) is a program within the Michigan Department of Community Health and provided by the Mid-Michigan District Health Department. It is for children and some adults with special health care needs and their families.

You can check the status of your application online or by calling 1-800-403-0864. You will need to have your case number to check the status of your application.

Who is eligible for Indiana Medicaid Program? Household Size*Maximum Income Level (Per Year)1$16,9712$22,9303$28,8884$34,8464 more rows

Indiana's Medicaid eligibility standards as of 2023 are: 208% of the federal poverty level (FPL) for children up to 1-year-old. 158% of FPL for children 1 to 18 years old; the Children's Health Insurance Program (CHIP) covers children at higher income levels, up to 250% of FPL.

Child Income Chart Household SizeFamily Income*1$37,185.00 or less$37,185.01 - $58,320.002$50,294.40 or less$50,294.41 - $78,880.003$63,403.20 or less$63,403.21 - $99,440.004$76,500.00 or less$76,500.01 - $120,000.004 more rows

A family with a gross income (before taxes) no greater than 250% of the poverty level may be eligible for the program. As of January 2021, for example, a family of four could qualify with a gross income of up to $66,250. For each additional member add $11,350.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232