Get Ky Map-350 2019-2025

The KY MAP-350 is an essential certification form for individuals seeking long-term care services or home and community-based waivers in Kentucky. This guide provides clear, step-by-step instructions on how to fill out the KY MAP-350 online, ensuring you understand each component and can complete the form accurately.

Follow the steps to successfully complete the KY MAP-350 online.

1. Click the ‘Get Form’ button to access the KY MAP-350 form and open it in the designated editing interface.
2. Review the estate recovery section carefully, which explains the state's obligations regarding Medicaid benefits and estate recovery rules. Acknowledge your understanding by signing and dating the form.
3. In section II, you will need to confirm your awareness of various home and community-based waiver programs. For each waiver, check the box indicating whether consideration for the program is requested or not. Sign and date each section accordingly.
4. Moving to section III, recognize your freedom to choose a Medicaid provider. This section requires your signature and date as confirmation.
5. In section IV, certify that you have been informed about the availability of resource assessment services for financial planning. Sign and date this section as well.
6. Fill out the recipient information in section V, including the Medicaid recipient's name, address, phone number, and Medicaid number. Additionally, provide details for the responsible party or legal representative, including their contact information.
7. If someone assisted you in completing the form, that person should sign and include their title, agency or facility name, and their address.
8. Finally, review all sections for accuracy before saving your changes, downloading a copy, printing, or sharing the form as necessary.

Complete your KY MAP-350 online today to ensure timely access to necessary services.