Medicaid Medical Assistance (MEDICAID) provides essential medical services for persons receiving Public Assistance and other low-income persons. Suffolk County Homeowners Insurance.Provide a permanent or year-round billing address to ensure receipt of your renewal application. Each proposal must be submitted on the forms provided. Fax: your Fair Hearing request to: 518-473-6735. You must complete and submit the form, "Termination of Domestic Partnership of Enrollees of Any of the Suffolk. How to fill out the Insurance Proposal Form: Guidelines and Instructions? This packet is designed so that you may be able to represent yourself and complete your divorce without an attorney.