Please be in touch with the Corperate Office to verify eligibility for Medicaid Benefits in NY.
732-893-7880
DSS requires all the spouse's financial information from the last five years, as well as signed Medicaid signature pages.
DSS requires all the Ex-Spouse's financial information from the last five years up until the date of divorce. Additionally a financial release is required to be signed by the Ex-Spouse.
DSS requires all of the Separated Spouse's financial information from the last five years up until the date of Separation. Additionally a financial release is required to be signed by the Separated Spouse.
DSS requires all of the Deceased Spouse's financial information from the last five years up until the date of death.
If you are not receving benefits, the DSS requires you to apply for VA benefits. Please download the VA Application by clicking here
VA Application for Veteran
VA Application for Surviving Spouse
VA Application for Veteran with a Spouse
Do you or your spouse receive any of the following?
PLEASE NOTE “Intending to Return Home” does not indicate short term in the facility. If one hopes to one day return home, they can check off that they intend to return home, and Medicaid allows them to keep their home for the time being. Should one NOT intend to return home, and there is no spouse or disabled child living in the home, Medicaid may require them to sell their home.
You have a zero projected NAMI.
PLEASE NOTE THAT THIS IS AN ESTIMATE OF WHAT YOUR MONTHLY NAMI CONTRIBUTION WILL BE BASED OFF THE INCOME AMOUNTS YOU PROVIDED ON THIS FORM.