Transfer Request Forms and Defective PA Forms
- Memo for Beneficiary Transfer Requests 09282016.pdf
- LTCA PA Request Notification 09282016.docx
- LTCA Defective PA Form (02032016) 07142016 Savable_final.pdf
- LTCA EPDW Transfer Form (02032016) 07142016 Savable_final.pdf
- LTCA State Plan Transfer Form (02032016) 07142016 Savable_Final.pdf
Form 719A Prior Authorization Request
Nursing Facility Forms
Long Term Care Program Medical Assistance Application
- Eligibility Determination and Enrollment Process for EPD Waiver: Response to G.W. Health Insurance Counseling Project (HICP) Fact Sheet (PDF)
- District of Columbia Long-Term Care/Waiver Medicaid Application (2018)
- Retroactive Medicaid Application for Institutional Care (2018)
- Resource FAQ Sheet .pdf
- EPD FACT Sheet.pdf
- Financial Eligibility Institutional Care Fact Sheet.pdf
- Spend down FAQ Fact Sheet.pdf
POF: Prescription Order Form
RN Attestation Forms for Annual PCA Level of Need Recertifications