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Mainstreaming Medical Care

Problem Forms

  • (Revised January 2017) Family members and staff may use this form when a person with an intellectual and developmental disability is having difficulty obtaining Medicaid.

  • Family members and staff may use this form if an individual is currently enrolled in a Medicaid HMO and is having difficulty obtaining a medical, dental, or behavioral health service that should be covered by the HMO. This form can also be used with the HMO has reduced the approved number of hours of a service (e.g., person care assistant services or private duty nursing).


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