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ATTENTION: Medicaid members may have received notices about their Social Security status and Medicaid eligibility. If you did, you do not need to submit a Medicaid application. If this applies to you, learn more here.

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Notification Forms

Please complete the following form to notify the Division of Care Management of a Managed Care Organization enrolled beneficiary's admission to a waiver program.

Waiver Notification

Please complete the following form to notify the Division of Care Management of a beneficiary's enrollment/disenrollment to the PACE program.

PACE Notification