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Member Change Report Form 295: Income Changes
On this screen, you can tell Medicaid if someone living in your home has new income or has loss of income.
| 1. | Check the box in the blue bar to open the part where you need to make changes. Type in the changes you want to make. |
| 2. | Do NOT un-check the box. If you un-check the box you will lose the changes you made. |
| 3. | All boxes with a * must be filled out before you can finish this screen. |
| 4. | When you have finished making changes to this screen, Click Go to Submit if you are ready to send the changes to Medicaid and there are no more changes to report -- OR -- Click Continue to go to the next screen and make more changes -- OR -- Click the box in the left side of the screen where you need to make changes and go to that screen If you Click Cancel, you will leave the Change Report Form 295 without making any changes. Changes to any part of this form will be lost. |
It may take up to 10 business days for your changes to show up on your record after you submit this form.