Effective Date: 
5/2016

Documents

Instructions

Updated: 05/2016

PURPOSE

A local intellectual and developmental disability authority (LIDDA) is responsible for completing Form 1040 to accompany a packet of materials the LIDDA is responsible for sending to a Medicaid managed care organization (MCO). The packet of materials includes documents related to an individual’s eligibility or reassessment for Community First Choice (CFC) services provided through a Medicaid MCO.

PROCEDURE

Enter all information – form is self-explanatory.

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