Form 2290 for Franklin Ohio 2024-2025

Form 2290 for Franklin Ohio: What You Should Know

Team:; Staten Island AOT Team or call. For information, contact the NYC Department of Mental Health at to receive an appointment online for an appointment in New York. New York State is responsible for the following NYC-AOT areas: Eliminate your Medicaid, CHIP, ASH, or Children's Health Insurance Program (CHIP) eligibility Requirements: Must enroll in a New York State qualified health plan (e.g., NYS Medicaid or Children's Health Plan (CHIP)). Must be an adult with a New York State Medicaid (e.g., NYS Medicaid or CHIP), NYS CHIP, NYS ASH, or NYS Federal Unemployment Tax Act (FTA) withholding. Must have completed a Qualified Physician or Surrogate (RPS) interview and provided proof of NYS or out-of-network health insurance coverage, if needed. Qualified Physician is in the process of providing proof of NYS or out-of-network health insurance coverage. Qualified Surrogate is a qualified health plan customer who has been assigned as a New York State “Family Member” for purposes of this New York State program since July 1, 2014. Any individual who qualifies through this program is eligible to receive medical benefits from NYS's Division of Medical Assistance in the form of NYS Medicaid in lieu of NYS ASH/CHIP. Qualified Surrogate, if assigned to be in the family by NYS Division of Medical Assistance, is eligible to receive NYS Medicaid in lieu of NYS ASH/CHIP and medical benefits such as: Health Care Provider Coverage, Pharmacy Services, Optometry, etc. Must not be the sole or primary caregiver Must have a NYS Medicaid or NYS CHIP enrolled or be eligible through NYS ASH and/or NYS CHIP.  Must not have obtained such health insurance outside the New York City AOT program (e.g., NYS Medicaid or Children's Health Plan (CHIP)).

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