Medicaid, ARHOME, and ARKids Beneficiaries

Watch for your renewal form, fill it out, and return it to Arkansas Medicaid right away to avoid losing Medicaid coverage if you are eligible.

Forms & Documents

Forms & Documents

Office of Long Term Care Forms

2018 Long-Term Services & Support Application
2018 Long-Term Services & Services Application (Spanish)
Long-Term Services & Supports Program Information
Long-Term Services & Supports Program Information (Spanish)


TitleTypePosted Date
Silver Haired Legislative Delegate Petition FormPDF01/03/2020
AAS-9511 Change of Client Status FormPDF08/01/2019
Money Follows the Person: Important Notice FormPDF05/13/2019
Money Follows the Person: 24 Hour Contact Information FormPDF05/12/2019
DHS-4000 Release of Info Authorization – Spanish EditionPDF05/11/2019
DHS-4000 Authorized to Disclose Health Info-Release of Info FormPDF05/11/2019
DHS-8504 Start Service FormPDF05/10/2019
DHS-8505 Informed ConsentPDF05/09/2019
DHS-8506 MFP Assessment and Personal History FormPDF05/08/2019
DHS-8507 Checklist of Clients Rights FormPDF05/07/2019
DHS-8508 Statement of Rights & Responsibilities of MFP Participants FormPDF05/06/2019
DHS-8510 Demonstration Services Freedom of Choice FormPDF05/05/2019
DHS-8511 Transition Risk Plan FormPDF05/04/2019
DHS-8512 Risk Mitigation Monthly FormPDF05/03/2019
DHS-8520 General Professional Recommendations FormPDF05/02/2019
DHS-8521 Demonstration Services Plan of Care FormPDF05/01/2019
DHS-8523 Housing Information FormPDF04/30/2019
MediMaide Checklist (Need copy of Prescriptions) FormPDF04/29/2019
Consent to Discuss FormPDF04/28/2019
Tier Level Request FormPDF04/27/2019
Transition Goods and Services FormPDF04/26/2019
Helping Hands Respite Programs formPDF02/19/2019

Information & Forms

Silver Haired Legislative Delegate Petition Form
Silver Haired Legislative Session Guidelines


Dealing with the Effects of Trauma
Infant Mental Health Therapist Provider Training