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Contact Information:
Does the patient live in New York?*
Yes
No
Does the patient live in Pennsylvania?*
Yes
No
Does the patient live in Nevada?*
Yes
No
Does the patient live in Missouri?*
Yes
No
Are you the patient?*
Yes
No
Does the patient have Medicaid?*
(Medicare is
NOT
enough)
Yes
No
I don't know
The patient needs Medicaid to join. (Medicare is NOT enough).
You need Medicaid to join. (Medicare is NOT enough).
Would you like help applying or determining eligibility?*
Yes
No
Patient will need Medicaid in order to join the program.
Unfortunately, this program is only for New York residents.
Unfortunately, this program is only for Pennsylvania residents.
Unfortunately, this program is only for Nevada residents.
Unfortunately, this program is only for Missouri residents.
Description
FreedomCare may contact me at this number via calls or texts (including through use of an automatic telephone dialing system) to provide information about or to help me enroll in CDPAP with FreedomCare. Your consent is not required to enroll. Message and data rates may apply.
*Marked fields are required fields. We always respect your privacy.
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