TN 62 (04-20)
   SI DEN01120.203 Mailing Addresses for Medicaid Eligibility Decisions on Trusts
   
   
   
   Once a decision on the trust has been made and is properly coded on the SSIRD, send
      a copy of the trust document to the appropriate State Medicaid agency as indicated
      below:
   
   
   
      1634 States
      
         
            
            
         
         
            
            
               
               | 
                   Colorado 
                  Department of Health Care Policy & Financing  1570 Grant St  Denver, CO 80203  ATTN: Trust Unit 
                  or fax to: 303-866-3552 
                  
                  or email as an attachment to: Medicaid.Trusts@state.co.us 
                  
                | 
               
               
                   South Dakota 
                  Department of Social Services  Division of Economic Assistance  700 Governors Drive  Pierre, SD 57501  ATTN: Medicaid Eligibility Program Administrator
                | 
               
            
            
               
               | 
                   Montana 
                  Department of Public Health & Human Services  PO Box 202925  Helena, MT 59620  ATTN: Trust Reviewer
                | 
               
               
                   Wyoming 
                  Department of Health  Office of Health Care Financing  6101 Yellowstone Rd., Suite 210  Cheyenne, WY 82002  ATTN: Trust Reviewer
                | 
               
            
         
      
    
   
      209(b) and SSI Criteria States
      
         
            
            
         
         
            
            
               
               | 
                   North Dakota 
                  Department of Human Services  Legal Advisory Unit  600 E Boulevard Ave Dept. 325  Bismarck, ND 58505-0250  ATTN: Trust Reviewer
                | 
               
               
                   Utah 
                  Department of Workforce Services  Centralized Imaging Unit  P O Box 143245  Salt Lake City, UT 84114 
                  or fax to: (801) 526-9500 or  1-877-313-4717
                   
                  
                | 
               
            
         
      
    
   If you are in the Denver Region and have any questions regarding where to send trusts
      contact ||DEN
      CPS.