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
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South Dakota
Department of Social Services Division of Economic Assistance 700 Governors Drive Pierre, SD 57501 ATTN: Medicaid Eligibility Program Administrator
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Montana
Department of Public Health & Human Services PO Box 202925 Helena, MT 59620 ATTN: Trust Reviewer
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Wyoming
Department of Health Office of Health Care Financing 6101 Yellowstone Rd., Suite 210 Cheyenne, WY 82002 ATTN: Trust Reviewer
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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
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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
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If you are in the Denver Region and have any questions regarding where to send trusts
contact ||DEN
CPS.