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Enrollment in the Health Benefits for Immigrant Adults (HBIA) program will be temporarily paused effective July 1, 2023.

Enrollment in the Health Benefits for Immigrant Seniors (HBIS) program will be temporarily paused effective Nov. 6, 2023.

Elizabeth M. Whitehorn, Director

Long Term Care - Short Form (Sheltered Care and Non-Medicaid facilities)

For Facilities that Qualify for the Short Form Cost Report Sheltered Care Homes, as well as Facilities which have no Medicaid Patients

Downloadable Cost Reports

All facilities licensed under the Nursing Home Care Act must file a Financial and Statistical Report for Long-term Care Facilities. The form for these facilities is commonly called a short form cost report and is filed with the Bureau of Health Finance within 90 days after the end of the facility's fiscal year. The cost report form changes each year, so make sure the proper form is used. Additional details regarding preparation and filing requirements can be found in the cost reporting instructions.

Sheltered care homes, as well as facilities which have no Medicaid patients and do not anticipate any Medicaid patients may meet the requirements for financial reporting by completing the Short Form of Financial and Statistical Report Schedules for Long Term Care Facilities. If the facility wants to be eligible for Medicaid reimbursement at a later date, it will have to complete the regular Financial and Statistical Report for Long Term Care Facilities before a Medicaid rate can be set.