HFS 3120, Medicaid Payment of Medicare Cost Sharing Expenses and HFS 3757, Medicare Saving for Qualified Beneficiaries

Information Memo

04/22/14

• Form HFS 3120 (pdf)/3120S (pdf) (R-03-14), Medicaid Payment of Medicare Cost Sharing Expenses, has been revised.
• Brochure HFS 3757(pdf) 3757S (pdf) (R-03-14), Medicare Savings for Qualified Beneficiaries, has been revised.
• HFS 3120/ (pdf) HFS 3120S (pdf) and HFS 3757/HFS 3757S, may be downloaded on the HFS website.

[signed copy on file]

Michelle R. B. Saddler

Secretary, Department of Human Services

Julie Hamos

Director, Healthcare and Family Services

Forms referenced:

HFS 3120

HFS 3120S

HFS 3757

HFS 3757S