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Your consent Please read and agree to the following before sending your answers.
I authorize Vista Verde Homes (Medicaid Meals) to use the information I provide, including my Medicaid Client ID, to identify programs I may qualify for and to share my information with Medicaid Managed Care Plans, Social Care Networks, and authorized service providers for eligibility review and referral purposes. I understand that participation is voluntary, I may withdraw at any time, and completing this form does not guarantee eligibility or services.
By submitting this form, you confirm that the information you provide is accurate to the best of your knowledge. You authorize Vista Verde Homes to use your responses to evaluate potential program eligibility. You consent to the limited sharing of your contact and qualification information with appropriate government, nonprofit, or community-based service providers for the purpose of facilitating referrals. You understand that participation is voluntary and that you may decline or withdraw from the referral process at any time. You acknowledge that Vista Verde Homes is not a healthcare provider, insurer, or government agency and does not guarantee acceptance into any program. I agree to the eligibility screening and referral authorization above.
By providing your phone number, you consent to receive informational calls and text messages regarding eligibility screening, referrals, application status, and available services. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for assistance.
You agree to receive emails about your eligibility screening, referrals, and application status. You can unsubscribe at any time.
I agree to receive emails about my screening and referrals. (optional)
Participation is voluntary. You can withdraw at any time. Completing this form does not guarantee eligibility or services.