Update Benefits Information | The Arc Master Trust

Name of Beneficiary*
First Last
Description of Change in Benefits*
*New Benefit Info Medicaid, please include the Medicaid card number, as well as the case number.
- Medicaid (*Please provide Medicaid Card Number and Medicaid Case Number)
- Family Supports Medicaid Waiver
- Aged and Disabled Medicaid Waiver
- SSI
- SSDI
- Food Stamps
*New Benefit Info Medicaid, please include the Medicaid card number, as well as the case number.
Name*
First Last
Phone*
Email*
Consent*
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