Enrollment Process


NOTE: Business Agreements and Dental Services Agreements must be signed before face sheets should be faxed.


Preparing the Applications: 

  1. Print face sheets for your Medicaid residents.
  2. Prepare a census list of which of these residents are “facility trust” where the facility handles the resident’s money or “family trust” where the family handles the money. Or instead of preparing a census list, it could be noted on the face sheet.
  3. On the face sheet please circle which responsible party is authorized to sign for the resident.
  4. Fax the face sheets for your Medicaid residents to Senior Care Solutions office to:          


The Senior Care Solutions (SCS) office will populate the enrollment applications with resident’s name, facility address, and responsible party. (Social Security numbers and Medicaid numbers will not be inserted at this time.)

Reviewing the Letters:

At the bottom of this document you will find the letters that will be sent to the families regarding this dental/vision in facility care. These letters come from you at the facility. You can revise them anyway you want. The families need to understand that regardless of whether their loved one has teeth, no teeth, or dentures, it is extremely important that they be seen by a dentist on a regular basis. You know your families and how best to express the importance for them to authorize.

There will be two different letters to review:

  1. Letter to families where family handles the money.
  2. Letter to families where the facility handles the money.

Printing the Letters:

The Senior Care Solutions office will gladly print these letters for you or they can be printed on your letterhead at the facility.  We need to know in advance if you want Senior Care to print the letters and how many will be facility trusts and how many family trusts.

Day of Enrollment:

The SCS Program Consultant will come to your facility and complete the enrollment.

The only assistance needed from the facility will be the following:

  • Facility provides envelopes and letters to the families (unless SCS printed the letters). If the envelopes do not have the facility address on the envelope, then it would be helpful to have labels printed before hand.
  • The SCS Program Consultant will address, stuff, and seal each envelope with the respective letter and application for your mailing.
  • The facility trust applications can be signed by a representative from the facility.


 Note:  On the applications for the residents where the facility handles their money, a representative from your facility is legally authorized to sign the application. If you have questions about this, please do not hesitate to ask about clarification.


The Program Consultant brings the enrollment applications signed by the facility to the SCS office for processing. The SCS office will process the paperwork for DHS offset approval.

A statement from Citizens Security Life will arrive once 704s start coming in.  No premiums are paid until offsets have been approved or the facility has received 704s. (See “Your First Statement” under the ACCOUNTING section of this manual.


Receiving the 704s:

Once 704s are approved scheduling can begin for the dental and eye doctor. Senior Care Solutions gets updates on a regular basis from the DHS offices on the status of the offset approvals, however; when you start getting your 704’s, please fax a copy to 501-821-4311.


NOTE: Before the program can go into effect, there must be a minimum of 20 residents enrolled.