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Medical Services – Appendix O, Renewal Forms Chart Eligibility Group MAGI Renewal DCO-95 DCO-777 DCO-811 DCO-950 DCO-7779 DCO-7781 DCO-81 DCO-237 DCO-662 DCO-702 DCO-704 DCO-710 DCO-712 DCO-713 DCO-727 Pub 405 Pub 407 DCO-106 DCO-107 DCO-108/108C DMS-2602 DCO-2603 DHS-3330 DCO- 4000 Families & Individuals ARKids A X X X ARKids B X X X Newborns X X X Parents & Caretakers X X X Former Foster Care X X X Adult Expansion Group X X Aid to Aged, Blind or Disabled Long Term Services and Supports Nursing Facility X X X X X ● ● ● ● Assisted Living Facility X X X X X ● ● ● X ● ARChoices Waiver X X X X ● ● ● X ● DDS Waiver X X X X ● ● ● X ● Medicare Savings Program ARSeniors X X X QMB X X X SMB X X X QI-1 X X X QDWI X X X Waivers TEFRA X X X X X X ● ● ● ● ● ● Autism X X X X X ● ● ● ● Workers with Disabilities X X X X ● ● ● ● Appendix O (01/17) 1 of 2 A green X signifies this form will be needed for a renewal. A red dot signifies this form will be needed for a renewal if a disability determination from MRT is needed.