Inquiry for a Medicaid Apartment at Village at the Harbor – San Juan County Public Hospital District #1

The District has a small number of assisted living Medicaid beds with Village at the Harbor. Interested individuals should fill out the application below to be considered. Please note: we are only accepting inquiries online; we will not be accepting applications in paper form, over the phone, or through an employee of the District.

Please fill out the form below. Prior to submitting, please ensure that you or the person you are applying on behalf of, meet the following criteria:

Medicaid eligibility and enrollment; proof of Medicaid will be required before enrollment. Note that we do not assist individuals with applying for Medicaid.
- If you are not currently enrolled in Medicaid, you can learn how to apply here: medicaidplanningassistance.org.
Individual applying for a Medicaid apartment must be 65 or older.
Individual applying for Medicaid must fall under the current guidelines and eligibility to live at Village at the Harbor.
- Please review: Disclosure of Services Provided by Village at the Harbor

Medicaid Apartment Application

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Name of Applicant(Required)

First Last

Your Email Address(Required)

Email Address Confirm Email Address

Phone Number(Required)

Have you been approved for Medicaid?(Required)

Yes

Residency Status(Required)

I am a resident of San Juan, Pearl, Brown, Stuart, Johns, or Henry Island.

I am not a resident of San Juan, Pearl, Brown, Stuart, Johns, or Henry Island.

Please note: at this time we are only accepting applications from residents of San Juan Island for Medicaid apartments. Applicants will be required to provide proof of residence at a later time.

I am over the age of 65. (If you are applying on behalf of a family member or loved one, are they over the age of 65?)(Required)

Yes

Are you a current resident of Village at the Harbor? (If you are applying on behalf of a family member or loved one, are they a current resident of Village at the Harbor?)(Required)

Yes

Have you been a resident at Village at the Harbor for more than three years?(Required)

Yes

Not eligible at this time.

We’re sorry! At this time, San Juan County Public Hospital District No. 1 is only accepting applications for Medicaid apartments from San Juan Island residents who meet our current application criteria. Please check our news page for further updates regarding Medicaid apartments and the application process.

Address of Applicant(Required)

Street Address Address Line 2 City State ZIP Code

Have you resided at your current address for at least three of the past five years?(Required)

Yes

Additional Addresses

At this time, to be eligible for a Medicaid apartment at Village at the Harbor, the District requires that each applicant have resided on San Juan Island or within the Hospital District for at least 3 of the past five years. Please add any addresses you have resided at on San Juan Island or within the Hospital District to meet the minimum time frame requirement to qualify for consideration for a Medicaid Apartment.

Address 2 (Optional)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address 3 (Optional)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address 4 (Optional)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address(Required)

My mailing address is the same as my physical address.

My mailing address is different than my physical address.

Mailing Address of Applicant

Street Address Address Line 2 City State ZIP Code

Contact Information

I am applying for a Medicaid apartment for myself.

I am applying for a Medicaid apartment on behalf of a family member or loved one and would like to receive communication regarding this application.

Name

First Last

How many years have you resided on San Juan, Pearl, Brown, Stuart, Johns, or Henry Island.(Required)

Medicaid Apartment Application

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Not eligible at this time.

Additional Addresses

San Juan Island EMS

Village at the Harbor

San Juan County PublicHospital District No. 1

San Juan County Public
Hospital District No. 1