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You may either mail or bring the completed Medicaid Application to the County Department of Social Services (DSS) in the county where you live. This will begin the application process. Additional forms will be required to be completed after the county evaluates your initial application for Medicaid.
Faxed applications and applications received over the internet are not acceptable.
Note: The free Adobe Acrobat Reader is required to view and print these PDF files.
| Program | Printer-Ready Application | Interactive Application (Fill out online and then print. This form can not be submitted electronically) |
|---|---|---|
| Medicaid for the Aged, Blind, or Disabled | DMA-5000 | DMA-5000-ia |
| Medicaid for Infants, Children, and Families (includes Health Choice) | DMA-5063 | DMA-5063-ia |
| Be Smart Family Planning Program | DMA-5063 and DMA-5063a | DMA-5063-ia and DMA-5063a-ia |
For more information, see:
