Health Care
Apply for Health Care
Apply online at the MNSure website or complete the Application for Health Coverage and Help Paying Costs (PDF) and mail or drop it off at our office. If applying for Long-term Care Health Care (nursing home & home/community based waiver services), complete the Application for Medical Assistance for Long-Term-Care Services (PDF). Please do not use the online application for Long Term Care.
Changes to your Health Care
For changes to your health care case, including adding a pregnant women or other family member and address changes, please contact your worker. A new application is not required in many situations.
- Addendum - English (PDF)
- Combined 6 Month Reporting Form (PDF)
- Household Report Form (PDF)
- Release of Information (PDF)
- Shelter Form (PDF)
- Claim Form for Medical Trips (DOC)
- Change Report Form - English (PDF)
- Change Report Form - Spanish (PDF)
- Asset Assessment for Medical Assistance (PDF)
- Addendum - Spanish (PDF)
Disclaimer
In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, religion, political beliefs, or disability. To file a complaint of discrimination, write:
United States Department of Agriculture
Director, Office of Civil Rights
1400 Independence Avenue SW
Washington, D.C. 20250-9410
You can also call:
- Voice: 866-632-9992
- TTY: 800-877-8339
- TTY: 866-377-8642
The U.S. Department of Agriculture is an equal opportunity provider and employer.