Complete and submit an Application for Assistance for health care coverage. The completed application will be directed to the appropriate human service zone office (formerly known as county social service office)
- If you are under age 65, not disabled, and you want medical coverage ONLY, complete the fillable Application for Health Care Coverage and Help Paying Costs form (SFN 1909) and return it to a human service zone office.
- If you want to apply for health care coverage and also want to apply for help with food, cash assistance, or child care, complete the Application for Assistance form (SFN 405) and return it to a human service zone office.
- If you are aged, blind, or disabled, and you ONLY want Medicaid coverage, the Medicare Savings Programs, or coverage in a basic care facility, complete the fillable Health Care Application for the Elderly and Disabled form (SFN 958).
- Contact a human service zone office and request an application by mail.
For information about public assistance programs, view the Application for Assistance Guidebook - Which contains IMPORTANT information about programs and client rights.