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Shawnda O'Brien, Director of Public Assistance
Shawnda O'Brien
Director
 

 

Applications for Public Assistance

Use the links below to apply.

Mail, fax, drop off, or email your application. See our Contact Us webpage for more information.

Copies of applications are available at local offices, and we can mail one to you if asked.

An electronic application is not available for programs other than MAGI (income-based) Medicaid at this time.

Medicaid Applicants please note:

  • Income-based Medicaid applicants are encouraged to apply at www.healthcare.gov. This is the fastest way to see if you’re covered.
  • Older age or disability Medicaid applicants should only use the following (paper) application at this time:

(for most assistance programs)
 

Other Applications

Review or Recertification

  • The Eligibility Review Form (GEN-72) can be used for most programs. The division sends a prefilled review application form with the standard recertification or review notice.
  • Please note the reporting requirements for our programs, which can be reported directly to your local office, with a GEN-72 or other form.

Other Forms


More Public Assistance forms can be found on our Forms and Information page.

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