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To apply for Medicaid, you will need to fill out and submit an application, also known as an Indiana Application for Health Coverage. Health coverage applications are processed by the Family and Social Services Administration (FSSA), Division of Family Resources (DFR).
- Forms
Forms. The following forms, for use in the Indiana Health...
- Forms
Forms. The following forms, for use in the Indiana Health Coverage Programs (IHCP), are maintained by the Indiana Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) and its contractors, as well as other local and federal agencies.
DFR: Becoming an authorized representative. All Counties. Fax: 888-436-9199 or deliver or mail to your local county office. If you do not see the form you are searching for in the sections below, you can search the state forms library. Indiana Application for SNAP and Cash Assistance (state form 53263)
22 sie 2024 · Before you can join MHS as an Indiana Medicaid member, you need to fill out an Indiana Medicaid application. There are several ways to apply for Medicaid in Indiana: Apply online for Medicaid though Indiana Family and Social Services Administration; Apply in Person: locate and contact your local DFR Office. Apply by Phone: call 1-800-403-0864.
Applying for Medicaid. Next Steps. GREAT CHOICE! You’ve taken the first step toward a healthier life – signing up for healthcare coverage. Keep this sheet as a reminder of important information and next steps. Your Application. Application Date: Member ID or Application ID: Receipt Number (if payment was made): Case Number: Your Navigator.
free number 1-800-403-0864, or visit the link above for online application. You will need the following information and documentation to complete the application(s): • Proof of Identity- for adults (can be a driver’s license, State ID card, Social Security
You have the right to apply for benefits at any time during normal office hours. The date you submit your application determines the date your benefits begin if you are eligible. You have the opportunity to submit the application online, by mail, fax, over the telephone, or in- person.