Forms & publications

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Application for aged, blind, disabled/long-term care coverage

18-005

Application for health care coverage for individuals seeking aged, blind, disabled coverage or long-term services and supports.

Form
Application for aged, blind, disabled/long-term care coverage PDF
Order Form

Classic Medicaid and the 18-005

Webinar sharing updates about Classic Medicaid and the updated 18-005 application for aged, blind, disabled and long-term support services coverage.

Publication
Classic Medicaid and the 18-005 PDF