Forms & publications

Notice: If you are a biller or provider, visit our Billers and Providers forms library.

Application for Medicare Savings Program

13-691

Application for the Medicare Savings Program, which may pay your Medicare premiums, copays and deductibles.

Form

Application for pregnant teen health care coverage (for teens under age 19)

14-430

Application for pregnant teen health care coverage for teens under the age of 19.

Form

Application for Tailored Supports for Older Adults (TSOA) program

18-008

Application for the Tailored Supports for Older Adults (TSOA) program which provides support for caregivers who are caring for a family member for free and those who do not have a family member to help them.

Form
Order Form

Application for Take Charge (family planning) services

13-781

Application for Take Charge (family planning) services.

Form

Assisters for Apple Health

19-000

List of assisters available to help individuals applying for or renewing Apple Health (Medicaid) coverage in Washington Healthplanfinder.

Publication

Authorization for release of information

80-020

Use this form to allow the Health Care Authority to release information or records.

Form

Authorized representatives

Webinar about authorized representatives and how the process works for Apple Health (Medicaid).

Publication

Available Washington Apple Health outreach/marketing materials

19-011

Form sharing how to order publications for Apple Health outreach materials in English or download materials in other languages.

Publication

Behavioral health (BH) incident report form

Use this form to submit a incident report about a behavioral health facility.

Form

Behavioral health benefits book

22-661

Find out what behavioral health services are available to you as an Apple Health (Medicaid) client.

Publication

Pages