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Forms & publications
Notice: If you are a biller or provider, visit our Billers and Providers forms library.
Application for Medicare Savings Program
13-691Application for the Medicare Savings Program, which may pay your Medicare premiums, copays and deductibles.
FormApplication for pregnant teen health care coverage (for teens under age 19)
14-430Application for pregnant teen health care coverage for teens under the age of 19.
FormApplication for Take Charge (family planning) services
13-781Application for Take Charge (family planning) services.
FormAssisters for Apple Health
19-000List of assisters available to help individuals applying for or renewing Apple Health (Medicaid) coverage in Washington Healthplanfinder.
PublicationAuthorization for release of information
80-020Use this form to allow the Health Care Authority to release information or records.
FormAuthorized representatives
Webinar about authorized representatives and how the process works for Apple Health (Medicaid).
PublicationAvailable Washington Apple Health outreach/marketing materials
19-011Form sharing how to order publications for Apple Health outreach materials in English or download materials in other languages.
PublicationBehavioral health (BH) incident report form
Use this form to submit a incident report about a behavioral health facility.
FormBehavioral health benefits book
22-661Find out what behavioral health services are available to you as an Apple Health (Medicaid) client.
Publication