Medical Assistance for Qualified Medicare Beneficiaries (PDF)

https://edocs.dhs.state.mn.us/lfserver/public/DHS-2087E-ENG

Medical Assistance for Service Limited Medicare Beneficiaries (PDF)

https://edocs.dhs.state.mn.us/lfserver/public/DHS-2087G-ENG

Medical Assistance for Qualified Working Disabled Individuals (PDF)

https://edocs.dhs.state.mn.us/lfserver/public/DHS-2087F-ENG

Medical Assistance for Qualified Individuals (PDF)

https://edocs.dhs.state.mn.us/lfserver/public/DHS-2087I-ENG

How do I apply?

Complete the Minnesota Health Care Programs Application for Certain Populations and return it to your county or Tribal office.

If you cannot print out the application, call your county or Tribal office and ask to have it mailed to you.

Download the form (PDF) Find your local county or Tribal office

Get help

You can find additional help at the following locations by calling them or visiting their websites:

TTY: Use your preferred relay service

  • Minnesota Aging Pathways at 800-333-2433
  • Disability Hub MN™ at 866-333-2466
Minnesota Aging Pathways Disability Hub MN County and Tribal office directory