Application for Health Coverage and Help Paying Costs
According to Minnesota Statute § 256.962, subd. 6 Application and assistance. (a) The Minnesota health care programs application must be made available at provider offices, local human services agencies, school districts, public and private elementary schools in which 25 percent or more of the students receive free or reduced-price lunches, community health offices, Women, Infants and Children (WIC) program sites, Head Start program sites, public housing councils, child care centers, early childhood education and preschool program sites, legal aid offices, and libraries. The commissioner shall ensure that applications are available in languages other than English.
Application for Health Coverage and Help Paying Costs (English)
Use this form or apply online at MNsure to apply for the following programs and help:
- Medical Assistance (MA)
- MinnesotaCare
- A tax credit and payment assistance to lower your cost for coverage
This form is also available in these languages:
- Hmong – MNsure application DHS-6696 (PDF)
- Somali – MNsure application DHS-6696 (PDF)
- Spanish – MNsure application DHS-6696 (PDF)
- Russian – MNsure application DHS-6696 (PDF)
- Vietnamese – MNsure application DHS-6696 (PDF)