Forms Directory

We encourage Minnesotans to:

  • Apply with free help from an assister, or
  • Apply online.

In limited cases, you may need to use a paper application. A MNsure-certified assister can tell you if that's the right path.

Paper Applications

Application WITH financial help (PDF) – DHS-6696

Use this form to apply for: 

  • Medical Assistance (MA), 
  • MinnesotaCare, and 
  • Qualified health plans with financial help through MNsure. 
This form is fillable so you can type in answers, print out the completed application and mail or fax it to us. This form is also available in Hmong, Russian, Somali, Spanish and Vietnamese.
 
 
Use this form if:

  • Health coverage from a job (employer-sponsored insurance) is available for someone in your household, and 
  • You are applying for health coverage with financial help through MNsure. 
Ask your employer to help you fill it out. This PDF form is also available in Hmong, Russian, Somali, Spanish and Vietnamese.
 

Application WITHOUT financial help (PDF) – DHS-6741

Use this form to apply for: 

  • Qualified health plans without any financial help through MNsure.
If you use this form, you will not get an eligibility decision for financial help.
 

This form is fillable so you can type in answers, print out the completed application and mail or fax it to us. This PDF form is also available in Hmong, Russian, Somali, Spanish and Vietnamese.

Application for Certain Populations (PDF) – DHS-3876

Use this form to apply if all the applicants in the household meet at least one of the following: 

  • Age 65 or older
  • Requesting help only with Medicare costs
  • Children in foster care
  • Age 21 years or older with no dependents and have Medicare coverage
  • Receiving Supplemental Security Income (SSI)
  • Applying for Medical Assistance for Employed Person with Disabilities (MA-EPD) 
This PDF form is also available in Hmong, Russian, Somali, Spanish and Vietnamese.

Need a hand? We're here.

If you aren’t sure where to begin, talk to a MNsure-certified assister. They can help you figure out your first step.

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