Help with your Medicaid Forms

​​Do you need assistance completing your Medicaid forms to determine your eligibility?

Once a year, the Michigan Department of Health and Human Services requires that you complete new paperwork related to your enrollment and eligibility for Medicaid. You should receive these forms in the mail from your Case Worker about 60 days before they are due.

Once you receive them, just complete the forms and return to your Case Worker by the due date.

Need help completing your forms?

We can help. Just call Member Services Monday - Friday, 8 a.m. to 5 p.m. Molina has representatives who speak your language available to speak with you.

Or you can call your worker using the number listed on the top of the form.

Did you lose your form?

You can get a copy of a new form online by visiting:,5885,7-339-71551_7338---,00.html

Have other questions?

Please reach out to Molina Healthcare of Michigan’s Member Services team Monday - Friday, 8 a.m. to 5 p.m. We’re always happy to help!​​​​​​