MyBenefits
The Med-QUEST Division accepts applications for medical assistance coverage online, over the phone, or by mail or Fax. Fill out the application as completely as possible. Completed applications ensure more timely determination. If additional information is needed, the Med-QUEST Division will contact you.
- Fillable PDFApplication
Fill out the application as completely as possible. Print the completed application and mail, fax or drop off the completed application to the Med-QUEST Division Eligibility Office nearest your home address.
- DHS 1100 “Application for Health Coverage and Help Paying Costs”
- Telephone, Fax, or Mail
- Phone at 1-877-628-5076
- TTY/TDD users call 1-855-585-8604
- Mail or fax delivered to Med-QUEST Division Eligibility Offices
- Community navigators and marketplace assisters are available free of charge to assist you
- Need a Language Interpreter? (16 languages)
