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Clear Form *DHS-3417-ENG* DHS3417ENG 210 Minnesota Health Care Programs Application Office Use Only DATE RECEIVED CASE NUMBER WORKER NUMBER Minnesota Department of Human Services CM/01/YY Answer all.

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Related content

MDHHS - Forms & Applications - State of Michigan
The Michigan Department of Health and Human Services (MDHHS) - Information on DHS...
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Related links form

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Contact support

Request an application by calling MinnesotaCare at (651) 297-3862 (Twin Cities Metro) or 1-800-657-3672 (toll-free). For TTY call 711 or 1-800-627-3529. Complete it and mail it in. Print the application from the Minnesota Department of Human Services website, complete it and mail it in.

It takes 30-45 days to process the application. Enrollees pay a monthly premium based on family size, income and the number of people in their family who are covered. Children under age 21 who meet a lower income guideline pay a fixed premium of $4 a month.

Coverage Options through MNsure Medical Assistance: Covers low-income Minnesotans, including children and pregnant women, as well as people with disabilities. There is no monthly premium. Enrollment is available year-round. MinnesotaCare: Covers lower-income Minnesotans who aren't eligible for Medical Assistance.

If your initial result says that you are eligible for Medical Assistance (MA) or MinnesotaCare, watch your mail. Within three weeks you should receive one or more of the following: A Minnesota Health Care Programs (MHCP) ID card. This means you have health care coverage.

DHS-6696: This form is used to apply for Medical Assistance (MA), MinnesotaCare, and affordable private health insurance (qualified health plans) with premium tax credits and cost-sharing reductions through MNsure.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232