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Clear Form *DHS3640ENG* DHS3640ENG 1211 Minnesota Health Care Programs (MHCP) Advance Recipient Notice of Noncovered Service/Item MHCP does not pay for everything, even some services or items that.

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Providers: If you see any inaccurate information about you or your practice, call the Provider Resource Center at 651-431-2700 or 800-366-5411.

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.

If you filled out your paper application correctly and we have all the information we need, your application is complete. Watch your mail. Within three weeks of when you sent or gave us your application, you should receive one or more of the following: A Minnesota Health Care Programs (MHCP) ID card.

If your family's income is more than 138% of the Federal Poverty Guidelines (FPG), but at or below 200% of FPG ($27,180 per year for an individual; $55,500 for a family of four) and you can't get affordable health coverage through your job, you may qualify for another public program called MinnesotaCare.

A state and federal program (called Medical Assistance in Minnesota) that provides health insurance that covers a broad array of health services for people, including families and children with low-incomes, older adults and people with disabilities.

Medical Assistance (MA) is Minnesota's Medicaid program for people with low income. MA does not require you to pay a monthly premium. MA members have small co-pays for some services, usually $1 - $3. MinnesotaCare is a program for Minnesotans with low incomes who do not have access to affordable health care coverage.

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.

Medical Assistance (MA) is Minnesota's Medicaid program for people with low income. MA does not require you to pay a monthly premium. MA members have small co-pays for some services, usually $1 - $3. MinnesotaCare is a program for Minnesotans with low incomes who do not have access to affordable health care coverage.

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© Copyright 1997-2025
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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