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  • Molina Pcp Change Form

Get Molina Pcp Change Form

Request to Change Primary Care Provider Medicaid (Healthy MI and CSHS) Molina Dual Options (MI Health Link) Members Name: Marketplace Medicare (DSNP) Members Molina ID #: Date of Birth: Please print.

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Call Member Services at 1-855-690-7784 (TTY 711). Fax completed form to 1-866-840-4993. Incomplete forms will not be accepted.

A member can change an address through the kynect hotline (1-800-635-2570) or kynect online. 2. Members can also visit or call their local DCBS office.

To change your managed care organization, call toll free (855) 446-1245 or (800) 635-2570 from 8 a.m. to 6 p.m. Eastern time to speak with a Medicaid services representative or go online to the kynect website. All plan changes made during open enrollment will take effect on Jan. 1, 2023.

Humana Healthy Horizons® in Kentucky is a Medicaid health plan built by Kentuckians for Kentuckians. You must renew your coverage each year. Renewal means you get to keep your coverage with us. If you don't renew your coverage, you can lose your healthcare coverage and the extras you get from us.

If you would like to change your plan you can call the Texas Enrollment Broker Helpline at 800-964-2777 or log into the Your Texas Benefits account .

​​​​​​​​​​​​​​​​​​​​​​Medicaid provides medical assistance to eligible low-income Kentuckians. Use the links below to learn more about some available programs and services. If members have any questions, please contact Member Services toll-free at (800) 635-2570.

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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