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Get BHSF 2-L 2007-2024

Rage for the person in the nursing home or group home. If you do not renew, medical coverage will end. You may renew by mail, phone, fax, or in person. After we hear from you, we will let you know if they still qualify. How to Renew By mail: Fill out and sign this form. Return the form and needed documents (see page 6) in the envelope provided. If you need extra space for any question, use a separate sheet of paper. By phone: Call the worker who sent you this form. You may also call (toll-free).

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