People with the following immigration status may be eligible for 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the child's full name, date of birth, and today's date in the designated fields.
3. Indicate the child's immigration status by selecting 'YES' or 'NO' in response to whether it falls into one of the eligible categories.
4. Fill out the home address and mailing address if different. Provide primary language(s) spoken by the child.
5. Answer questions regarding health insurance coverage and enrollment in Health Home Care Management, marking 'YES' or 'NO' as applicable.
6. Complete caregiver contact information for up to two caregivers, ensuring to specify their relationship to the child and legal guardian status.
7. Provide any additional information required, including current providers and mental health diagnosis if known.
8. Finally, ensure all necessary signatures are obtained before submitting the form for processing.

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