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Click 'Get Form' to open the DHS-3876 ENG application in the editor.
Begin by reading the Notice of Privacy Practices and Rights and Responsibilities. It's crucial to understand your rights before proceeding.
Fill in your personal information in Section 1, including your name, date of birth, and contact details. Ensure accuracy as this information is vital for processing your application.
In Section 2, list all household members living with you. Provide their names, social security numbers, and relationships to you.
Complete Sections 3 through 13 by answering questions about citizenship status, income sources, assets, and any medical coverage you currently have.
Review all sections for completeness. If additional space is needed for answers, attach a separate sheet with the question number referenced.
Sign and date the application in the designated area. Remember that an authorized representative must also sign if applicable.
Attach required proofs as listed on page A of the form. This may include income statements or identification documents.
Submit your completed application by mailing it to your county agency using the addresses provided on pages B and C.

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Is MinnesotaCare the same as Blue Plus?

MinnesotaCare from Blue Plus is a healthcare plan for people who need affordable healthcare but dont qualify for Medical Assistance, Minnesotas Medicaid program. MinnesotaCare from Blue Plus is available in all Minnesota counties.

Is MN Care considered Medical Assistance?

Medical Assistance (MA) is Minnesotas 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.

What is the income limit for MinnesotaCare?

MinnesotaCare is for families with income at or below 200% of the Federal Poverty Guidelines (FPG) ($30,120 per year for an individual; $62,400 for a family of four), but above 138% of FPG ($20,783 for an individual; $43,056 for a family of four).

What is the Medical Assistance program in Minnesota?

MA is Minnesotas largest health care program and serves children and families, pregnant women, adults without children, seniors and people who are blind or have a disability. Most people who have MA get health care through health plans. You can choose a health plan from those serving MA members in your county.

What is the difference between medical assistance and MinnesotaCare?

It is online at .applymn.dhs.mn.gov. ApplyMN is a smart application that only asks questions based on the program(s) requested, the household composition and an applicants response to previous questions.