Renewal forms for health care programs
We need to review your information at certain times to see whether you are still eligible for Minnesota Health Care Programs (MHCP). This review process is called renewal.
When it is time to renew, DHS will send you a notice explaining what to do.
- We will check electronic data sources to see whether you and your household still qualify. If we can confirm eligibility without needing a renewal form from you, we will send you a notice and an information summary. You must review the information summary to make sure all the information about you and your family is correct. If you have a change or correction, you must report it to your servicing agency. If everything is correct, there is nothing you need to do.
- For those enrolled in Medical Assistance for People Who Are Aged 65 or Older or People Who are Blind and Have A Disability (MA-ABD), or if you have a Medicare Savings Program (MSP), see the DHS webpage for more information on an automatic renewal.
- For those enrolled with Medical Assistance for Families, Children and Adults Without Children and MinnesotaCare, see Renew My Coverage page for more information.
- If we cannot confirm and renew eligibility for one or more people in your household using electronic data sources, we will send a renewal form for you to complete, sign and return by the due date. Contact your servicing agency to request a reprint if you lose your renewal form:
- When anyone in your household is enrolled with Medical Assistance, contact your county or Tribal worker.
- If no one in your household is enrolled with Medical Assistance, but is enrolled with MinnesotaCare, contact DHS Health Care Consumer Support.
These are the renewal forms which can be reprinted by clicking the links:
- MHCP renewal for people who are age 65 or older and people who are blind or have a disability; people enrolled in a Medicare Savings Program; people enrolled in Medical Assistance with a spenddown, and people who are age 21 or older without children and have Medicare coverage (DHS-3418) (PDF)
- MHCP renewal for people receiving long-term care services (DHS-2128) (PDF)
- Minnesota Family Planning Program renewal (DHS-4740) (PDF)
- Medical Assistance - Breast and Cervical Cancer coverage renewal (DHS-3525) (PDF)