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  1. • Use this application to apply for anyone in your family. • Apply even if you or your child already has health coverage. You could be eligible for lower-cost or free coverage. • If you’re single, you may be able to use a short form. Visit HealthCare.gov. • Families that include immigrants can apply. childYou can apply for your

  2. The system used in Georgia to pay benefits to individuals who are eligible for Food Stamps. Individuals receiving assistance are issued an EBT debit card, which is used to access their food stamp accounts.

  3. Application for Health Coverage & Help Paying Costs. Form Approved. OMB No. 0938-1191. You may qualify for a free or low-cost program even if you earn as much as $94,000 a year (for a family of 4). Who can use this application? Apply faster online. What you may need to apply. Why do we ask for this.

  4. For info on applying for Medicaid, please review the attached documents. Medicaid Application - English (PDF, 456.05 KB) Medicaid Application - Spanish (PDF, 949.13 KB) Medicaid Application - Attachment A (PDF, 163.25 KB) Medicaid Application - Attachment B (PDF, 139.29 KB)

  5. application? • Use this application to apply for anyone in your family. • Apply even if you or your child already has health coverage. You could be eligible for lower-cost or free coverage. • If you’re single, you may be able to use a short form. Visit HealthCare.gov. • Families that include immigrants can apply. You can apply for your

  6. Use this application to see what coverage you qualify for. • Affordable private health insurance plans that offer comprehensive coverage to help you stay well. • A new tax credit that can immediately help pay your premium for health coverage. • Free or low-cost insurance from Medical Assistance.

  7. GEORGIA DEPARTMENT OF HUMAN SERVICES Division of Family and Children Services Form Approved OMB No. 0938-1191 Use this tool to help answer questions in Attachment A about any employer health coverage that you’re eligible for (even if it’s from another person’s job, like a parent or spouse).

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