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1. medicaid.georgia.gov › document › publicationGEORGIA DEPARTMENT OF HUMAN SERVICES Division of Family and...

   medicaid.georgia.gov › document › publication

   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.

2. dhs.georgia.gov › sites › dhsGeorgia Department of Human Services Application for Benefits

   dhs.georgia.gov › sites › dhs

   Step 1. Fill out the application. Read the questions carefully and give accurate information. Sign and date the application. Step 2. Turn in the application. You will need to tear off pages 1 -3 and keep it for yourself. Mail, fax, or bring in pages 4-8 of this application to your local Division of family & Children Services (DFCS) office.

3. medicaid.georgia.gov › form-94a-medicaid-streamlined-application › downloadApplication for Health Coverage & Help Paying Costs

   medicaid.georgia.gov › form-94a-medicaid-streamlined-application › download

   • 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

4. dhs.georgia.gov › document › documentGeorgia Department of Human Services Application for Benefits

   dhs.georgia.gov › document › document

   If you need help filling out this application or need help communicating with us, ask us or call 1-877-423-4746. If you are deaf or hard of hearing, please call GA Relay at 1-800-255-0135. Our services are free.

5. dch.georgia.gov › dch › filesGEORGIA DEPARTMENT OF HUMAN SERVICES Division of Family and...

   dch.georgia.gov › dch › files

   • Free or low-cost insurance from Medicaid. 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? • Use this application to apply for anyone in your family. • Apply even if you or your child already has health coverage. You could be

6. odis.dhs.ga.gov › General › HomeApplication for Benefits - Georgia

   odis.dhs.ga.gov › General › Home

   If you are applying for Food Stamps (SNAP), TANF and/or Medicaid, you can file an application for benefits with only your name, address, and signature. However, it may help us to process your application quicker if you complete the entire form. You may use this form to file a joint application for more than

7. dfcs.georgia.gov › document › documentGEORGIA DEPARTMENT OF HUMAN SERVICES Division of Family and...

   dfcs.georgia.gov › document › document

   • Families that include immigrants can apply. You can apply for your child even if you aren’t eligible for coverage. Applying won’t affect your immigration status or chances of becoming a permanent resident or citizen. • If someone is helping you fill out this application, you may need to complete Attachment C.