How to Apply


You can submit your application in the following ways:

    1. Online at the select “Apply”  Or 
    2. Fill out an application and return the following ways:
      1. Email your signed application
      2. Fax your signed application to 419-774-0051.
      3. Mail signed applications can also be mailed to the address below.
        *If you are applying for Medicaid, your tax status information is needed. Please complete the MAGI Tax Information Worksheet and submit with your application.
      4. Deliver in person - Signed applications can be placed in the exterior or interior drop box at:
        171 Park Ave East
        Mansfield, OH 44902
    3. Call 1-844-640-6446 Select option #2.


As part of the application, you will need to submit a number of verification documents. The specific documents accepted are listed in the application, but in general we will need to verify:

  • Who is in the household
  • All household income, and
  • Basic information such as identity, Social Security Number(s) and Birth Verification(s) *
    *If you have provided these documents to us with in the last 7 years, you will not be required to provide them again.

Please write your name and case number or social security number on all verification documents.


Once you have submitted your application, you will receive a phone call and/or letter in the mail giving you an appointment date and time to complete a phone interview. That appointment will generally be within 7 days from the submission of your application*.

During the interview, your caseworker will be able to answer any questions you may have about the application process.

* Please note: Applications for waiver Medicaid and for those in nursing homes are scheduled separately and will not necessarily fall into these timeframes. Certain other Medicaid applications for benefits may be completed without an actual interview. If yours fits the criteria, you will be notified accordingly.


At the end of your interview, your caseworker will review with you any additional verification documents we need to complete your case. You will be mailed a checklist for these documents due 10 days from the date of your interview. The sooner you return the verification documents, the sooner your case can be completed.

Return verification documents to us with your name, date of birth, and case number on ALL documents.

  1. Email documents to:
  2. Fax documents to 419-774-0051.
  3. Mail documents to the address below.
  4. Deliver in person - Documents can be placed in the exterior or interior drop box at:
    171 Park Ave East
    Mansfield, OH 44902
Phone: 419-774-5400 
Fax: 419-774-0051
Hours of Operation: Monday‑Friday
Call Center Hours: Monday‑Friday
8:00am - 3:30pm


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