Report a Change with Medicaid

Report a change in the following ways:

  1. Online at select "Manage Benefits" and log in to your Self Service Portal account.
  2. Download the Change Form and return along with verification documents, in the following ways. Include your name, date of birth, and case number (if available) on ALL documents.
    1. Email to
    2. Fax 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
  3. Call 1-844-640-6446 select option 2. 
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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