Medical Assistance Renewal Request

Renewa​ls online

​​​​Residents can request the following Department of Human Services forms with the online request form below.

​​DHS-5576 Combined Six-Month Report
  • Use this form if you receive SNAP, Housing Support (GRH), Medical Assistance with a spenddown, or MA-EPD. 
  • Do not use this form if experiencing unstable housing, age 65 or older with no income, people with disabilities and no income, traveling farmhands, or living on American Indian tribal lands.​
DHS-3727 Combined Annual Renewal for Certain Populations 
  • Complete this form if you receive income from the Social Security Administration along with any of the following programs:
    • SNAP
    • Minnesota Supplemental Aid (MSA)
    • Housing Support (GRH)
    • Medical Assistance, including the Medicare Savings Program.
 DHS-8107 Household Update Form 
  • You can use this form to complete your yearly recertification if you are receiving SNAP and any cash program. If enrolled in Medical Assistance, including the Medicare Savings Program, a separate form is required.
 DHS-2128 Renewal for People Receiving Long-Term Care Services 
  • This form is used for people enrolled in Medical Assistance, living in a skilled nursing facility, or receiving services through a community waiver.
 DHS-3418 Minnesota Health Care Programs Renewal 
  • ​This is the annual renewal form for Minnesota Health Care Programs for certain populations:
    • ​​​​21 years of age or older with no dependents and have Medicare coverage
    • 65 years of age or older
    • A child currently in foster care
    • Blind or have a certified disability​
DHS-8262 Minnesota Health Care Programs Renewal for Families, Children and Adults
  • This is the annual renewal form for Minnesota Health Care Programs for families, children and adults. ​​ ​

Applications for Maxis-based hea​lth care:

DHS-3876 Application for Certain Populations
  • This application is for anyone who is 65 years and older, is blind or disabled, enrolled in Medicare, receives Social Security income, or applying for MA-EPD.
DHS-3531 Application for Medical Assistance for Long-Term Care Services
  • Not currently active on Medical Assistance and may live in or looking to move into a nursing home or apply for community waiver services to remain in your home.
DHS-3543 Request for Payment of Long-Term Care Services
  • Currently active on Medical Assistance Program and may live in or looking to move into a nursing home or apply for community waiver services to remain in your home.

​​If you prefer to fill out the form online before returning to your county office, you can access forms from the Department of H​uman Services website.  Search forms by the four-digit number or search by form name.​

​Renewals by ​​phone

If you would like to complete your Medical Assistance renewal over the phone, please call 651-554-5611 between 10 a.m.–2 p.m. Monday-Friday.  ​​


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Last updated: 10/22/2024 4:00 PM