Additional Forms You May Need

Additional Information for Select Medicaid Programs (PDF) Authorization to Disclose Health Information – FM 921 (PDF) Adult Disability Report – FM 3218 ME (PDF) Disability Application Cover Letter – FM 3213-F ME (PDF) Adult Application Checklist – FM 3218-G ME (PDF)

Healthy Connections provides full Medicaid benefits to uninsured individuals who are found in need of treatment for breast or cervical cancer or pre-cancerous lesions (CIN 2/3 or atypical hyperplasia).