How We Help /

How To Apply

Filling out an application is easy, but we’re always happy to answer questions along the way!

Our staff can assist by phone or in person at one of our regional offices. We can even arrange to meet you at your home or another convenient location, if that helps.

Applying to Specialized Care for Children

To apply, you may download and print out the application form below. You may also contact one of our regional offices to request that the forms be mailed to you. If you need help determining which region you’re in, use our Find an Office page.

How long does it take?

Once you’ve submitted your application, a Care Coordination Team at your local regional office will review your application and send you an Authorization to Release Health Information. This authorization allows us to receive the medical records necessary to confirm whether your child has an eligible condition.

We work as quickly as we can to determine if and how we can help your child. Our goal is to begin making a difference in the life of your family as soon as possible!

Find out how we protect your privacy (English or Spanish)