Apply for the MI Choice Medicaid Waiver Program

You can apply for the MI Choice Medicaid Waiver Program using the form below. If you have any questions, please reach out to us using our Contact page.

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Person in need of services

Name
Address
Email Address
MM slash DD slash YYYY
Health insurance: Check all that apply
Veteran Status:
Services needed: Check all that apply

Contact person, if not the person in need of services:

Name
Relationship to person in need of services: Check all that apply
This field is for validation purposes and should be left unchanged.