Form H1200-MBI, Application for Benefits – Medicaid Buy-In

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Documents

Effective Date: 1/2022

Availability

English PDF: Form H1200-MBI
Spanish PDF: Form H1200-MBI-S

Instructions

English and Spanish forms can be found under the title "Form to apply for Medicaid for People with Disabilities Who Work – Medicaid Buy-In (H1200-MBI)".