It's easy to apply for CHIP! You may apply by printing the CHIP application below and mailing, faxing, or delivering your application to a Department of Social Services local office. You may also contact your nearest Department of Social Services office or call 1-800-305-3064 to request an application be sent to you.
The start date of medical coverage depends on the date the application is received by the Department. An interview is not required to apply for medical assistance, but you may request one.
Medical coverage may go back three months prior to the month the application is received by the Department, if you have unpaid medical bills and you meet eligibility requirements during this time period. If you are interested in eligibility for the prior three months, include proof of income from the month(s) prior to the month the application is submitted to the Department.