It's easy to apply!

1. You can apply online at https://nheasy.nh.gov;
2. You can apply by printing out one of the following Applications, completing it, and mailing it in to your local District Office. To find the District Office that serves your area, please see Catchment Areas

If you only want to apply for Medicaid or for other insurance affordability programs available through the Marketplace, use the Application for Health Coverage & Help Paying Costs (Form 800MA)
La solicitud de cobertura de salud y los costos de pago Ayuda (Spanish)
You may also fax in your application for Medicaid to (603) 271-8604. Or you may call us at 1-800-852-3345, extension 9700 to apply for Medicaid over the phone.

If you would like to apply for all the types of assistance we offer, including cash, Food Stamps, child care assistance, and Medicaid, complete both of the following forms:

• Application for Assistance (Form 800)
  • Solicitud de Asistencia (Spanish)
• Medical Assistance for Children, Pregnant Women, and Parent/Caretaker Relative (Form 800 Insert)
  • Asistencia Médica para niños, mujeres embarazadas, y el padre / cuidador relativa (Spanish)
• You can contact your local District Office to request an application. To find the District Office that serves your area, please see Catchment Areas

After completing an Application, you may also need to:

• Talk to a Family Services Specialist (FSS) about your situation and your needs. During this interview, the FSS will tell you about program requirements. The FSS will also tell you about your benefits. We will tell you if this interview is required; and
• Give us proof of your household circumstances.
  These are examples of the types of proof you may need to give us:
  Examples of Acceptable Proof (Form 800V)
  Ejemplos de Prueba Aceptable (Spanish)
  
  To avoid delays if you are scheduled for an interview, please have the proofs listed in Form 800V with you.

Information that every Applicant must know:

• Programs & Services Guide (Form 800A)
  • Guía de Programas y Servicios (Spanish)
• Your Rights & Responsibilities (Form 811R)
  • Sus derechos y responsabilidades (Spanish)
• Reporting Requirements Handout (Form 215)
  • Exigencias de información Folleto (Spanish)
• How to Report a Change in Your Case (Form 217)
  • Cómo informar de un cambio en su Caso (Spanish)
• It Takes A Village (Form 77U)
  • Se necesita un pueblo (Spanish)
• Your Rights To An Administrative Appeal

Information that every SNAP Applicant must know:

• Food Stamp Pamphlet (Form 77d)
  • Cupones de Alimentos Folleto (Spanish)
• How to Use Your NH EBT Card
  • Cómo usar su tarjeta EBT NH (Spanish)
• Change Report Form (Form 470)
  • Cambio Formulario de Informe (Spanish)

Information that every Financial Assistance to Needy Families (FANF) Applicant must know:

• Cash Restrictions Fact Sheet (BFA Form 214)
  • Las restricciones de caja Hoja Informativa (Spanish)
• Fact Sheet (Form 260)
  • Hoja de hechos (Spanish)
• Financial Assistance to Needy Families (FANF) pamphlet (Form 77a)
  • Asistencia financiera para familias necesitadas (FANF) folleto (Spanish)
• Lump Sum Payments and FANF (Form 77i)
  • Pagos globales y FANF (Spanish)
• 60-Month Time Limit (Form 242)
  • El Límite de 60 Meses de por vida para Ayuda Económica a Familias Necesitadas (Spanish)
• How Your Benefits Will Change When You Go To Work (Form 757)
  • Cómo Cambiarán Sus Beneficios Cuando Comience A Trabajar (Spanish)

Information that every NH Child Care Scholarship Applicant must know:

• Eligibility information and reimbursement information which can be found at the Child Development Bureau Web site.
• Billing and reimbursement forms needed for NH Child Care Scholarship.
• Go to Child Care Resource & Referral for information about how to find affordable and supportive child care in NH.

Information that every Adult Program Applicant must know:

• Cash Restrictions Fact Sheet (BFA Form 214)
  • Las restricciones de caja Hoja Informativa (Spanish)
• NH State Supplement Programs (Form 77c)
  • Programas suplemento del estado NH (Spanish)
• Liens and Estate Claims Pamphlet (Form 77s)
  • Gravámenes y Raíces reivindicaciones Folleto (Spanish)
• Reimbursement Agreement and Acknowledgment (Form 770)
  • Acuerdo de reintegro y Reconocimiento (Spanish)

Information that every Nursing Home or Community Based Care (Long Term Care) Applicant must know:

• Verification Checklist, Long Term Care
• Release of Information - Long Term Care

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