2025 Medicaid (Medical Assistance) Plan Documents and Forms
Medicaid (Medical Assistance)
Prior Authorization List (PDF)
Prior Authorization List - Arabic (PDF)
Prior Authorization List - Hmong (PDF)
Prior Authorization List - Russian (PDF)
Prior Authorization List - Somali (PDF)
Prior Authorization List - Spanish (PDF)
Prior Authorization List - Vietnamese (PDF)
Member Release of Information Form (PDF)
Member Release of Information Form - Arabic (PDF)
Member Release of Information Form - Hmong (PDF)
Member Release of Information Form - Russian (PDF)
Member Release of Information Form - Somali (PDF)
Member Release of Information Form - Spanish (PDF)
Member Release of Information Form - Vietnamese (PDF)
Statement of Representative Form (PDF)
Statement of Representative Form - Arabic (PDF)
Statement of Representative Form - Hmong (PDF)
Statement of Representative Form - Russian (PDF)
Statement of Representative Form - Somali (PDF)
Statement of Representative Form - Spanish (PDF)
Statement of Representative Form - Vietnamese (PDF)
Power of Attorney short form
Deceased Member: Affidavit for the Collection of Personal Property (mncourts.gov)
Advance Directives Info (PDF)
Parent/Guardian Authorization Form for Unaccompanied Minors (PDF)
Provider and Pharmacy Directory (PDF)
Provider and Pharmacy Directory - Arabic (PDF)
Provider and Pharmacy Directory - Hmong (PDF)
Provider and Pharmacy Directory - Russian (PDF)
Provider and Pharmacy Directory - Somali (PDF)
Provider and Pharmacy Directory - Spanish (PDF)
Member Handbook (PDF)
Member Handbook - Hmong (PDF)
Member Handbook - Somali (PDF)
Member Handbook - Spanish (PDF)