Health Insurance Enrollment Assistance

How to Qualify for Medicaid

Need assistance applying for Medicaid or exploring other coverage options? In order for our coordinators to assist you in applying for coverage, you will need to complete an authorized representative form, you must meet certain citizenship requirements (some non-citizens may apply), you must be an Ohio resident, you must have a social security number and you must meet certain financial requirements.

The authorized representative form needs the top section of page 1 under section 1 completed, your signature at the bottom of page 1 where it says "signature of person granting authority" and also a signature at the bottom of page 2. This form can be emailed to Outreach.Enrollment@frhc.org or dropped off at the Five Rivers location nearest you. You can also call 937-281-6800 if you'd like to speak to a rep today.