Washington State Health Care Authority Forms

This Form is used for enrolling in or making changes to the retiree plan offered by Metlife in Washington.

This document is an application form for the Medicare Savings Programs in Washington. It is available in Amharic.

This Form is used for applying for Medicare Savings Programs in Washington for Cambodian-speaking residents.

This Form is used for applying for the Behavioral Health Integration (BHI) Grant in the state of Washington.

This form is used for midyear enrollment in the Flexible Spending Arrangement (FSA) and Dependent Care Assistance Program (DCAP) in Washington.

This document provides a quick reference sheet for dental tooth, arch, and quad numbering in Washington's ProviderOne Billing system.

This form is used for submitting a statement for individuals who choose Option 2 Training in Washington and need it in the Russian language.

This form is used for submitting fax cover sheets in Washington state.

This document is for applying for Washington Apple Health services for the aged, blind, disabled, and long-term services and supports in Washington state.

This document is a form used to apply for Washington Apple Health for elderly, blind, and disabled individuals in need of long-term care services and supports.

This form is used for applying for health care coverage in the state of Washington.

This form is primarily used by residents of Washington who speak Lao, to apply for health care coverage programs that are provided by the state's Health Care Authority. It includes detailed instructions in Lao to guide applicants through the process.