Out of Pocket Reimbursement Forms
- Out of Pocket Reimbursement Fillable 2026 - English [PDF]
- Out of Pocket Reimbursement Fillable 2026 - Spanish [PDF]
- Out of Pocket Reimbursement Fillable 2026 - Amharic [PDF]
- Out of Pocket Reimbursement Fillable 2026 - French [PDF]
- Out of Pocket Reimbursement Fillable 2026 - Chinese [PDF]
- Out of Pocket Reimbursement Fillable 2026 - Japanese [PDF]
- Out of Pocket Reimbursement Fillable 2026 - Korean [PDF]
- Out of Pocket Reimbursement Fillable 2026 - Vietnamese [PDF]
Fact Sheets
- Know Your Rights [DOC]
- Home and Community-Based Services Waiver for Individuals with Intellectual and Developmental Disabilities (II/DD) [DOC]
- Grievances/Appeals [DOC]
- EPD Waiver Program [DOC]
- DC Healthy Families [DOC]
Other Forms
- Conflict of Interest Statement [DOC]
- Citizenship Supplemental Form [PDF]
- Authorized Representative Form [PDF]
- Authorized Representative Form - Spanish [PDF]
- Authorization for Use and Disclosure of Private/Protected Health Information [DOC]
- DC Standard Application for Health Coverage & Help Paying Costs [PDF]
- DC Standard Paper Application - Spanish [PDF]
- Employer Coverage Tool [PDF]
- Employer Coverage Tool - Spanish [PDF]
- Immigration Status List [PDF]
- Immigration Status List - Spanish [PDF]
- Insurer's Annual Reporting Form [DOC]
- QMB Application Packet May 2014
- DC Unassisted Application [PDF]
Retroactive Medicaid Application [PDF]
Annual Reports
- FY 13 Annual Report [PDF]
- FY 12 Annual Report [PDF]
- FY 11 Annual Report [PDF]
- FY 10 Annual Report [PDF]