Annual Reports

• FY 13 Annual Report [PDF]
• FY 12 Annual Report [PDF]
• FY 11 Annual Report [PDF]
• FY 10 Annual Report [PDF]

Fact Sheets

• Hospital Based Presumptive Eligibility (HBPE) Qualified Hospital Election Packet [PDF]
• Know Your Rights  [DOC]
• Home and Community-Based Services Waiver for Individuals with Intellectual and Developmental Disabilities (II/DD)  [DOC]
• Health Services for Children with Special Needs, Inc. (HSCSN)  [DOC]
• Office of Health Care Ombudsman and Bill of Rights  [DOC]
• Grievances/Appeals  [DOC]
• EPD Waiver Program  [DOC]
• DC Healthy Families [DOC] 

Out of Pocket Reimbursement Forms

• Out of Pocket Reimbursement Fillable- 2026.pdf[PDF]
• Out of Pocket Reimbursement Fillable-Spanish-2026[PDF]
• Out of Pocket Reimbursement Fillable- Amharic-2026
• Out of Pocket Reimbursement Fillable- French- 2026
• Out of Pocket Reimbursement Fillable- Chinese-2026
• Out of Pocket Reimbursement Fillable - Japanese- 2026
• Out of Pocket Reimbursement Fillable -  Korean - 2026
• Out of Pocket Reimbursement Fillable - Vietnamese- 2026

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]