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Application for Health Coverage & Help Paying Costs

Apply Faster Online


 Apply by Paper

DCH-1426 Application
for Health Coverage

Word      PDF

Michigan offers several medical assistance programs. Each program covers different groups of people and each program has different eligibility requirements. When you apply for a program, your age, income, financial resources, and other information will be used to determine if you are eligible. You must also meet the financial and non-financial eligibility conditions for that program.

The DCH-1426, Application for Health Coverage & Help Paying Costs, is the paper application to use to apply for healthcare coverage in Michigan. Health care coverage refers to Medicaid, Healthy Michigan Plan, Children’s Health Insurance Program (CHIP), private health insurance plans that offer comprehensive coverage, and a tax credit that can help pay your premiums for health coverage.


The DHS-1171, Assistance Application no longer contains any information regarding Medicaid and cannot be used to apply for healthcare coverage.

The MSA-1582, Plan First! Application, and the DCH-0373, Healthy Kids/MIChild application are obsolete and are no longer acceptable assistance applications.

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 •  Apply On-line
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