Bureau of Eligibility Policy

How to Apply for Medical Benefits

You can apply:

Apply Online
Note: If you apply online, you do not need to complete a paper application.

By Mail

Download a Medical Application.

Mail completed application to:
Department of Workforce Services
PO Box 143245
Salt Lake City, UT 84114-3245

By Fax

Download a Medical Application.

Fax completed application to:
Department of Workforce Services
Fax: 801-526-9505
Toll-free Fax: 1-888-522-9505

In Person

Download a Medical Application.

You may apply at any Department of Workforce Services (DWS) office. Please click here and type in your zip code to find an office near you.

For answers to your questions on how to apply, please call the Department of Workforce Services (DWS) at: Salt Lake County: (801) 526-0950 or Toll free: (866) 435-7414.

Medical Applications

If you want to apply for Medical only, please print out the application below.
Medical Only Application - English
Medical Only Application - Spanish

If you want to apply for Nursing Home Medicaid or Long Term Care Medicaid, please print out the application below:
Long Term Care Application - English
Long Term Care Application - Spanish

If you want to apply for Medical as well as other programs
(Food Stamps, Child Care and/or Financial assistance),
please print the application below. If you fill out and turn in this multi-program application, you do not need to fill out a Medical only application.
Multi-Program Application - English
Multi-Program Application - Spanish

If you are not able to print the above applications,
you can request to have one mailed to you by calling:
Salt Lake County: 801-526-0950 or Toll-free: 866-435-7414.