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  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.

Application

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Application Download

For more information or to request an application to be mailed, please call our hotline Toll-Free at:

1-800-226-0768

TTY: 1-866-675-8440

The HBWD Application is available for download in Portable Document Format (PDF). You will need Adobe Acrobat Reader® to view or print these files.

If Acrobat Reader is not already installed on your computer, click on the icon below for a free Download. Then follow the instructions to install the program.