Complete the form if you are applying for yourself and your family and you do not have full health insurance coverage from your job or Medicare. Get the form
You can submit the form in different ways:
- Create DC HealthLink account - Go there
- Call 1 (855) 532-5465 and submit an application over the phone or
- Get help from a trained expert by calling 1 (855) 532-5465 or going to the DC HealthLink website
Print out the application for Coverage with Financial Assistance for Families and
- Mail it to:
DC Health Link
Department of Human Services
Case Record Management Unit
P.O. Box 91560
Washington, DC 20090
- Or Fax it to: (202) 671-4400
- Or come in person to any ESA Service Center