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2025 Medical Assistance + Medicare Plan Documents and Forms

Notice regarding a Benefit Change:

Effective October 31, 2025 the Minnesota Department of Human Services has ended the Housing Stabilization Services (HSS) benefit under the Medical Assistance program. UCare has updated our Member Handbooks to reflect that Housing Stabilization Services will no longer be covered. The HSS benefit is no longer available to anyone through Medical Assistance.

If you have questions or need help, call UCare Customer Service at the number on the back of your member ID. If you have a case manager, they can help you find other services you might be able to get.

Medical Assistance + Medicare

Member Release of Information Form (PDF)
Member Release of Information Form - Arabic (PDF)
Member Release of Information Form - Hmong (PDF)
Member Release of Information Form - Russian (PDF)
Member Release of Information Form - Somali (PDF)
Member Release of Information Form - Spanish (PDF)
Member Release of Information Form - Vietnamese (PDF)

Prior Authorization List (PDF)
Prior Authorization List - Arabic (PDF)
Prior Authorization List - Hmong (PDF)
Prior Authorization List - Russian (PDF)
Prior Authorization List - Somali (PDF)
Prior Authorization List - Spanish (PDF)
Prior Authorization List - Vietnamese (PDF)

Power of Attorney short form
Deceased Member: Affidavit for the Collection of Personal Property (mncourts.gov)

Statement of Representative Form (PDF)
Statement of Representative Form - Arabic (PDF)
Statement of Representative Form - Hmong (PDF)
Statement of Representative Form - Russian (PDF)
Statement of Representative Form - Somali (PDF)
Statement of Representative Form - Spanish (PDF)
Statement of Representative Form - Vietnamese (PDF)

Medicare Coverage Updates

Appeals Form (PDF)

Prescription Drug Claim Form (PDF)