Med-Connect (Medicaid for Employees with Disabilities)


You can apply for these benefits by completing a state application form. This form can be done online, mailed, or dropped off at a local DSS Regional Office.  For a list of local offices, please follow this link.  You can also authorize someone else to do the application paperwork for you.

To apply online, please visit, under ‘Apply for Benefits.’

Households and individuals who wish to apply for Medicaid for Employees with Disabilities (MED-Connect), SNAP (food stamps), Medicaid for the Aged/Blind/Disabled (HUSKY C), and/or cash assistance can download this application: 

Application for Benefits (W-1E) - English

Application for Benefits (W-1ES) - Solicitud de Beneficios - Spanish

You have the right to a copy of the completed application. You can request a copy from DSS at any time in either in electronic or paper format.

For additional information on how to apply, please visit