Print an Application for Elderly and Persons

with Disabilities



The application is listed below and is available in PDF format in different languages.

Please choose your language.

English - Spanish (español)


Additional Information

After filling out your application, you need to send it to the KanCare Clearinghouse at P.O. Box 3599, Topeka, KS 66601, or you can fax your application to 1-844-264-6285.