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CMH Financial Application

Financial Application to apply for Ohio Children With Medical Handicaps (CMH).  This form has replaced the CPA (Combined Programs Application). Please use this application effective 03/04/2019

This form is required for all applicants that currently don't have Ohio Medicaid and want to participate in the CMH program.

The new tax law passed by congress has caused several changes in the 1040 Tax Form, and that has changed what pages CMH needs to process your financial application.  This change is listed in SECTION C of the new application. 

Click the "Download" button to view the "CMH Financial Application" resource.