Medicaid Agency

State of Alabama

Official Website: https://medicaid.alabama.gov

The Alabama Medicaid Agency, which began operations on January 1, 1970, is a state/federal program that pays for medical and long-term care services for low-income pregnant women, children, certain people on Medicare, disabled individuals and nursing home residents. The individuals must meet certain income and other requirements. Many of our programs have transformed over the years, but our vision and values have remained the same.

Forms & Documents

Browse all Medicaid Agency government forms

41 - 60 of 112 forms

Form Title Topics
Fillable form used to tell Medicaid about changes in a recipient's status, such as a change in address, income, or marital status
Fillable MedWatch form from FDA for voluntary reporting of adverse events, product problems and product use errors
For Completing Sterilization Consent Form
Form 373 Instructions - DMARDS/Biological Injectables - Effective 8/28/19
Form used if a Medicaid recipient or applicant wishes to give a trusted person permission to represent or help them (Also known as an authorized representative)
For pharmacists to use to notify primary care providers of vaccine administration - Updated 2/1/19
Gateway to Community Living - Informed Consent With Options Counseling Form - For Case Managers
Goes along with the paper application - To be filled out if someone in the household is eligible for health coverage from a job
Goes along with the paper application - To be filled out if someone in the household is eligible for health coverage from a job
Goes along with the paper application - To be used if the applicant or family member is American Indian or Alaska Native
Goes along with the paper application - To be used if the applicant or family member is American Indian or Alaska Native
Goes along with the paper application - To be used if the applicant wishes to give a trusted person permission to help with the application (Also known as an authorized representative)
Hepatitis C Antiviral Agents PA Form - Revised 10/28/19
Hepatitis C Antiviral Agents PA Form - Revised 10/28/19
Hysterectomy Consent (providers only)
Instructions for ACD Evaluation Report
Instructions for Completing Sterilization Consent Form
List of Specialized Nutritional Products - Updated 7/9/19
Men's Sterilization Consent Educational Packet
Miscellaneous PA Request Form

Contact Information & Office Locations

All 12 contact points

Auburn Office

Address:
687 North Dean Road
Suite 300
Auburn, AL 36830

Phone numbers:
  • (866) 371-4072 (toll free)
Fax numbers:
  • (877) 814-8309

Birmingham Office

Address:
468 Palisades Blvd.
Birmingham, AL 35209-5154

Phone numbers:
  • (866) 371-4073 (toll free)
Fax numbers:
  • (877) 814-8302

Decatur Office

Address:
2119 Westmead Dr. SW
Suite 1
Decatur, AL 35603-1050

Phone numbers:
  • (866) 371-4074 (toll free)
Fax numbers:
  • (877) 814-8304

Dothan Office

Address:
2652 Fortner St.
Suite 4
Dothan, AL 36305-3203

Phone numbers:
  • (866) 371-4075 (toll free)
Fax numbers:
  • (877) 814-8305

Florence Office

Address:
412 S. Court Street
Suite 200
Florence, AL 35630-5664

Phone numbers:
  • (866) 371-4076 (toll free)
Fax numbers:
  • (877) 814-8303

Gadsden Office

Address:
200 West Meighan Blvd.
Suite D
Gadsden, AL 35901-3200

Phone numbers:
  • (866) 371-4077 (toll free)
Fax numbers:
  • (877) 814-8306

Headquarters

Address:
501 Dexter Avenue
Montgomery, AL 36104

Phone numbers:
  • (334) 242-5000 (main line)

Huntsville Office

Address:
6515 University Drive, NW
Suite B
Huntsville, AL 35806-1775

Phone numbers:
  • (855) 733-3160
Fax numbers:
  • (877) 295-8813

Mobile Office

Address:
2800 Dauphin Street
Suite 105
Mobile, AL 36606-2400

Phone numbers:
  • (866) 371-4078 (toll free)
Fax numbers:
  • (877) 814-8308

Montgomery Office

Address:
3060 Mobile Highway
Montgomery, AL 36108

Phone numbers:
  • (866) 621-6509 (toll free)
Fax numbers:
  • (877) 814-8307

Selma Office

Address:
106 Executive Park Lane
Selma, AL 36701

Phone numbers:
  • (866) 371-4079 (toll free)
Fax numbers:
  • (877) 814-8311

Tuscaloosa Office

Address:
907 22nd Avenue
Tuscaloosa, AL 35401-5822

Phone numbers:
  • (866) 371-4080 (toll free)
Fax numbers:
  • (877) 814-8310

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