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Medicaid Waiver Application

These are the forms that you will need in order to submit a complete Medicaid Waiver application based upon the most recent update (2018). Complete the paper application, privacy policy, and release and submit it along with accompanying documentation to Region 6 per the contact information file OR submit online via the below site. Contact us if you need any help or have questions about the process. Note that PEAK does not accept Medicaid Waivers, however the funds can be used to self-direct services for individuals wanting to attend PEAK with their staffmembers.

Application (pdf)Download
Privacy policy (pdf)Download
Release of Information (pdf)Download
Region 6 Contact Information (pdf)Download

Online Waiver Application

You can now submit the application and check status online!
IDD Waiver Application

Other Resources

Petition for Appointment of a Guardian and/or Conservator (pdf)Download

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