the Plan

To find out if you qualify to enroll in Amida Care’s Medicaid Live Life Plus plan, please fill out the following form, and one of our representatives will contact you. As always, we respect your privacy and will not share your information.

Please note: The starred fields ( * ) are required information.

  • MM slash DD slash YYYY
  • I agree that an Amida Care representative may contact me as follows:
    *The Amida Care representative will not mention Amida Care but will identify themselves by name
    **Amida Care is not listed on the return address on the envelope