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Proof of Medicaid Coverage
2021 1095B/Proof of Medicaid Coverage Form Is Available Upon Request
Proof of Medicaid Coverage

If you would like a copy of your 1095B form stating that you had minimum essential coverage through Medicaid during 2021, you may request it by any of the methods below.  

Please submit only one request per household and be sure to provide all contact information including phone number, email and address. Please do not include personally identifiable information (PII) like SSN# when requesting through email.

Call: 1-844-640-6446
Visit: Contact Us Form
Email: medicaid@medicaid.ohio.gov
Mail: Ohio Department of Medicaid - ATTN ODM-TA
50 West Town Street
Suite 400
Columbus, OH 43215