Personal Information

The information provided in this section is only for managing your online profile.

Providing your Date of Birth and Social Security Number will allow you to recover your User Name if forgotten.

It will also allow your account to be linked to your Medicaid case more easily.

* Red asterisk indicates required

Continuing with the information you entered will result in a previous account being disabled when you click Sign Up on the Sign Up page. That account will no longer be available and you will no longer have access to messages posted to that account's Message Center.

Suggestion:
 Click Forgot User Name to recover your user name or click Forgot Password to recover your password.