Coastal Campaign Assistance Form
Fill out the form below and the Campaign will connect you with an enrollment assistor!
What county do you live in?
Best Contact Phone
May We Text You?
New Application (Medicaid or PeachCare for Kids)
Renewal Application (Medicaid or PeachCarefor Kids)
Help following up on an existing application
Help with a Medicaid or PeachCare denial
Information on Resources for Children with Disabilities
SSI Medicaid or Katie Beckett Deeming Waiver Resources
Child(ren) Full Names & Date of Birth
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