- 1). Gather your documentation. To apply to become a Medicaid provider, you'll need to provide details about your business, including your license information. You'll also need to provide identifying information about yourself, including your Social Security number.
- 2). Contact the health and human services agency in your state to get a Medicare provider application. You may be able to find the application online. For example, if you are in Florida, you can obtain a Florida Medicaid Provider Enrollment Application from the Florida Alcohol & Drug Abuse Association's website (see Resource).
- 3). Fill out the form and send it in to the address indicated on the form. The address will depend upon which state you live in and where you got the application from.
Source...