Medicaid Nursing Facility Provider Information

The Department of Children and Families (DCF) district offices staff determines eligibility for Institutional Care Program (ICP) services.

  • To begin the ICP application process, a nursing facility refers the resident to the DCF by completing a
    Client Referral Notice [199 KB PDF], CF-ES Form 2506A.

  • Providers must use the Client Discharge and Change Notice [187 KB PDF], CF-ES Form 2506, to advise public assistance specialists of the placement status of institutional Medicaid applicants and recipients.

Copies of these forms are also available from the Department of Children and Families, Office of Economic Self Sufficiency.


Reporting Medicaid Fraud