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Form 1095-B: Health Coverage

If you, your spouse or one of your dependents were enrolled in Medicaid, ARKids or the Arkansas Works Program at any time in 2019, DHS will mail you an IRS tax form 1095-B, upon request. Forms will be mailed throughout the year, upon request, beginning January 20, 2020.  It is possible that some people will receive their form before others.

Requests for 1095-B forms can be made by:

Information You Need to Give DHS with Your Request

For requests made by email and U.S. mail, please include the recipient’s name, the tax year for which you are requesting a form, a phone number where you can be reached for questions, and a return email or mailing address to where the form will be sent.

Please contact your local DHS county office or the helpdesk for questions.

Arkansas Department of Human Services
Arkansas Department of Human Services

Arkansas Department
of Human Services
(501) 682-1001

TTY: 1-800-285-1131 or dial 711 for Arkansas Relay Service

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