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Medicare Advantage (MA) State Certification Form

Subject to the guidelines and procedures of the Centers for Medicare & Medicaid Services (CMS), before an applicant entity may apply to become a Medicare Advantage organization, it must submit a completed MA State Certification Form to CMS.

The form is available from CMS on their website. The form is completed by the applicant then submitted to the state at the address below. The state will certify whether the applicant is authorized to bear risk associated with the MA plans it is offering in the state and whether the entity meets state solvency requirements.

Submit application forms to:

Carol Anderson
Examinations Section
700 W. State Street, 3rd Floor
P. O. Box 83720
Boise, ID 83720-0043
(208) 334-4309