(612) 205-4148Linkcaremn@gmail.comOffice Mon–Fri, 9AM–5PM · Emergency assistance 24/7
HCBS · CFSS · 245D licensed
Link Home CareConnecting care · to home
For case managers & referring partners

Make a referral.

This online form collects the information on a standard referral, for waiver services or CFSS, so intake has everything it needs in one submission. It takes about 10 minutes.

Start the referral Download PDF form
4 stepsabout 10 minutes
Attachsupport plan & assessments
24–48 hrsintake follow-up

Referral form

All fields are required. If something doesn’t apply, enter N/A or None.

1 · Referral information
This field is required.
This field is required.
Enter a 10-digit phone number.
Enter N/A if none.
This field is required.
We’ll send intake updates here.
Enter a valid email address.
This field is required.
2 · Client general information
This field is required.
This field is required.
This field is required.
This field is required.
Enter a 9-digit SSN (XXX-XX-XXXX).
Enter a 10-digit phone number.
This field is required.
This field is required.
This field is required.
Enter a 5-digit ZIP code.
Gender
Please select one.
Race / ethnicity (select all that apply)
Please select at least one (or “Do not respond”).
This field is required.
Enter a 10-digit phone number.
This field is required.
Enter a 10-digit phone number.
Please choose an option.
3 · Type of service request

Select every service being requested, then enter the authorized hours per week.

Select at least one service.
4 · Medical information
This field is required.
This field is required.
This field is required.
This field is required.
This field is required.

5 · Supporting documents

Documents included with this referral
Select the documents you are including.
PDF, Word, or image. Combine documents into one PDF if you can (8 MB max). You can also email them to Linkcaremn@gmail.com.
Attach a file under 8 MB.

6 · Message

This field is required.
The Link Letter

Stay connected with Link Home Care

A short, friendly update about once a month: new caregiver openings, waiver and CFSS program changes, and tips for families and case managers. No spam, unsubscribe anytime.

  • Job openings first
  • Waiver & CFSS news
  • Family care tips
This field is required.
Enter a valid email address.
I’m a…
Please select one.
Something went wrong. Please try again or email Linkcaremn@gmail.com.
Families & individuals

Check my eligibility

Three quick steps. All fields are required unless marked optional. Our team will contact you within 1 business day.

About you
This field is required.
This field is required.
Enter a valid email address.
Enter a 10-digit phone number.
This field is required.
Your Minnesota Health Care Programs ID (8 digits). Enter “Don’t know” if you don’t have it handy.
This field is required.
Program & services
Waiver or program
Please select your waiver or program.
Services you’re interested in (select all that apply)
ICLS is only available on the Elderly Waiver (EW) or Alternative Care (AC). CFSS is open to MA members and waiver participants who qualify through a MnCHOICES assessment.
Please select at least one service.
Caregiver
Caregiver
Please choose preferred or agency caregiver.

Your information is confidential and only used to confirm eligibility and connect you with services.