This video explains the Medicaid Non-Covered Services form, and how and when it should be utilized. This section only pertains to you if your clinic is participating in Medicaid in your state. There are 2 downloads (one if clinic in Wisconsin, other if clinic in Minnesota) available that are customizable Word documents of the Medicaid Non-Covered Services Form, that your clinic can utilize if desired. If your clinic is in a different state, feel free to customize the form to fit your needs.