New Patient Enrollment Documentation

Please bring the following documents with you when you come to your enrollment appointment:

 

For CHP+/Medicaid

The following documents are helpful, but not required:

• CO Drivers License/CO State ID
• Birth certificates for all family members applying
• Resident alien card (if applicable)
• Medical expenses for last three months if you are requesting Medicaid coverage
• Health insurance information if applicable
• Business ledgers or profit or loss statement for previous month if self-employed
• Proof of any non-work income (social security, worker's compensation, retirement, etc.) 

 

For Colorado Indigent Care Program (CICP) / Sliding Scale*

• CO Drivers License/CO State ID
• Medicaid denial letter if applicable
• Resident alien card if applicable
• Health insurance information if applicable
• Business ledgers or profit or loss statement for previous month if self-employed
• Proof of income for last month if employed
• Proof of any non-work income (social security, worker's compensation, retirement, etc.) 

*Please Note: CICP and Sliding Scale applications must be completed in-person at one of our Enrollment Services locations.

 

For Uninsured / Sliding Scale

• Identification card, if applicable
• Business ledgers or profit or loss statement for previous month if self-employed
• Proof of income for last month if employed
• Proof of any non-work income (social security, worker's compensation, retirement, etc.) 

 

Printable Applications

You may print the following application(s) and bring it with you to your appointment:

Medicaid Application

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