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Application Resources for Partners

Please note: The information on this page is intended for Eligibilty Sites and Community Partners.  If you would like to apply for Medicaid or Child Health Plan Plus, click here.

 

Beginning October 1, 2013, the Departments of Health Care Policy and Financing and Human Services, and Connect for Health Colorado will use standardized, common applications to determine eligibility for medical and public assistance. Consumers will have the option to apply online through PEAK, or Connect for Health Colorado, in person, by mail or by calling toll free   1-800-221-3943 or TDD 1-800-659-2656.

           Click here for a Quick Reference Guide to the New Paper Applications

           Click here for Additional Guidance on the new Paper Application (updated 10/21/2013)

 

Application for Health Coverage & Help Paying Costs

The Application for Health Coverage & Help Paying Costs, also known as the Medical Only Application or Single Streamlined Application, can be used by consumers to apply for health care coverage. This application is for health care coverage only.

English application  

Spanish application 

 

Application for Public Assistance

The Application for Public Assistance, also known as the Single Purpose Application, can be used by consumers to apply for both health care coverage and food and cash programs.

English application

English application (large print)

Spanish application—coming soon

 

Additional Information Needed for Colorado Medical Programs

The Additional Information Needed for Colorado Medical Programs, also known as the Supplemental Page, should be used by consumers if they:

  •     Completed the prior “Application For Medical Assistance (Medical Only Application)”

  •     Completed the prior “Application for Public Assistance (Single Purpose Application)”; or

  •    Are currently enrolled in a medical program and are reporting income or any other changes. 

English Supplemental Page

Spanish Supplemental Page—coming soon