Colorado Indigent Care Program (CICP) Information For Providers

Please contact the Department to request a blank copy of the 2020-21 Annual Provider Application

• Clinic Client Excel Application - Effective July 1, 2020
• Hospital Client Excel Application - Effective July 1, 2020
• FPL Calculator - Effective April 1, 2020

Program data is due annually with the Annual Provider Application for CICP Clinics and with the DSH Audit data for CICP Hospitals.

• Lawful Presence Affidavit - English
• Lawful Presence Affidavit - Spanish
• Lawful Presence Waiver

• SAVE Access Request