Required Documentation for Enrollment Screening
Specific documentation is required to properly screen you and your family for charity care and financial assistance programs, such as such as Proof of Identity & Lawful Presence, Proof of Denver County Address, Proof of Income, Pregnancy Verification and Other Miscellaneous Documentation. There are several documents that can be used for each requirement and documents that are acceptable for one program may not apply to all. We recommend that you bring the document that can be used for every program, if possible, to every appointment. Without the required documents, we will not be able to process your application.
If you have questions about applying for the CICP, DFAP, Medicaid, CHP+ or insurance through Connect for Health Colorado, please call us at (303) 602-2300.
Proof of Identity & Lawful Presence
|U.S. Citizens are not required to provide any documentation of their identity and citizenship status, as long as this information can be verified by an electronic system. For the automated verification to occur, we need to have your full name, date of birth, and Social Security Number. Providing certain documents can be used to prove Identity or Lawful Presence and/or help us to be successful with the electronic verification. These documents include, but are not limited to, the following:
Legal Permanent Residents must provide one of the following:
- Driver’s License or government-issued Photo ID;
- US Passport;
- Birth Certificate;
- Social Security Card;
- Certificate of Naturalization (DHS forms N-550 or N-570);
- Certificate of US Citizenship (DHS forms N-560 or N-561)
- Legal Permanent Resident Card
- Employment Authorization Card
- I-94 if a Refugee or Asylee
- Any one of the documents listed above for Medicaid/CHP+ can be used to prove lawful presence
|Proof of Identity only, examples of accepted documents include, but are not limited to:
- School/University Photo ID Card
- Non-US Passport/Immigration Card
- Employment Photo ID Card with Employer Information
- Photo ID from CostCo/Price Club, etc. or Credit Card with Photo
- Photo ID from Denver Recreation Center
- Birth Certificate or Adoption Papers for Minor Child
- Foreign Consulate Photo ID Card
- Foreign Electoral/Voter Photo ID Card
Proof of Denver County Address
|If the applicant or his/her spouse owns or leases a residence in Denver County, the applicant must present one of the following:
- Current month and prior month rent receipt, which must include the applicant’s name, the location of the rental property, and the printed name and phone number of the landlord;
- Copy of current lease with landlord name and phone number;
- Current month mortgage statement;
- Current property tax receipt;
- One household bill (i.e. water, gas & electricity), paycheck stub, or other income check stub with applicant’s pre-printed name and Denver County address from both the current month and the prior month;
- Non-household bills (i.e. credit card or cellular phone bills), bank statements, correspondence from a government agency, printed with the applicant’s name and address, or hospital/physician bills will be accepted only if there is evidence that they were mailed to the address, not printed from an electronic source. Current month and prior month required.
- If the applicant carries a Colorado Address Confidentiality Program (ACP) Card, this card can be used as proof of address until the expiration date indicated on the card.
If neither the applicant nor his/her spouse owns or leases a residence in Denver County, but they reside with a friend or relative who owns or leases a residence in Denver County, the applicant must present:
- A Denver Health Affidavit completed and signed by the friend or relative, and notarized within the past 14 days, stating that the client lives with him/her AND any of the documents listed above for the person with whom the client is living, to document that he/she lives in Denver County.
To be screened with the Z rate, the applicant must present one of the following:
- An original letter from a homeless shelter, Colorado Coalition for the Homeless Outreach Worker, or other Social Services agency, signed within the past 14 days, indicating that the person signing the letter has knowledge that the client is homeless;
- An original letter from a Denver Health Social Worker who has knowledge that the client is homeless;
- Mail received at 2323 Curtis St. from the current and prior months;
- (For CICP only, not allowable for the DFAP Z rate) A Denver Health Affidavit completed and signed by a friend or relative, and notarized within the past 14 days, stating that the client either uses his/her address as a mailing address or to stay occasionally, or that the client lives with him/her but does not pay any of the household expenses AND any of the documents listed above for the person who signed the Affidavit, to document that he/she lives in Denver County.
Proof of Income for all Responsible Parties in Household
- Pay stubs from previous/current month of work. Should have at least one month of consecutive pay stubs.
- If no pay stubs are available, then bring a typed letter from your employer on company letterhead showing gross income for previous and current month, how long you have been employed there, actual hours worked per week, pay per hour and pay frequency. (You may also use our employment letter to provide income information.)
- If you are self-employed, bring your business ledgers, mileage sheet(s) and documentation of your business expenses for the previous and current months.
- If you have unearned income, you must know the monthly amount. (To apply for Medicare Savings Programs, you must bring your Social Security Notice of Award showing your monthly income amount.)
Pregnancy Verification (Only if Pregnant)
- • Pregnancy statement with due date from the doctor or clinic
Other Miscellaneous Documentation
- Documentation of the value of your assets, i.e. bank statements, Motor Vehicle registrations, and real estate records.
- Health insurance cards, including Medicaid, CHP+, and commercial insurance, for all family members, if any
- Denver Health cards for CICP, DFAP/Sliding Fee Scale, if any
- One month of receipts for childcare, elderly care, child support, and alimony paid. These items may be used as deductions.
- Bills or receipts for health care costs incurred in the last year that have not been covered by insurance or a health program. These may be used as deductions
- Divorce or separation decree or court-stamped request for divorce or separation