Health Care Assistance Program 

Do I qualify for medical assistance?

Health Care Assistance Program Eligibility Criteria includes:

• •  Application must be submitted within 90 days of service
  • Applicant must be a Roosevelt County resident (at least 90 days prior to service)

Income Criteria:

• • Single, $12,000
  • Married, $16,000
  • Each dependent up to 4, $1,200
  • Maximum, $20,800

Eligible Service Providers covered under HCAP include:

• •  Hospitals
  • Ground Transport / Air Ambulance

Application and Instructions

Please print and completely answer all questions to expedite the application process.

Heath Care Assistance Program (HCAP) Policy and Procedure Manual

FY23 Annual Health Care Assistance Report

FY22 Annual Health Care Assistance Report

FY21 Annual Health Care Assistance Report

FY20 Annual Health Care Assistance Report

FY19 Annual Health Care Assistance Report