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.

Health Care Assistance Program (HCAP) Policy

Annual Health Care Assistance Report