For additional help with Medical Assistance Applications, please call the Health First Colorado Member Contact Center at 1-800-221-3943.For additional help with requests for Supplemental Nutrition Assistance Program (SNAP) or cash assistance, please call 1-800-536-5298.
For additional help with Child Care Assistance Program (CCAP) applications, contact your local county office.
Authorized RepresentativeYou can give a trusted person permission to talk about this application with us, see your information, and act for you on matters related to this application, including getting information about your application and signing your application on your behalf. This person is called an “Authorized Representative” and takes legal responsibility for the information provided in this application. If you’re a legally appointed representative for someone on this application, submit proof with the application.You'll need to answer these questions about the person who is helping you apply to keep going with the application.We'll need electronic signatures from you and your Authorized Representative. To sign, each person should check the box and type his or her name in the box. Keep in mind that signing the application electronically is the same as signing on paper.
You can give a trusted person permission to talk about this application with us, see your information, and act for you on matters related to this application, including getting information about your application and signing your application on your behalf. This person is called an “Authorized Representative” and takes legal responsibility for the information provided in this application. If you’re a legally appointed representative for someone on this application, submit proof with the application.
You'll need to answer these questions about the person who is helping you apply to keep going with the application.
We'll need electronic signatures from you and your Authorized Representative. To sign, each person should check the box and type his or her name in the box. Keep in mind that signing the application electronically is the same as signing on paper.
Guardian or Power of Attorney Court appointed legal guardians and representatives with power of attorney must provide proof (i.e. court documents or a signed durable power of attorney).If you are a parent applying for your child(ren) you do not need to complete this section.You'll need to answer these questions about the guardian or power of attorney to keep going with the application.We'll need electronic signatures from the person(s) completing the application. To sign, each person should check the box and type his or her name in the box. Keep in mind that signing the application electronically is the same as signing on paper.
Court appointed legal guardians and representatives with power of attorney must provide proof (i.e. court documents or a signed durable power of attorney).
If you are a parent applying for your child(ren) you do not need to complete this section.
You'll need to answer these questions about the guardian or power of attorney to keep going with the application.
We'll need electronic signatures from the person(s) completing the application. To sign, each person should check the box and type his or her name in the box. Keep in mind that signing the application electronically is the same as signing on paper.
An Authorized Representative is a trusted person over the age of 18 you let: fill out this application, talk about this application with us, see your information, get information about your application, and sign your application on your behalf. An Authorized Representative also takes legal responsibility for the information provided in this application. This person is NOT an Agent/Broker, Health Coverage Guide, or a Certified Application Counselor.
An Authorized Representative is a trusted person over the age of 18 you let:
Certified Health Coverage Guides can provide you local, in-person education and help applying for health insurance. You do not have to pay for a Health Coverage Guide's help. A Health Coverage Guide's job is to provide unbiased assistance with qualifying and enrolling in health insurance coverage. Certified Application Counselor Organizations have trained Certified Application Counselor staff who help individuals with education, application assistance, and enrollment into health coverage. There is no cost for assistance.