CIHCP Handbook
Download the complete CIHCP Handbook or select a section below.
- Section 1000 - Program Administration
- Section 2000 - Eligibility Criteria
- Section 3000 - Case Processing
- Section 4000 - Service Delivery
- Section 5000 - State Assistance Fund
- Section 6000 – Supplemental Security Income Reimbursement
Forms and Instructions
- 3064 - Application for Health Care Assistance
- 3065 - Worksheet
- 3066 - Report of Changes
- 3067 - Appointment Notice
- 3068 - Request for Information
- 3069 - Health Care Services Record
- 3072 - CIHCP Monthly Financial Report
- 3073 - Eligibility Dispute Resolution Request
- 3076 - Case Record Information Release
- 3077 - Notice of Eligibility
- 3078 - Claim Processing Notification
- 3079 - Facility Payment Rate Request
- 3080 – SSI Appellant Notification
- 3081 - Appellant – Provider Assignment
- 3082 - Notice of Ineligibility
- 3083 - Optional Health Care Services Notification
- 3084 - Employment Verification
- 3085 - Statement of Self-Employment Income
- 3086 - End of Year Report
- 3087 - TMHP Confidentiality Agreement
- 3088 - Request for State Assistance Funds (90 percent)