Roosevelt County Medical Assistance Program
(Indigent Program)
Do you need help with your hospital and ambulance bill? The Roosevelt County
Indigent program may be able to help. Funding for the program comes from
the county's indigent fund.
- A Hospital claim must be submitted within 90 days of service.
- Ambulance bills must be submitted within 90 days of service.
Who is eligible for the assistance program?
-
Residents of Roosevelt County who have lived a minimum of three months prior to the
date of medical services provided.
-
County residents living in households receiving benefits from one of the following: Food
Stamps,TANF, GA, Homeless
The following documentation must be provided with the completed
Program Application (click here to download):
- Proof of residency: A notarized statement by landlord or neighbor, a rental
lease agreement, utility bill or driver's license
- Proof of Income: Check stubs for the last two months. If applicant is unemployed,
two notarized letters stating how their expenses are covered
- Federal income tax return
- Gross receipts sales tax form
- Award letters for benefits
- Bank statements
For more information contact:
Erminia Chavez
Roosevelt General Hospital
42121 US Hwy 70
Portales, NM 88130
Phone: 575.356.3410
Fax: 575.356.9200
Click here to view the
official Roosevelt County page for more information.
Carol Acosta-Flores
Roosevelt County Indigent Administrator
109 W 1st Street Room B-5
Portales, NM 88130
Phone: 575.356.5307
Fax: 575.356.8307