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To begin the Financial Coverage Program application process, please complete the three documents below and send back to SHS. To request hard copies of these forms, and to learn more about the Financial Coverage Program, please contact Tina Feigitsch at tfeigitsch@nd.gov or 701-328-4816.
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Once completed, these three documents can be emailed, mailed, or faxed to SHS using the contact information below. Applications will be reviewed, and you will be contacted by SHS staff to complete the application process.
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Email: tfeigitsch@nd.gov
Mail: ND DHHS
Special Health Services Unit
Attn: Tina Feigitsch
600 East Boulevard Ave. Dept. 325
Bismarck, ND 58505
Fax: 701-328-1645