Request for Application - Enrollment Entity

Apply to become a Your Health Idaho Enrollment Entity.

Application Timelines

Request for Applications (RFA) Issue Date:

00/00/2026

Deadline for submission of questions:

00/00/2026

Responses to questions posted in the RFA area of: Your Health Idaho Website by:

00/00/2026

Closing date for receipt of application:

00/00/2026

Target date for selection notification:

00/00/2026

Target award date: Your Health Idaho Website by:

00/00/2026

Information to Prepare for the Application

1. Business History, Population Served, References and Previous Work
2. Proposed Subcontractor Information

Applicant Information

1. Name of entity / organization *

2. Entity mailing address *

3. Entity street address (if different than mailing address) *

3b. City *

3c. State *

3d. Zip *

4. Company Federal ID Number (or SSN, if an individual rather than a company)

5. Name and title of person responsible for signing the agreement *

(large 3b. individually

6. Name and title of person acting as the point of contact for the company (if different than the person signing the agreement)

7. Contact person's direct telephone number *

8. Contact person's email address *

9. Please provide three (3) references – please include their name, title, phone number, and email address *

PART 1 ORGANIZATION CHARACTERISTICS

1. For organizations, which category best describes you? *

PART 2 YOUR POPULATION

Please describe the general population you serve — examples to provide are:

• Geographic region(s): (e.g., Elmore County”)
• Target population(s): (e.g. Unhoused, Low Income, etc.)
• Specific needs of your population(s): (e.g., Language or Literacy Barriers)
• Agencies / Organizations You Collaborate With
• Number of Families You Serve Annually
• Number of For-Profit Businesses You Serve Annually (if applicable)
• Number of Non-Profit Businesses You Serve Annually (if applicable)
• Other Targets

Please Describe *

How likely is your target population to enroll in coverage through Your Health Idaho? *

If they'll need help enrolling, please describe any potential barriers (lacking computer or internet access, language barriers, literacy difficulties, etc.)

Please Describe

Using the number sliders below, please indicate the percentage of your target population that fits within the characteristics (if known)

Receives publicly subsidized medical coverage:

Is uninsured

Is underinsured

Is insured through individually purchased private insurance:

Is self-employed and covered by health insurance:

Receives federally subsidized medical coverage (e.g., Medicare, Medicaid, etc.):

Obtains health coverage through an association:

Is insured through employer (small group market):

Is insured through employer (large group market):

PART 3 CURRENT AND POTENTIAL CAPACITY TO PROVIDE ASSISTANCE

1. Please indicate the Education and / or Outreach services you currently offer (select all that apply): *

In Person
Phone

Describe Education and / or Outreach Services: *

2. Please indicate the number of staff trained and currently conducting Outreach and / or Education: *

3. Please indicate the services you currently offer (if applicable) in providing enrollment assistance for subsidized medical coverage (select all that apply):

In Person
Phone
Online

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Request for Application - Enrollment Entity

Application Timelines

Request for Applications (RFA) Issue Date:

00/00/2026

Deadline for submission of questions:

00/00/2026

Responses to questions posted in the RFA area of: Your Health Idaho Website by:

00/00/2026

Closing date for receipt of application:

00/00/2026

Target date for selection notification:

00/00/2026

Target award date: Your Health Idaho Website by:

00/00/2026

Information to Prepare for the Application

Applicant Information

PART 1 ORGANIZATION CHARACTERISTICS

PART 2 YOUR POPULATION

Please describe the general population you serve — examples to provide are:

If they'll need help enrolling, please describe any potential barriers (lacking computer or internet access, language barriers, literacy difficulties, etc.)

Using the number sliders below, please indicate the percentage of your target population that fits within the characteristics (if known)

PART 3 CURRENT AND POTENTIAL CAPACITY TO PROVIDE ASSISTANCE

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