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From either the West Slope or East Slope:
From Montrose, drive east on US50 past Cimarron about 2.7 miles and turn south on County Road/Forest Road 858 that goes to the Silverjack Reservoir. From Gunnison, drive west on US50 past the Blue Mesa Reservoir, down through a narrow canyon section, up over a pass at 8,700 ft., then down a long and winding descent toward Cimarron. The turnoff is one mile past the turnoff for CR864 and just past a small resort on the south side of the highway. It's a long, 22 miles drive back on a graded, dirt road, suitable for passenger cars, but can be dusty and/or washboarded. Continue past the Silverjack Reservoir about a mile and then make a right turn to cross the creek and then make an almost immediate left onto FR861.1. If you fail to make this left turn, you'll find yourself ascending toward Owl Creek Pass. Hikers can also come in from Owl Creek Pass, the road for which turns off from US550, about 2 miles north of Ridgway. That road is CR8 or FR858. Hikers coming from Durango, Telluride, Ouray or Ridgway will probably want to use that approach. In which case, they will need to drive over Owl Creek Pass to near the Silverjack and locate FR861.1 to make the proper turn.
For all approaches, once you're on FR861.1, it's a 4.6 mile drive back to the end of the road and the trailhead for the Middle Fork of the Cimarron. We found the road to be generally passable for most vehicles, however, the time we were in here, there had been heavy rains the week before that had left sections of degraded road where small streams had swept across. Smaller passenger cars would have had difficulty getting past those damaged areas. We do not know if and how well they have been repaired, hence, the higher clearance recommendation. (Report from 2017: Some of those minor creek crossings still present a problem for lower clearance vehicles.)
The trailhead area apparently use to be a campground years ago, but the tables and designated sites have been removed. There are now plenty of primitive camp spots on fairly level ground in the trees to use and a vault toilet. There's also a nice meadow shortly after where the trail begins and some other campsites there.