The combination of pandemic impacts, high inflation, and disruptions in people’s livelihoods has put many older Coloradans at risk of being unable to cover their medical expenses. This is particularly true for those who have not yet reached the age of eligibility for Medicare. The Colorado state Department of Health Care Policy and Financing (HCPF) acknowledges this situation, noting that it is “creating both health risk and anxiety” and “it is especially important for all Coloradans to have health care coverage.”
One source of help in securing this coverage is Colorado’s Medicaid program, which HCPF calls “Health First Colorado.” (There is also a companion program called “Child Health Plan Plus (CHP+),” which offers health care coverage for certain children and pregnant women.) In this article we will cover the basics of how you go about qualifying for and using the benefits of Health First Colorado. Note that all state Medicaid programs are governed by Federal Medicaid law and regulations.
When and where you can apply for Medicaid benefits in Colorado
HCPF says Coloradans can apply for Health First Colorado any time of the year. Unlike Medicare or other types of coverage, there is no “enrollment period” for Medicaid. The quickest and easiest way to apply is visit www.healthfirstcolorado.com/apply-now/ or Colorado.gov/PEAK. You can apply online any hour of the day, upload needed documents with your application, and track the status of your application.
If you prefer applying by mail, you can find information on how to do that at www.colorado.gov/hcpf/how-to-apply#by-mail. You can download a paper version of the application at this site or at your county’s department of health and human services (see www.colorado.gov/cdhs/contact-your-county). Alternately, you can apply in person at these county offices.
Finally, you can apply over the phone by calling 1-800-221-3943, option 1. Hours of service are Monday thru Friday, 8 a.m. to 4 p.m. Be advised that hold times may be long.
There are application assistance sites around the state that can help you with your application, including taking care of in-person applications. See www.apps.colorado.gov/apps/maps/hcpf.map for locations of assistance sites.
Your eligibility for Colorado Medicaid
To be eligible for Colorado Medicaid, you must be a resident of the state and also be a U.S. national, citizen, permanent resident, or legal alien. You must be in need of health care/insurance assistance and have a financial situation that would be characterized as low-income or very-low-income. To qualify, you must have an annual household income (before taxes) that is below the following amounts:
|Household Size*||Maximum Income Level (Per Year)|
(* For households with more than eight people, add $6,277 per additional person.)
About questions you will be asked to qualify for Medicaid in Colorado
What is counted as “income” on your application?
Income can include money you derive from working, called “earned income,” or from rentals, investments or a business where you are not actively working, called “passive income.” If you get a paycheck from an employer, you may need to show a paystub to verify that income. If you work for yourself or have passive income, HCPF will ask for proof of the amount of income.
How about assets?
In most cases, HCPF will ask you for information about your assets (like homes, cars, bank accounts) only if you or someone else on the application may need long-term services and support or has a disability. Most people who need health insurance to cover only things such as prescription drugs, physician visits, counseling and hospitalization will not have their assets counted.
If you are denied Medicaid coverage
After submitting a Colorado Medicaid form, applicants will generally receive word of their enrollment status in a little over a month. A denied Medicaid application does not mean you will never be accepted into the program. If denied, you may file an appeal that will request the appropriate state agency to review your information. This does not promise enrollment into the program, but it may increase your chances. Information on how to start the appeal process will be in your denial letter.
Common reasons for being denied Medicaid coverage are having an income that is too high or not being a citizen or legal resident of the U.S. To prove citizenship or residency, you will have to give your Social Security number or immigration number. Also, applicants will not get Medicaid if they are not state residents in the state where they apply. You can also have your Medicaid application denied for not following the application guidelines. Applications must be complete, and the information on the application must, of course, be true.
What does Colorado’s Medicaid program cover?
Health First Colorado covers doctor visits, hospitalization, prescription drugs, dental and behavioral health care when you get the service from a participating provider. Individuals with disabilities may qualify for more. You do not have a deductible under Health First Colorado, unlike most commercial coverage (and Medicare, for that matter). But you may have co-pays for some services. However, some enrollees have no co-pays, and there is a monthly limit on co-pays. Some services, like dental, are subject to an annual maximum.
How do you find if your doctor accepts Health First Colorado coverage?
You can search for Health First Colorado doctors, pharmacies and other providers through the Find a Doctor tool at www.HealthFirstColorado.com/find-doctors or on the free PEAKHealth mobile app. Or you may simply ask your doctors if they accept Medicaid coverage. (You can download the PEAKHealth app in the Apple App store or Google Play store.)
For more information . . .
You can find comprehensive details on items mentioned in this article plus more information on Colorado’s Medicaid program at https://www.healthfirstcolorado.com/.