Paul Sanchez
Health First Colorado is Colorado's Medicaid program, which provides free or low-cost public health insurance for qualifying individuals. It covers doctor visits, emergency care, preventive care, and other procedures and treatments. Enrollment is open year-round. If an individual has other insurance or Medicare, Health First Colorado is the payer of last resort, meaning that it will only pay for services after any other coverage has paid first.
| Characteristics | Values |
|---|---|
| Name of Medicaid program in Colorado | Health First Colorado |
| Other names | Colorado's Medicaid Program, Colorado Medical Assistance Program |
| Who is it for? | Low-income families, children adopted from foster care, pregnant women |
| What does it cover? | Doctor visits, emergency care, preventive care, screenings, immunizations, other procedures and treatments |
| Is it free? | Yes, for those who qualify |
| Can you have it with another insurance? | Yes, but Health First Colorado will be the payer of last resort |
| Enrollment period | Year-round |
| How to apply? | Online, in person, by phone, or by mail |
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What You'll Learn
- Health First Colorado is Colorado's Medicaid program
- It is the payer of last resort when a member has other insurance
- Enrollment in Health First Colorado is year-round
- Health First Colorado covers doctor visits, emergency care, and preventive care
- Child Health Plan Plus (CHP+) is public low-cost health insurance for certain children and pregnant women
Health First Colorado is Colorado's Medicaid program
Enrollment in Health First Colorado is year-round. To be eligible, applicants must meet monthly income guidelines. If you qualify for Health First Colorado, you can still purchase a private health insurance plan at full price. However, you will not qualify for financial help to lower the cost of your health insurance plan through Connect for Health Colorado.
If you no longer qualify for Health First Colorado, you have a 60-day special enrollment period to sign up for a plan through Connect for Health Colorado. You may be able to get financial help to lower the cost of private health insurance through Connect for Health Colorado if you do not qualify for Health First Colorado or Child Health Plan Plus (CHP+). CHP+ is public low-cost health insurance for certain children and pregnant women who earn too much to qualify for Health First Colorado but not enough to pay for private health insurance.
Health First Colorado is the payer of last resort when a member has other insurance or Medicare. Federal regulations require that all available resources be used before Health First Colorado considers payment. This means that if a member can provide for their care, they must pay for medical benefits first. If there is a responsible third party who should be paying for the member's health benefits, such as a health insurance provider, that party should pay first.
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It is the payer of last resort when a member has other insurance
Health First Colorado (Colorado's Medicaid program) is the payer of last resort when a member has other insurance or Medicare. This means that if a member can provide for their care, they must pay for their medical benefits first. If there is a third party responsible for paying for the member's health benefits, such as a health insurance provider, that party should pay first. Federal regulations require that all available resources be used before Health First Colorado considers payment.
The "payer of last resort" is also referred to in Medicaid as "third-party liability" under the Social Security Act. State Medicaid programs must take "all reasonable measures to ascertain the legal liability of third parties". If the payer of last resort has paid a bill that should have been covered by another entity, the state or local agency that is the payer of last resort may seek reimbursement.
In the context of Health First Colorado, this means that if a member has other insurance, that insurance is primarily responsible for covering the member's medical expenses. Health First Colorado will only step in if the other insurance does not cover the full cost of the member's care or if the member has exhausted all the benefits provided by their insurance.
It's important to note that Health First Colorado has specific guidelines and requirements for coordination of benefits to ensure that the correct party pays first. This includes cost-avoiding claims when another party is known to be responsible for payment or cost-recovering from a claim that Health First Colorado paid but should have been covered by another party.
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Enrollment in Health First Colorado is year-round
Health First Colorado is Colorado's Medicaid program. It is free or low-cost public health insurance for Colorado residents who meet certain monthly income requirements. It covers doctor visits, emergency care, preventive care, and other procedures and treatments. Enrollment in Health First Colorado is year-round, meaning there is no open enrollment period. Applications can be submitted through Connect for Health Colorado or Colorado's Program Eligibility and Application Kit (PEAK) eligibility system at any time during the year.
To enroll in Health First Colorado, you can apply online, in person, by phone, or by mail. If you apply through Connect for Health Colorado, they will let you know if you and your family are likely to qualify for Health First Colorado and/or CHP+ (Child Health Plan Plus), and will send your application to the State of Colorado for a full eligibility determination. If you apply through PEAK, and you are likely to qualify for financial help to buy a private health insurance plan, the State of Colorado will send your application to Connect for Health Colorado.
If you are already enrolled in Health First Colorado and your situation changes, you may need to review your coverage and make changes. For example, if your income changes, you will need to see if you and your family still qualify for Health First Colorado or CHP+. If you no longer qualify, you may still be eligible for a tax credit to help purchase private health insurance through Connect for Health Colorado.
It is important to note that Health First Colorado is the payer of last resort when a member has other insurance or Medicare. This means that if a member is able to provide for their own care, they must pay for their medical benefits first. If there is a responsible third party who should be paying for the member's health benefits, such as a health insurance provider, that party should be paying first.
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Health First Colorado covers doctor visits, emergency care, and preventive care
Health First Colorado, Colorado's Medicaid program, is free or low-cost public health insurance for those who qualify. It is primarily for low-income families and is managed by both the state and federal governments. It can cover doctor visits, emergency care, and preventive care such as screenings and immunizations. It also covers other procedures and treatments.
Health First Colorado is the payer of last resort when a member has other insurance or Medicare. This means that if a member can provide for their care, they must pay for medical benefits first. If there is a responsible third party, such as a health insurance provider, that party should pay first. Federal law requires Health First Colorado to be the "Payer of Last Resort".
If you qualify for Health First Colorado, you can still purchase a private health insurance plan, but you will not qualify for financial help to lower the cost of your health insurance plan through Connect for Health Colorado. You will pay the full price for your health insurance plan.
Health First Colorado enrollment is year-round, and there is no open enrollment period. Applications can be submitted through Connect for Health Colorado or Colorado's Program Eligibility and Application Kit (PEAK) eligibility system at any time during the year.
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Child Health Plan Plus (CHP+) is public low-cost health insurance for certain children and pregnant women
Child Health Plan Plus (CHP+) is a low-cost health insurance program for certain children and pregnant women in Colorado. CHP+ is designed for those who earn too much to qualify for Health First Colorado (Colorado's Medicaid program) but cannot afford private health insurance. CHP+ provides coverage for medical and dental care at participating providers.
The program is administered by the Department of Health Care Policy and Financing, and applicants must have a household income below 260% of the Federal Poverty Level (FPL). CHP+ costs vary depending on household size and income, and services are provided through Managed Care Organizations (MCOs). MCOs are groups of healthcare providers that work together to meet the needs of CHP+ members. These providers include doctors, clinics, hospitals, and pharmacies. The county of residence determines which MCO a CHP+ member enrols with.
CHP+ members can access dental benefits through DentaQuest, which offers a range of preventive, diagnostic, and treatment services. There are no monthly premiums or co-pays for pregnant women, and Native Americans and Alaskan Natives are also exempt from co-pays. The maximum out-of-pocket expense for CHP+ members is limited to 5% of their annual income.
CHP+ is distinct from Health First Colorado, which is Colorado's Medicaid program. Health First Colorado is free or low-cost public health insurance for qualifying individuals and families. It covers doctor visits, emergency care, preventive care, and other treatments. When an individual has multiple insurance coverages, Health First Colorado serves as the payer of last resort, meaning that other insurance providers or responsible third parties must pay first.
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Frequently asked questions
Health First Colorado is Colorado's Medicaid Program. It is free or low-cost public health insurance for those who qualify.
Yes, you can have Health First Colorado alongside another insurance. However, Health First Colorado is the payer of last resort, meaning that it will only pay for services after any other coverage you have has paid first.
Federal regulations require that all available resources be used before Health First Colorado considers payment. This means that if a member can provide for their care, they must pay for medical benefits first.
You can apply for Health First Colorado online, in person, by phone, or by mail.
Health First Colorado can cover doctor visits, emergency care, preventive care such as screenings and immunizations, and other procedures and treatments.
