Paul Sanchez
Colorado's Medicaid program, Health First Colorado, is a public health insurance program for low-income individuals and families. It is funded by a federal-state partnership and administered by the Department of Health Care Policy and Financing. The program has seen fluctuations in enrollment numbers over the years, with a significant increase during the economic downturn of 2008-2009. With a large budget, Health First Colorado offers benefits such as behavioral health services, dental care, and discounted health care services for low-income families. While some individuals have expressed dissatisfaction with their experience, others have praised the program for its thoroughness and ease of pre-qualification. Eligibility for Health First Colorado is determined by income guidelines, with different thresholds for children, pregnant women, adults, and individuals with disabilities.
| Characteristics | Values |
|---|---|
| Name of Colorado's Medicaid Program | Health First Colorado |
| Administered by | Department of Health Care Policy & Financing |
| Funded by | Federal-state partnership |
| Eligibility | 138% of the federal poverty level |
| Income eligibility determined by | Modified Adjusted Gross Income (MAGI) |
| Dental services | Included for members of all ages |
| Behavioral health services | Included |
| Medicare deductibles and co-insurance | Covered by Health First Colorado |
| Co-pays | Based on ability to pay |
| Application | Online at Colorado.gov/PEAK |
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What You'll Learn
Eligibility requirements
In general, eligibility for Medicaid depends on income, and in Colorado, the threshold is 138% of the federal poverty level. For a family of four, this equates to $32,900. If your family's income is below this level, then you qualify for Medicaid. If your income is too high for Medicaid, your child may still qualify for the Children's Health Insurance Program (CHIP), which covers medical and dental care for children and teens up to age 19.
Children, pregnant women, parents and caretakers, people with developmental, intellectual, and physical disabilities, and adults can all potentially qualify for Health First Colorado. Members are eligible for behavioral health services, including mental health and substance use disorder care, with no co-pays. Dental services are also a program benefit for members of all ages.
The Health First Colorado Buy-In Program for Working Adults with Disabilities lets adults with a qualifying disability "buy into" Health First Colorado if they earn too much to qualify otherwise. Their monthly premium is based on their income. To qualify, you must have a qualifying disability through Social Security or the State Disability Determination vendor, and your family income must be below 450% of the Federal Poverty Level (FPL).
The Emergency Medical Services (EMS) benefit covers family planning and emergency services for people who qualify for Health First Colorado but do not meet immigration or citizenship requirements.
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Funding and costs
Colorado's Medicaid program, Health First Colorado, is funded by a federal-state partnership and administered by the Department of Health Care Policy and Financing. The state's Medicaid rolls declined from 2006 to 2007 as the state's economy was strong, but when the economy declined in 2008-2009, unemployment rose and many people lost their health insurance. Medicaid numbers began to rise, jumping from 436,000 in 2008-2009 to 620,000 three years later. The Department of Health Care Policy and Financing, which administers Medicaid, has a nearly $8 billion budget, with roughly $1.6 billion covered by the state's general fund. The majority of the funding is provided by the federal government, with the rest coming from sources like the Hospital Provider Fee.
Medicaid is the primary public health insurance program for those with low incomes, and people on Medicaid typically don't have to pay for medical services, although there may be co-pays for some things. The Affordable Care Act (Obamacare) expanded eligibility for Medicaid, and around 400,000 people in Colorado signed up under the expanded criteria. For those in the “expansion population”, the federal government paid for everything for the first few years. In the next fiscal year, the state was expected to pay $120.7 million for the expansion, rising to $222 million in 2020 when the state and federal government settled into a 90/10 split.
Eligibility for Medicaid in Colorado is now 138% of the federal poverty level, which is $32,900 for a family of four. For a single adult with no dependent children, eligibility was $12,060 in 2017. The Health First Colorado Buy-In Program for Working Adults with Disabilities lets adults with a qualifying disability who earn too much to qualify for Health First Colorado buy into the program, with a monthly premium based on their income. The Medicare Buy-In is one of the benefits of the Medicare Savings Programs, and the Qualified Medicare Beneficiary (QMB) program pays for Part A and B premiums, as well as Medicare deductibles and co-insurance. Health First Colorado will pay for Medicare deductibles and co-insurance, except for small co-pays for those not living in a nursing facility.
The Colorado Indigent Care Program (CICP) provides discounted health care services to low-income people and families, although it is not a health insurance program. Co-pays are based on the individual's ability to pay.
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Application process
Health First Colorado is Colorado's Medicaid program. It provides free or low-cost healthcare for Colorado children and adults who qualify. To qualify, applicants must meet specific monthly income requirements. There is no open enrollment period for Health First Colorado, and applications can be submitted at any time during the year.
There are several ways to apply for Health First Colorado:
- Online: The fastest way to apply is online at Colorado.gov/PEAK.
- In person: You can apply in person at your county of residence's local county office or at a local application assistance site.
- By mail: You can fill out a paper application and mail it in or drop it off at your county of residence's local county office or at a local application assistance site.
If you have already applied for Health First Colorado and did not qualify, you can explore other options. The best way to find out if you qualify is to apply. You will be asked to provide the following information when you apply:
- Name and birth date
- Social security number (for applicants who have them)
- Immigration document numbers (for applicants who have them)
- Address where you live and/or get mail
- Employer and income information for everyone in the household
- Income from self-employment or business
- Information about other income such as Social Security Administration or Supplemental Security Income, child support, or pension
- Other forms of unearned income such as gifts or loans from family and friends
- Information about how you'll file your taxes (if you file them)
- Information and policy numbers for other health insurance you may have, including Medicare
- Medicaid information from another state
If you have proof of identity, such as a driver's license or a social security card, you need to provide it. However, if you do not have identification, you do not need to show proof of identity.
Once your application is complete, you will receive a notification from the State of Colorado with your application results. You will also be notified if more information is needed to complete the process. You can also check the results of your application through your PEAK account. If you do not have a PEAK account, you can create one at Colorado.gov/PEAK.
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Benefits and services
Health First Colorado is Colorado's Medicaid program. It is public health insurance for those who qualify. It is funded jointly by a federal-state partnership and is administered by the Department of Health Care Policy & Financing.
Health First Colorado offers a range of benefits and services to its members. Firstly, it provides comprehensive healthcare coverage for those with low incomes, including children, adults, and families. There are no co-pays for behavioral health services, including mental health and substance use disorder care, which are provided through regional organizations. Dental services are also covered for members of all ages, although there may be some restrictions on the types of procedures covered.
Additionally, Health First Colorado offers a Buy-In Program for Working Adults with Disabilities, allowing adults with qualifying disabilities who earn too much to otherwise qualify for the program to "buy-in" at a monthly premium based on their income. The program also includes the Breast and Cervical Cancer Program (BCCP), which provides coverage for uninsured or underinsured women diagnosed with breast or cervical cancer, as well as conditions that may lead to cancer if left untreated.
Health First Colorado also has a Medicare Savings Program, where members can receive benefits such as coverage for Medicare deductibles and co-insurance. Furthermore, Health First Colorado provides a simplified method for calculating income eligibility based on Modified Adjusted Gross Income (MAGI), making it easier for individuals to understand their eligibility.
Finally, Health First Colorado offers a mobile app and online resources to help members manage their health coverage and update their information. This includes the ability to manage accounts and access information through the Colorado PEAK website and the Health First Colorado mobile app.
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History and changes
Health First Colorado, also known as Colorado's Medicaid Program, is public health insurance for eligible Coloradans. It is funded by a federal-state partnership and administered by the Department of Health Care Policy and Financing. The program provides health coverage for those with low incomes, including children, adults, pregnant women, and people with disabilities.
Colorado's Medicaid Program has undergone several changes over the years, with fluctuations in enrolment numbers and updates to eligibility criteria. Here is a timeline of the key developments:
- 2006-2007 -: Colorado's Medicaid rolls declined as the state's economy remained strong.
- 2008-2009 -: When the economy declined and unemployment rose, many people lost their health insurance, leading to an increase in Medicaid enrolment.
- 2012 -: The Affordable Care Act, also known as Obamacare, expanded Medicaid eligibility. This led to a significant increase in enrolment, with many previously uninsured individuals gaining coverage.
- 2014 -: Colorado's Medicaid Program was affected by the implementation of the Affordable Care Act. The state saw an increase in enrolment, with around 400,000 people signing up under the expanded eligibility criteria.
- 2017 -: The program continued to evolve, with updates to eligibility criteria and funding structures. The state proposed budget cuts that could impact federal health programs, including Medicaid.
- 2021 -: Health First Colorado introduced a Buy-In Program for Working Adults with Disabilities, allowing adults with qualifying disabilities and higher incomes to "buy into" the program by paying a monthly premium based on their income.
- 2024 -: While some individuals shared positive experiences with Colorado Medicaid, others encountered challenges, such as issues with insurance coverage and unexpected out-of-pocket expenses.
Colorado's Medicaid Program has been an essential component of the state's healthcare system, providing coverage for thousands of residents. The program has adapted to changing economic conditions, healthcare policies, and the diverse needs of its population. While generally regarded as a valuable safety net, there have been mixed experiences, highlighting areas for continued improvement.
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Frequently asked questions
Colorado Medicaid, or Health First Colorado, is the government's health care program for low-income kids and adults.
Eligibility is now 138% of the federal poverty level. For a family of four in Colorado, that's $32,900. If your family's income is below that level, then you qualify for Medicaid.
You can find an online application for public assistance programs at Colorado.gov/PEAK. You can also call the Medicaid Call Center at 800-221-3943 for general questions or 800-359-1991 for questions about application status.
People on Colorado Medicaid typically don't have to pay for medical services, though there may be co-pays for some things. Colorado Medicaid covers behavioral health services, including mental health and substance use disorder care. It also covers dental services for members of all ages.
Colorado Medicaid is highly regarded by many of its users, with some calling it "incredible" and "pretty great for healthcare." However, there are also individuals who have had negative experiences with the system, such as unexpected costs and sudden loss of coverage.
