Within Colorado there are different types of government-funded medical assistance programs for qualifying individuals and families. These programs provide residents of Colorado with access to affordable health insurance with lower costs. CO offers different programs for children, families and adults. However, all members of a family, if eligible, can fall under a single program or policy. The state of Colorado utilizes two federally-funded medical assistance programs for its citizens: Child Health Plan Plus and Health First Colorado, Colorado’s version of Medicaid. The main difference between the two is the income level of the applying family. Health First Colorado is specifically for low-income families who cannot afford health insurance, and Child Health Plan Plus is intended for those with incomes too high to qualify for Health First Colorado, but still too low to afford private health insurance. Before applying for any medical assistance program in the state, it is important to learn what the programs are, what the requirements are and what to expect from the program if accepted.
Eligibility Requirements for Medical Assistance Programs in Colorado
The Child Health Plan Plus (CHIP) is an option for legal minors and pregnant women who at least 19 years of age and who have an income low enough to qualify for benefits. Applicants must also be lawful residents of the state of Colorado, and cannot be eligible for Health First Colorado or have other forms of health insurance. Applicants can apply online to immediately determine eligibility, or if an application is submitted by mail, responses are made in a maximum of 45 days. In general, applicants must have income that falls under 260 percent of the Federal Poverty Level (FPL).
The program membership lasts a year for minors and 60 days after pregnancy ends for pregnant women. Children must reapply every year to maintain coverage. Women, however, can only receive coverage during pregnancy. Once a mother gives birth, she is no longer eligible for CHIP after the 60-day grace period unless she becomes pregnant again.
For Health First Colorado, those who qualify for Medicaid qualify for this program. Applicants must meet income guidelines and be either a child or a pregnant woman over 19 years of age with a household income under the 260 percent of the FPL.
Health First Colorado must also be renewed yearly, but does not have an age limit. Depending on the applicant, some recipients may still have to pay small out-of-pocket copayments to receive services.
Applying for Medical Assistance Programs in Colorado
Both the Child Health Plan Plus and Health First Colorado programs can be applied for through Colorado PEAK online, in person at the applicant’s county office or at a local application site. Applying by mail is also an option, and a fully completed application must be mailed to the local county office.
Finally, those wanting CHIP benefits can apply by phone. For those who may have trouble with the application, staff at the local county office or an application site are prepared to assist with all sections about which an applicant may be unsure.
Paper and phone applicants will receive a decision within 45 days, but online applicants will receive immediate feedback regarding their qualification for CHIP or Health First Colorado benefits.
It should be noted that applicants may also be required to provide a variety of documents proving citizenship status, Social Security Numbers, identity and income as part of the verification process. Substitutes or representatives are not accepted for these application processes.
Benefits and Fees of Medical Assistance Programs in Colorado
The Child Health Plan Plus program acts as a form of medical insurance for those who qualify. The program requires an annual enrollment fee, but includes primary care, emergency and hospital services, child dental care, prescriptions and immunizations, mental and behavioral care and maternity care (prenatal to postpartum).
Depending on the county in which a beneficiary resides, each participant will have a network of available physicians who accept CHIP patients. Some counties have multiple networks, but each household must commit to only one network.
The standards for CHIP fees are $25 for one child and $35 for two or more children. Fees are subject to change, however. Adult pregnant women involved in the CHIP Prenatal Care Program do not pay a fee. American Indians and Alaskan Natives are also exempt from any fees. However, for households that earn more than 214 percent of the FPL, a higher fee is assessed.
Depending on a household’s income, small copayments may also be required. However, these payments never exceed $50 and include emergency assistance. Those benefitting from CHIP are not required to ever pay more than 5 percent of the household annual income out-of-pocket.
For Health First Colorado, benefits are the same as those of Medicaid, including prescriptions, primary care, family planning, dental services, maternity care and other services.
Health First Colorado will also require small copayments, but there is no annual fee for enrollment. However, some are exempted from copayments. These include minors, pregnant women, American Indians and Alaskan Natives, and those housed in nursing facilities. Beneficiaries formerly in foster care are required to pay copayments for prescriptions only.