Colorado and the ACA’s Medicaid expansion

Rebranded as Health First Colorado

Where in your state to call or visit for Medicaid.How to apply

Online at Colorado PEAK; in person at a county office; by phone at 1-800-221-3943 (TDD: 1-800-659-2656); by submitting an application by mail to the address included on the application form. Forms also available at a county office or application assistance site.

Who is eligible in your state to get Medicaid?Who is eligible

Children 0-18 with family incomes up to 142% of FPL; children with family incomes up to 260% of FPL qualify for Child Health Plan Plus (CHP+); pregnant women with family income up to 195% of FPL; (pregnant women with family income up to 260% of FPL qualify for CHP+);  non-elderly adults with family income up to 138% of FPL; some individuals who are elderly or disabled.

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  • September 26, 2016

As of June 2016, Colorado Medicaid was renamed Health First Colorado.

Through Medicaid expansion and a well-functioning health insurance marketplace — both outcomes of the 2010 Affordable Care Act (ACA) — Colorado has reduced its uninsured rate from 14.3 percent to 6.7 percent – a drop of more than 50 percent.

The Kaiser Family Foundation estimated in January 2016 that there are still more than 225,000 uninsured residents in Colorado who are eligible for Medicaid but not yet enrolled. As of April 2016, enrollment in Colorado Medicaid and CHIP had reached 1,349,202 people – a 72 percent increase since the end of 2013, driven largely by the state’s decision to expand coverage for adults without dependent children.

Who qualifies for Medicaid in Colorado?

Each state sets eligibility criteria for the covered populations, which must meet minimum standards set by the federal government.

Colorado’s income limits for Medicaid qualification are:

  • 142 percent of FPL for children ages 0-18; children with family incomes up to 260 percent of FPL qualify for Child Health Plan Plus (CHP+)
  • 195 percent of FPL for pregnant women; pregnant women with family income up to 260 percent of FPL qualify for CHP+
  •  138 percent of FPL for nonelderly adults

Individuals who are elderly or disabled may also qualify for benefits.

Colorado is also one of the states that uses state Medicaid funds to provide coverage for lawfully-present children and pregnant women who have not yet been in the US for five years (the time frame required in order to qualify for Medicaid benefits under the regular Medicaid program that’s funded by state and federal money). This has mostly been the case since 2009, but the provision was extended to apply to all income-eligible lawfully-present children and pregnant women.

Where can you sign up for Medicaid?

If you think you may qualify for Medicaid, you can apply a number of ways:

  • Online at Colorado PEAK. “PEAK” stands for Program Eligibility and Application Kit, and Colorado PEAK is a website for applying for food, cash, and medical assistance programs. Colorado’s state-run health insurance exchange (Connect for Health Colorado) connects with PEAK, so you’ll be able to enroll in Medicaid or CHIP if you start at the exchange website too.
  • In person at your county office.
  • By telephone: 1-800-221-3943 (TDD: 1-800-659-2656).
  • By mail: print an application, fill it out, and mail it to the address included on the application form. You can also get a form at your county office or an application assistance site.

Medicaid expansion

One of the Affordable Care Act’s primary strategies for reducing the uninsured rate is Medicaid expansion to cover low-income, non-elderly adults without dependent children. Medicaid expansion was a required element of the ACA as originally written. However, a coalition of states challenged Medicaid expansion and several other provisions of the ACA, and the case ended up before the Supreme Court in 2012. While the Court rejected most of the challenges, it did rule that Medicaid expansion was optional.

Fortunately for Colorado’s uninsured residents, the state opted to expand Medicaid. Gov. John Hickenlooper signed the legislation authorizing Medicaid expansion in May 2013.

As of late 2013, when the exchanges and Medicaid expansion were first up and running, about 45 percent of Colorado’s 737,000 uninsured qualified for Medicaid or CHP+ according to the Kaiser Family Foundation. And under the ACA, another 22 percent qualified for premium subsidies to help them afford private health insurance through the health insurance marketplace.

By 2015, the total uninsured population in Colorado had shrunk to 593,000 people, and 38 percent of them are eligible for Medicaid (18 percent were eligible for premium subsidies). So while there were initially 331,000 uninsured residents eligible for Medicaid, that had dropped to about 225,000 after two years of expanded eligibility for Medicaid. But it should also be noted that Colorado’s current population growth puts it among the top five states in the nation.

History of Medicaid in Colorado

The federal legislation establishes Medicaid was enacted in 1965, and Colorado authorized its program in 1969. Milestones in Colorado’s Medicaid and Child CHP+ programs as well as federal Medicaid legislation are detailed on the Colorado Center on Law & Policy website.

Medicaid expansion in Colorado went into effect Jan. 1, 2014, and Medicaid enrollment has grown by 72 percent in the ensuing years. The growth includes both those who were newly eligible under Medicaid expansion as well those who qualified under existing eligibility criteria but had not previously enrolled.