Colorado and the ACA’s Medicaid expansion

Rebranded as Health First Colorado, enrollment has grown by 73% since 2013

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

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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, according to the Colorado Health Access Survey — a drop of more than 50 percent. US Census data put the uninsured rate slightly higher, at 7.5 percent, in 2016. But there is no doubt that the uninsured rate has fallen dramatically in Colorado, due in large part to Medicaid expansion.

As of November 2017, enrollment in Colorado Medicaid and CHIP had reached 1,352,546 people — a 73 percent increase since the end of 2013, driven largely by the state’s decision to expand coverage for adults without dependent children.

H.B.1384, introduced in Colorado in the 2018 legislative session, would direct the state to conduct a study on the costs and feasibility of a Medicaid buy-in program, a public-private partnership option, or a community based or regionally based option for health coverage in the state. If the legislation were to be enacted, the state would conduct the study and submit a report to lawmakers by February 2019. The legislation wouldn’t implement a Medicaid buy-in program itself, but would potentially pave the way for the state to seek federal permission, at some point in the future, for a program in which people who aren’t eligible for Medicaid would be allowed to purchase coverage through Colorado’s Medicaid program.

Legislation to implement Medicaid work requirement fails

The Trump Administration began approving work requirements for Medicaid programs in early 2018, with KentuckyIndiana, and Arkansas getting the first approved work requirement waivers. Numerous Republican governors have since indicated an interest in pursuing work requirements, as have a few Democrats.

Colorado expanded Medicaid as called for in the ACA, with no state-based changes to the program. But in February 2018, Democratic Governor, John Hickenlooper, noted that he would be open to the possibility of imposing a Medicaid work requirement in an effort to prevent people from “freeloading on the system.”

In March, Rep. Susan Beckman (R, District 38) and Senator Larry Crowder (R, District 35) introduced S.B.214, which would have directed the state to seek permission from CMS, by March 2019, to implement a Medicaid work requirement, a monthly income verification requirement, and a five-year limit on Medicaid coverage for non-disabled enrollees. But the bill died ten days later, in a 3-2 vote in the Health and Human Services Committee. So for now, Colorado will not seek a federal waiver to impose a work requirement for Medicaid.

Hickenlooper is term-limited as governor, so Colorado will have a new governor in 2019. Numerous candidates are vying to replace Hickenlooper in the November 2018 election, including Congressman Jared Polis, who is on record as opposing Medicaid work requirements.

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.

Medicaid enrollment in Colorado grew by 73 percent between late 2013 and late 2017, driven mostly by the expanded eligibility rules. The bulk of that enrollment growth was in the first two years after Medicaid expansion took effect—the enrollment increase stood at 72 percent by early 2016. This is similar to the trends other states have seen, with enrollment growth mostly leveling off by 2016/2017.

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 73 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.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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How to apply in CO

Children from birth through age 18 with family income levels up to 266% of FPL; pregnant women with incomes up to 213% of FPL; and nonelderly adults — with or without dependent children — with incomes up to 138% of FPL. Pregnant women with incomes up to 322% of FPL are eligible for MCAP.

Eligibility: 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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