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Colorado and the ACA’s Medicaid expansion

Nearly half a million Coloradans are covered under Medicaid expansion

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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% to 6.7%, according to the Colorado Health Access Survey — a drop of more than 50%. U.S. Census data put the uninsured rate slightly higher, at 8%, in 2019. But there is no doubt that the uninsured rate has fallen dramatically in Colorado, due in large part to Medicaid expansion.

As of early 2021, enrollment in Colorado Medicaid and CHIP had reached more than 1.5 million people — a 93% increase since the end of 2013. This increase was driven largely by the state’s decision to expand coverage for adults without dependent children, as well as the COVID pandemic that resulted in widespread job/income losses.

ACA Medicaid eligibility expansion in Colorado

One of the Affordable Care Act’s primary strategies for reducing the uninsured rate is Medicaid expansion to cover low-income adults under the age of 65. (Eligibility rules did not change for adults age 65 or older; they are still subject to both income and asset limits for Medicaid eligibility. Here’s how that works in Colorado.)

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. Then-Governor 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% of Colorado’s 737,000 uninsured qualified for Medicaid or CHP+ according to the Kaiser Family Foundation. And under the ACA, another 22% qualified for premium subsidies to help them afford private health insurance through the health insurance marketplace.

Medicaid enrollment in Colorado grew by 72% in the first two years of Medicaid expansion implementation. Medicaid enrollment growth had largely leveled off by 2016/2017, but it spiked again in 2020, due to the COVID pandemic.

The Families First Coronavirus Response Act, enacted in March 2020, provides states with additional federal Medicaid funding. But as a condition of receiving that funding (which all states opted to take), states are prevented from disenrolling anyone from Medicaid unless they move out of state or request a coverage termination. This means that the normal eligibility redetermination process has not been happening since early 2020.

Coupled with the widespread job losses in the early days of the pandemic, Medicaid/CHIP enrollment has grown significantly across the country in 2020 and 2021. By early 2021, Medicaid enrollment in Colorado had surpassed 1.5 million people, and was nearly double what it had been in 2013.

As of December 2020, Medicaid expansion enrollment in Colorado was 488,200, accounting for nearly a third of the state’s total Medicaid/CHIP enrollment.

Colorado has accepted federal Medicaid expansion

  • 1,563,445 – Number of Coloradoans covered by Medicaid/CHIP as of May 2021
  • 780,025 – Increase in the number of Coloradoans covered by Medicaid/CHIP fall 2013 to May 2021
  • 50% – Reduction in the uninsured rate from 2010 to 2019
  • 100% – Increase in total Medicaid/CHIP enrollment in Colorado since Medicaid expansion took effect

Who is eligible for Medicaid in Colorado?

Since 2016, Colorado Medicaid has been called Health First 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:

  • 147% of FPL for children ages 0-18; children with family incomes up to 265% of FPL qualify for Child Health Plan Plus (CHP+; Colorado’s CHIP coverage)
  • 200% of FPL for pregnant women; pregnant women with family income up to 260% of FPL qualify for CHP+
  • 138% of FPL for adults under the age of 65

Note that “income” refers to an ACA-specific version of modified adjusted gross income (MAGI). All of the above income limits include a 5% income disregard that’s added to MAGI for the purposes of determining Medicaid/CHIP eligibility for children, pregnant women, and nonelderly adults.

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 U.S. 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.

How does Medicaid provide financial assistance to Medicare beneficiaries in Colorado?

Many Medicare beneficiaries receive Medicaid financial assistance that can help them with Medicare premiums, lower prescription drug costs, and pay for expenses not covered by Medicare – including long-term care.

Our guide to financial assistance for Medicare enrollees in Colorado includes overviews of these programs, including Medicaid nursing home benefits, Extra Help, and eligibility guidelines for assistance.

How do I enroll in Medicaid in Colorado?

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.) 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.

Colorado Medicaid history

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 Colorado Medicaid enrollment has grown by 93% 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.

The Trump administration began approving work requirements for Medicaid programs in early 2018, with KentuckyIndiana, and Arkansas getting the first approved work requirement waivers. But Medicaid work requirements are not in effect anywhere in the country as of 2021, due to court rulings, state decisions to suspend them, and the COVID pandemic. And the Biden administration has notified states in 2021 that it is reconsidering all previously approved Medicaid work requirement waivers; some had already been revoked as of mid-2021.

But in the early days of work requirement proposals, numerous Republican governors expressed an interest in them, as did 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 Gov. 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.” S.B.214, introduced the following month, would have directed the state to seek permission from CMS 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.

Hickenlooper was term-limited as governor, and now represents Colorado in the U.S. Senate. Jared Polis was elected as Colorado’s governor in 2018 and took office in January 2019. Polis is on record as opposing Medicaid work requirements.

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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Apply for Medicaid in Colorado

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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