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Colorado and the ACA’s Medicaid expansion

More than 380,000 Coloradans benefit from 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 percent to 6.7 percent, according to the Colorado Health Access Survey — a drop of more than 50 percent. U.S. 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. Total Colorado Medicaid and CHIP enrollment was 1,337,805 as of June 2020. Colorado Medicaid is called Health First Colorado.

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 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.”

In March 2018, 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.

Hickenlooper was term-limited as governor. 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, and for now, Colorado is not seeking a federal waiver to impose one.

Who is eligible 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

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.

Medicaid expansion in Colorado

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.

As of June 2019, Medicaid expansion enrollment in Colorado was 380,400.

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 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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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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