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Colorado and the ACA’s Medicaid expansion

More than half a million Coloradans are covered under Medicaid expansion; Low-income undocumented pregnant people and children will gain eligibility as of 2025

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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% in 2010 to 6.6% in 2021, according to the Colorado Health Access Survey. 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 2022, enrollment in Colorado Medicaid and CHIP had reached more than 1.7 million people — a 118% 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, particularly early in the pandemic.

And the Families First Coronavirus Response Act has played a significant role in the continued growth in Medicaid enrollment; it has paused Medicaid eligibility redeterminations since March 2020. So the normal periodic eligibility re-checks have not been happening. As a result, people have continued to enroll in Medicaid, but very few people have been disenrolled during the pandemic (a state can only disenroll people if they move out of state or request that their coverage be terminated). In trade for this, states are receiving additional federal Medicaid funding for the duration of the COVID public health emergency, which is currently expected to last at least until mid-October 2022.

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 2022, Medicaid expansion (Group VIII) enrollment in Colorado was 547,571, accounting for more than a third of the state’s total Medicaid enrollment.

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, and has continued to grow every since.

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 since 2020. By early 2022, Medicaid enrollment in Colorado had surpassed 1.7 million people, and was more than double what it had been in 2013.

Medicaid expanded to cover undocumented pregnant people as of 2025

In June 2022, Colorado Gov. Jared Polis signed HB1289 into law (details here). Under the terms of the new law, Medicaid and CHIP coverage will be available, starting in 2025, to undocumented pregnant people and children who would otherwise be eligible except for their immigration status.

Colorado was already one of the states that provided Medicaid/CHIP coverage to lawfully present immigrant children and pregnant women who hadn’t yet been in the U.S. for five years (there is normally a five-year wait before a lawfully present immigrant can obtain Medicaid or CHIP, but states can opt to waive that waiting period).

But starting in 2025, Colorado will join several other states that are using state funds to provide Medicaid/CHIP coverage to undocumented children and undocumented pregnant people who would otherwise qualify based on their income. And postpartum Medicaid coverage will continue for a year after the baby is born, helping to improve maternal health in Colorado.

Colorado has accepted federal Medicaid expansion

  • 1,710,885 – Number of Coloradoans covered by Medicaid/CHIP as of February 2022
  • 927,465 – Increase in the number of Coloradoans covered by Medicaid/CHIP from fall 2013 to February 2022
  • 50% – Reduction in the uninsured rate from 2010 to 2019
  • 118% – 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 eligibility 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). Coverage is available to lawfully-present immigrant children. As of 2025, income-eligible children who are undocumented immigrants will also be eligible for Medicaid/CHIP.
  • 200% of FPL for pregnant women; pregnant women with family income up to 260% of FPL qualify for CHP+ (Coverage is available to lawfully present immigrants who are pregnant. As of 2025, this coverage will also be available to undocumented pregnant people who would otherwise qualify for Medicaid except for their immigration status; postpartum coverage will continue for a year after the birth)
  • 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.

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 118% 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. 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 revoked all previously-approved Medicaid work requirement waivers. 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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