Colorado Medicaid is a health insurance program for low-income residents in Colorado. It provides coverage for a variety of medical services, including doctor visits, hospital stays, and prescription drugs. Colorado Medicaid also provides coverage for long-term care services, such as nursing home care. Colorado Medicaid does not work out of state, meaning that people who are enrolled in Colorado Medicaid cannot use their coverage to pay for medical services in another state. However, there are some exceptions to this rule. For example, people who are enrolled in Colorado Medicaid may be able to get coverage for emergency medical services in another state. People who are enrolled in Colorado Medicaid and who are planning to travel out of state should contact their health plan to find out what coverage is available.
Colorado Medicaid Managed Care Plans
Colorado Medicaid offers managed care plans to its beneficiaries. These plans provide comprehensive health care services, including doctor visits, hospital stays, prescription drugs, and mental health care. There are nine managed care plans available to Colorado Medicaid beneficiaries. Each plan has its own network of providers and benefits.
To enroll in a Colorado Medicaid managed care plan, you must be a Colorado resident and meet the eligibility requirements for Medicaid. You can enroll in a managed care plan by calling the Colorado Medicaid Enrollment Center at 1-800-221-3943 or by visiting the Colorado Medicaid website.
Once you are enrolled in a managed care plan, you will be assigned a primary care provider (PCP). Your PCP will be responsible for coordinating your care and referring you to specialists when necessary.
Colorado Medicaid managed care plans offer a wide range of benefits, including:
- Doctor visits
- Hospital stays
- Prescription drugs
- Mental health care
- Substance abuse treatment
- Dental care
- Vision care
- Hearing care
The benefits that are available to you will depend on the managed care plan that you choose. Some plans offer additional benefits, such as gym memberships or transportation assistance.
| Managed Care Plan | Website | Phone Number |
|---|---|---|
| Anthem Colorado | www.anthemcolorado.com | 1-800-749-4849 |
| Bright Health | www.brighthealth.com | 1-833-783-1678 |
| Centura Health | www.centura.org | 1-800-236-8872 |
| Clover Health | www.cloverhealth.com | 1-800-937-3526 |
| Colorado Access | www.coloradoaccess.org | 1-800-431-1731 |
| Kaiser Permanente | www.kaiserpermanente.org | 1-800-464-4000 |
| Mountain Health CO-OP | www.mountainhealthcoop.org | 1-800-639-5228 |
| Rocky Mountain Health Plans | www.rmhp.com | 1-855-668-2142 |
| UnitedHealthcare Community Plan of Colorado | www.uhccommunityplan.com | 1-800-373-4505 |
Colorado Medicaid Fee-for-Service Program
Colorado’s Medicaid program, known as Health First Colorado, provides medical coverage to eligible individuals and families with low incomes. Health First Colorado offers two main types of coverage: Health First Colorado (MediCaid Fee-for-Service) and Health First Colorado (Managed Care).
Health First Colorado (MediCaid Fee-for-Service) is a traditional Medicaid program that allows members to choose their own doctors and other healthcare providers. Members can see any provider who accepts Medicaid. Health First Colorado (Managed Care) is a type of Medicaid that requires members to choose a managed care organization (MCO). MCOs are private companies that provide a range of health care services to members.
Health First Colorado covers a wide range of medically necessary services, including:
- Doctor’s visits
- Hospital care
- Prescription drugs
- Mental health services
- Substance abuse treatment
- Dental care
- Vision care
- Hearing aids
- Durable medical equipment
- Home health care
- Nursing home care
To be eligible for Health First Colorado (MediCaid Fee-for-Service), you must meet certain income and asset limits. The income limits are based on the federal poverty level (FPL). For example, a family of four with a gross income of less than $46,630 per year is eligible for Health First Colorado (MediCaid Fee-for-Service).
To apply for Health First Colorado (MediCaid Fee-for-Service), you can:
- Apply online at the Health First Colorado website
- Call the Health First Colorado Contact Center at 800-221-3943
- Visit your local county Department of Human Services office
Once you apply for Health First Colorado (MediCaid Fee-for-Service), you will be asked to provide documentation to verify your eligibility. This documentation may include:
- Proof of income
- Proof of assets
- Proof of citizenship or lawful presence in the United States
- Proof of identity
If you are approved for Health First Colorado (MediCaid Fee-for-Service), you will receive a Health First Colorado Member ID card. You can use this card to access medical services from any provider who accepts Medicaid.
Health First Colorado (MediCaid Fee-for-Service) provides comprehensive medical coverage to eligible individuals and families with low incomes. To learn more about Health First Colorado (MediCaid Fee-for-Service) or to apply for coverage, visit the Health First Colorado website or call the Health First Colorado Contact Center at 800-221-3943.
| Category | Income Limit |
|---|---|
| Family of 1 | $15,550 |
| Family of 2 | $21,300 |
| Family of 3 | $27,030 |
| Family of 4 | $32,760 |
| Family of 5 | $38,490 |
Out-of-State Emergency Medical Services
If you are a Colorado Medicaid recipient and you experience a medical emergency while out of state, you are covered for emergency medical services. This coverage is provided by your Medicaid managed care plan, and it includes the following:
- Hospitalization
- Physician services
- Prescription drugs
- Durable medical equipment
- Home health care
- Skilled nursing care
To receive emergency medical services while out of state, you must go to the nearest hospital or emergency room. You do not need to get prior authorization from your Medicaid managed care plan. However, you should call your plan as soon as possible after you receive care to let them know where you are and what services you received.
There are some important things to keep in mind about out-of-state emergency medical services:
- You may be responsible for paying a copayment or coinsurance for the services you receive.
- Your Medicaid managed care plan may not cover all of the services that you receive. If you receive services that are not covered by your plan, you may be responsible for paying the full cost of those services.
- If you are traveling out of the country, you may need to purchase additional travel insurance to cover your medical expenses.
If you have any questions about out-of-state emergency medical services, you should contact your Medicaid managed care plan.
| Service | Covered | Copayment/Coinsurance |
|---|---|---|
| Hospitalization | Yes | May apply |
| Physician services | Yes | May apply |
| Prescription drugs | Yes | May apply |
| Durable medical equipment | Yes | May apply |
| Home health care | Yes | May apply |
| Skilled nursing care | Yes | May apply |
Thank you for taking the time to learn more about Colorado Medicaid’s coverage out of state. I hope you found the information insightful and helpful. Remember, Medicaid programs can be complex and subject to change, so it’s always best to verify specific coverage and eligibility requirements with your local Medicaid office or call the customer service number on the back of your Medicaid card. If you have any further questions or concerns, feel free to give them a ring. And be sure to check back later for more updates and information related to Colorado Medicaid. Stay healthy and take care!