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Understanding Colorado Medicaid Eligibility

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While you’ve likely heard the term Medicaid at some point in your life, or perhaps have some understanding of what it entails, not many people are familiar with the specifics of the program. For starters, Medicaid is both a federal and state run insurance program that provides health care to individuals with limited income and resources regardless of age.

In Colorado, the state’s Medicaid program goes by the name Health First Colorado. For residents that qualify, Health First Colorado will help to cover costs for doctor visits, preventive care, emergency care, and more.

Since they’re occasionally conflated or mistaken for one another, it’s important to note that Medicaid (and Health First Colorado) differs from that of Medicare. While both are government healthcare programs, Medicare is primarily for seniors over the age of 65. Medicaid, as we mentioned, applies to low-income families regardless of age.

Health First Colorado Eligibility

Eligibility for Health First Colorado is based on an individual’s Modified Adjusted Gross Income (MAGI), which is reported on your tax return. If you meet one of the following eligibility criteria, you may qualify for Health First Colorado.

Health First Colorado Eligibility Criteria:

  • Children up to the age of 18 with household income under 260% of the Federal Poverty Level.
  • Pregnant women over the age of 19 with household income under 260% of the Federal Poverty Level.
  • Parents and caretaker relatives with a dependent child whose household income does not exceed 133% of the Federal Poverty Level.
  • Adults without a dependent child whose household income does not exceed 133% of the Federal Poverty Level.

In terms of what income is counted toward your Medicaid eligibility, note that it can be income from any number of sources. This may be your employment wages, stock dividends, IRA withdrawals, pensions payments, Social Security Income, Social Security Disability Income, Veteran’s benefits, and more.

There are additional Medicaid programs available, as well, that provide long-term care for eligible Colorado seniors. These programs include Nursing Home Medicaid, Home and Community Based Services (HCBS), Aged Blind and Disabled (ABD), among others. The financial eligibility requirements for these programs, along with how and where these benefits are provided, vary depending on the specific program.

If you apply for Health First Colorado online through Colorado PEAK, oftentimes you can find out if you qualify for benefits right away. However, if you apply by mail, a response to find out if you qualify can take up to 45 days.

If at any time you would like to check the status of your coverage, such as ensuring that your coverage is still active, you can do this online through the “Check My Benefits” button on the Colorado PEAK website or Health First Colorado mobile app.

In the event that you no longer qualify for Medicaid, Health First Colorado will send you a letter in the mail notifying you of this change. The letter will include the date in which your benefits will end, as well as instruction for how to appeal the decision if you feel it has been wrongly made.

Health First Colorado Enrollment

Once you’ve confirmed your eligibility, you have a few options available to you for enrollment. If you’d like to enroll online, you can do so at the following site: enroll.healthfirstcolorado.com. Additionally, you have the option of enrolling by phone using the following numbers: 1-303-839-2120 (Denver residents), or 1-888-367-6557 (outside of Denver). Note that these numbers are dedicated to enrollment and not for informational purposes.

There are no dedicated open enrollment periods for Colorado’s Medicaid Program, so you can apply at any time. In most cases, your benefits will start right away once it has been confirmed that you qualify. Once your benefits start, your Health First Colorado card will arrive in the mail in about 7-10 days and will be sent to the address listed on your application.

If at any point you change your Health First Colorado plan, your new health plan will start on the 1st of the next month. So, for example, if you changed your plan on June 15, your new plan coverage would start on July 1. Note, however, that you’ll still be covered by Health First Colorado until your new plan is active.

If you experience a change in income or family size and lose your Health First Colorado coverage as a result, you will be eligible for a Special Enrollment Period that lasts for 60 days from the date your coverage ends.

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