Frequently Asked Questions - photo

Health First Colorado Frequently Asked Questions

 

  • Are state employees eligible for Health First Colorado?

    Yes, if they meet the income and eligibility rules.

  • Are there co-pays or enrollment fees for Health First Colorado?

    Health First Colorado (Colorado’s Medicaid Program) does not have an enrollment fee, but in some circumstances co-pays may be required. Health First Colorado members who are pregnant, living in a nursing facility, or age 18 and younger do not have to pay co-pays. For more information on co-pays, visit the Benefits and Services Overview page.

  • Can I get help to quit smoking?
    • Contact the Colorado QuitLine at 1-800-QUIT-NOW (1-800-784-8669) for free coaching and support.
    • Talk with your health care provider about the benefits and risks of taking smoking cessation medications while you are pregnant. Health Care Colorado covers two 90-day courses of smoking cessation medication with counseling to help you quit.
    • Are you committed to keeping your kids safe from second hand smoke? Find the Smoke Free Homes Pledge here: Raise Smoke-Free Kids
  • Can same-sex couples who are married in Colorado be considered in the same household for purposes of applying for Health First Colorado?

    Yes, effective October 7, 2014, Colorado began to recognize same-sex marriage. When applying for Health First Colorado (Colorado’s Medicaid Program), same-sex couples joined by marriage in Colorado can now apply as one household and should identify as being married. Also, same-sex couples who were married out of state in a state that permits same-sex marriage will be recognized as a married couple in Colorado for purposes of applying for Health First Colorado.

  • Does Health First Colorado cover smoking cessation products?

    Health First Colorado (Colorado’s Medicaid Program) covers smoking cessation products (e.g. Chantix, nicotine patches and nicotine gum) with a prior authorization.

    Learn more about how to Quit Smoking.

  • English is not my first language. Will Health First Colorado pay for a translator during my doctor visits?

    Translators are not a Health First Colorado (Colorado’s Medicaid Program) benefit. Doctors and other medical providers must offer effective communication with their patients. Effective communication includes translators, American Sign Language interpreters, written material in another language, or other options to help people who speak a language other than English and for people with a disability. For more information, contact the Americans with Disabilities Act (ADA) Coordinator.

  • How can I check the status of my Health First Colorado application?

    If you applied for Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus (CHP+), you can check your application status online through Colorado PEAK.

    Even if you applied by mail, in-person, or over the phone, you can still create a Colorado PEAK account and find out the status of your application online. It may take up to 45 days — or up to 90 days if the application requires a disability determination — from the date your application was received for a case number to be assigned to you. Once you are assigned a case number, you can check your status and benefits online through Colorado PEAKGet more information about your case number and where to find it.

  • How can I find out what medical claims Health First Colorado has paid for?

    You can submit a written request to receive copies of medical claims paid by Health First Colorado (Colorado’s Medicaid Program). The person making the request must be the Health First Colorado member or an authorized party. To become an authorized party you must fill out a Personal Representative Form. The completed Personal Representative form must be sent to Health First Colorado with a client’s request. Health First Colorado screens and processes the request to make sure it meets the Health Insurance Portability and Accountability Act (HIPAA) requirements. This may take up to two weeks.

    Please send your written request to the following address:

    Department of Health Care Policy & Financing
    Privacy Officer
    1570 Grant Street
    Denver, CO 80203

    Your request must include:

    • Dates of service requested
    • Member’s name
    • Member’s Health First Colorado ID Number
    • Photocopy of the member’s Health First Colorado card
    • Last 4 digits of the member’s Social Security Number
    • Member’s Date of Birth
    • A return mailing address
    • The relationship of the authorized party to the client
    • Copy of the member’s and authorized party’s identification or driver’s licenses
  • How do I apply for Health First Colorado?

    See the Apply Now page.

  • How do I change my Health First Colorado health plan?

    You can change your Health First Colorado (Colorado’s Medicaid Program) health plan at any time during the first 90 days after you join. After 90 days, you can change once a year during your open enrollment, which is the two months before your birth month. You can also change your health plan any time you have good cause. Some examples of good cause might be:

    • You move out of the health plan’s area
    • The health plan does not cover the service you need
    • You received poor quality care in the health plan you’re in now
    • You can’t find a provider to treat your problem
    • Health First Colorado Enrollment made a mistake and put you in the wrong health plan

    If you are on Health First Colorado Basic (formerly called regular Colorado Medicaid), you can join a health plan at any time.

    To find out more about choosing your Health First Colorado health plan, See the Choose a Health Plan page or call Health First Colorado Enrollment at 303-839-2120 (in Denver) or 1-888-367-6557 (outside of Denver). Hours: Monday-Friday, 8:00 a.m. to 5:00 p.m. (closed state holidays). The Health First Colorado Enrollment number is not for information on benefits or to find out if you qualify.

  • How do I get behavioral health services?

    A Behavioral Health Organization can arrange your mental health and substance use disorder care. You do not need a referral from your doctor to go to your Behavioral Health Organization. You do not need to enroll in a Health First Colorado (Colorado’s Medicaid Program) health plan to get behavioral health care. If you need mental health and/or substance use disorder services, contact the Behavioral Health Organization in your area.

  • How do I prove I was covered by Health First Colorado or Child Health Plan Plus when I file my taxes?

    Internal Revenue Service (IRS) Form 1095-B is a federal tax document that includes information about the months in 2015 that you and/or others in your household were enrolled in qualifying health care coverage, also known as Minimum Essential Coverage (MEC). IRS 1095-B forms sent out by the Colorado Department of Health Care Policy & Financing will show the months that you were enrolled in Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus (CHP+).

    You do not need Form 1095-B to file taxes. It is for your records. IRS Form 1095-B is your proof of the months during the prior year that you received qualifying health coverage. You should keep this form with your other tax documents. If you file federal taxes, you may want to bring Form 1095-B with you when you file. If you do not file federal taxes, keep this document for your records.

  • How do I request a Health First Colorado card?

    Option 1: Print a card from your home computer. See: How can I print a Health First Colorado card through PEAK?

    Option 2: You can view your Health First Colorado (Colorado’s Medicaid Program) card from the PEAKHealth mobile app. PEAKHealth is for current Health First Colorado and Child Health Plan Plus (CHP+) clients. You must have a Colorado.gov/PEAK account or create one to sign in. PEAKHealth can be downloaded at the Apple iTunes Store or Android/Google Play App Store for free. PEAKHealth is not for people who want to apply for benefits. With the PEAKHealth app and a PEAK Account you can:

    • Update your income and upload your paystub
    • Update your contact and household information
    • Set up payments for Child Health Plan Plus (CHP+) enrollment fees or the Health First Colorado Buy-in program premiums
    • Learn about how to stay healthy
    • Find a Health First Colorado or CHP+ doctor
    • View an electronic version of your Health First Colorado card
    • View your Health First Colorado or CHP+ benefits

    Option 3: You can also call or go in person to your local County Department of Human Services to request a card be mailed. The card will take up to two weeks to arrive.

    Option 4: Finally, you can call or email the Customer Contact Center to request a card be mailed. When calling, choose option 5 to speak to a representative about ordering a replacement Health First Colorado card.  If emailing, please specify the member you are requesting a card for, and be sure to include your name, date of birth and the last four of your Social Security number.  Once you’ve completed the process the card will be mailed to the address on file and should arrive within two weeks.

  • How do I sign up for a Health First Colorado health plan?

    First, you should review the different Health First Colorado plans and decide which one is the best one for you. See the Choose a Health Plan page or call Health First Colorado Enrollment (formerly called HealthColorado) at 303-839-2120 (in Denver) or 1-888-367-6557 (outside of Denver). Hours: Monday-Friday, 8:00 a.m. to 5:00 p.m. (closed state holidays). Note: The Health First Colorado Enrollment number is not for information on benefits or to find out if you qualify.

  • How is Child Health Plan Plus (CHP+) different from Health First Colorado?

    Child Health Plan Plus (CHP+) is public low-cost health insurance for certain children and pregnant women. It is for people who earn too much to qualify for Health First Colorado (Colorado’s Medicaid Program), but not enough to pay for private health insurance. See the Child Health Plan Plus page for more information.

  • How is Health First Colorado different from Medicare?

    Medicare is a federal government-sponsored health care program primarily for seniors. Health First Colorado (Colorado’s Medicaid Program) is health care for low-income families and is managed by both the state and federal governments. Medicare and Health First Colorado differ in terms of who they cover, how they are funded and governed. To find out more about Medicare visit Medicare.gov or call Medicare Customer Service at 1-800-633-4227.

  • How long will it take to find out if I qualify for Health First Colorado?

    If you apply online through PEAK you may find out if you qualify immediately. If you apply by mail, it may take up to 45 days to find out if you qualify.

  • I am a college student who does not live at home but my parents claim me as a tax dependent on their taxes. Do I need to include my parents’ income on my Medical Assistance application?

    Yes. If you are a tax dependent of someone else, you need to include their income information on your application. If you do not know it, you will need to contact that person to get their income information.

  • I am a Health First Colorado member. What do I do if I am out-of-state and need to go to the doctor?

    If you are temporarily out of the state but still a resident of Colorado, you may receive some Health First Colorado (Colorado’s Medicaid Program) benefits under certain conditions:

    1. It is a medical emergency.
    2. Your health would be endangered if you were required to return to Colorado for the medical care/treatment.
    3. The health care provider that treats you must enroll in the Health First Colorado program. Health care providers can visit the For Our Providers page for more information.

    If you have more questions about seeing a health care provider out of state, call the Customer Contact Center.

  • I am a Health First Colorado or Child Health Plan Plus member and I just had a baby. How do I get health care coverage for my newborn?

    If you are a woman enrolled in Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus (CHP+) when your baby is born, you can add your newborn to your case online by reporting a change through your PEAK account at Colorado.gov/PEAK, or using the PEAKHealth mobile app. Your baby will then be automatically enrolled in health coverage until his or her first birthday.

    You also have the option to report the birth of your baby to your county of residence human services office or a Medical Assistance (MA) site case worker near you. Once your baby is added to your case and you have their State ID, you are able to take your baby to the doctor.

  • I am currently on Health First Colorado but recently started getting health insurance through my job. Do I need to cancel my coverage?

    No, you do not have to cancel your Health First Colorado (Colorado’s Medicaid Program) coverage, but you do need to tell us if your income has changed. If your income has changed since you applied for Health First Colorado it is important that you update the income we have on file for you. You can update your income, contact information, job information, and other information by logging on to your PEAK Account at Colorado.gov/PEAK to report a change. You can also report a change to your local County Human Services Office or a Medical Assistance Site in your community.

    After you tell us what your new income is, we check to see if you still qualify for Health First Colorado.

    • If you do still qualify for Health First Colorado then you do not have to do anything. Depending on your income, you can still qualify for Health First Colorado even if you have private health insurance through your employer. If you have both private health insurance and Health First Colorado, your private health plan will pay your medical costs first, and then what is left over may be covered by Health First Colorado. If you still qualify for Health First Colorado, but do not want Health First Colorado coverage, you can contact your local County Human Services Office and ask them to close your case.
    • If you no longer qualify for Health First Colorado you will get a letter in the mail that states your Health First Colorado benefits are ending. The letter will tell you the date that your benefits will end as well as how you can appeal the decision if you do not agree.
  • I am enrolled in a veteran’s (VA) health care program. Can I also be enrolled in Health First Colorado?

    Yes. Veterans who qualify can have both VA health care program coverage and Health First Colorado. To find out if you and your family qualify for Medicaid see How To Apply.

  • I changed my Health First Colorado health plan. When will my new health plan start?

    If you change your Health First Colorado (Colorado’s Medicaid Program) health plan then your new health plan starts the 1st of the next month. For example, if you change your Health First Colorado health plan on February 6, then your new health plan will start March 1st.

    Until your new plan is active you are still covered by Health First Colorado, but some health care providers may not be able to see you. Make sure you have your Health First Colorado card on hand when making your appointment and when you go to your health care provider’s office.

    If you have questions about your Health First Colorado health plan, call Health First Colorado Enrollment at 303-839-2120 (in Denver) or 1-888-367-6557 (outside of Denver). Hours: Monday-Friday, 8:00 a.m. to 5:00 p.m. (closed state holidays). Note: The Health First Colorado Enrollment number is not for information on benefits or to find out if you qualify.

  • I have Health First Colorado but my income has recently changed. How can I update my income?

    If you are a current Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus (CHP+) member and you need to tell us about a change in your income, log on to your PEAK account at Colorado.gov/PEAK to report the change. This is the fastest and easiest way to tell us about the change in your income. You can get in-person help updating your income using your PEAK account from a Certified Application Assistance Sites in your community. If you do not have a PEAK account, you can create a PEAK Account at any time, even if you did not apply online.

    You can also report income changes using the PEAKHealth mobile app or by contacting your local County Human Services Office or a Medical Assistance Site in your community.

    After you tell us what your new income is, we will need to see if you and your family still qualify for Health First Colorado or CHP+. If you do still qualify then you do not have to do anything. If you no longer qualify for Health First Colorado or CHP+ we’ll check to see if you and your family still qualify for a tax credit to help purchase private health insurance through Connect for Health Colorado.

  • I legally changed my name. How do I change my name on my Health First Colorado or Child Health Plan Plus case?

    There are two ways to report that you have legally changed your name.

    1. Contact your local county office or Medical Assistance site.
    2. If you are enrolled in Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus (CHP+) and do not receive food assistance, cash assistance, or financial assistance to purchase private health insurance through Connect for Health Colorado, you can also call the Customer Contact Center at 1-800-221-3943 / State Relay: 711 to change your name.
  • I suspect that my doctor may be involved with Health First Colorado fraud. What should I do?

    If you suspect your doctor, medical equipment provider, or any other Medicaid provider of fraud, please report it to us.

  • I suspect that someone I know may be involved with Health First Colorado fraud. What should I do?

    If you suspect someone of Health First Colorado (Colorado’s Medicaid Program) member fraud, please report it to us.

  • I was involved in an accident that was not my fault and I don’t want Health First Colorado to pay for the medical bills. What should I do?

    The Tort and Casualty Unit in the Benefits Coordination section of the Department of Health Care Policy & Financing recovers money from a legally responsible third party when the Department has paid claims on behalf of a Health First Colorado (Colorado’s Medicaid Program) member. These circumstances commonly include payments, awards, or settlements from auto, homeowners’ and malpractice insurance carriers intended to compensate the members for their injuries. Health First Colorado has an automatic lien by statute in these circumstances. We are required by state and federal law to take all reasonable measures to identify parties and to seek reimbursement from those legally responsible parties.

  • I was told Health First Colorado pays for services only after other types of coverage pay first. What are some of the other types of coverage that pay for my services before Health First Colorado?

    Health First Colorado (Colorado’s Medicaid Program) is the payer of last resort in most situations. This means Health First Colorado pays for services only after any other coverage you may have pays first. If you have health coverage other than Health First Colorado, you should report that information to us. You can report other health coverage at Colorado.gov/PEAK.

    The following types of coverage may be required to pay for your services before Health First Colorado:

    • Employer-sponsored insurance
    • Workers’ compensation
    • Medicare
    • COBRA
    • Veteran’s (VA) health care program
    • Casualty insurance
    • Dental insurance
    • Vision insurance
    • Pharmacy insurance
  • I’m a Health First Colorado member and received a letter stating my eligibility was being redetermined. What does this mean?

    This means your Health First Colorado (Colorado’s Medicaid Program) eligibility is being reviewed to see if anything has changed. The law requires us to determine if those enrolled in Health First Colorado still qualify at least every 12 months. Your redetermination or renewal date is one year from the date you qualified for Health First Colorado. Near the date your eligibility will be redetermined and you will receive a letter asking you if anything has changed (such as your address, family size or income). If you have questions about your redetermination date please contact your local county human services office or call the Customer Contact Center.

  • Is my Health First Colorado coverage active?

    You can check if your Health First Colorado (Colorado’s Medicaid Program) coverage is active by going to the Colorado PEAK website and clicking on the Check My Benefits button or you can view your card from the PEAKHealth mobile app.

    You can also call your local County Department of Social/Human Services or the Customer Contact Center for assistance.

  • Is there an open enrollment period for Health First Colorado?

    You can apply for Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus (CHP+) at any time. Health First Colorado and CHP+ do not have open enrollment periods. Get more information on the How To Apply page.

  • My child is currently on Health First Colorado or Child Health Plan Plus. If I think I may qualify for Health First Colorado do I need to apply or will I be automatically enrolled?

    You will need to complete an application even if your children are currently enrolled in Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus (CHP+) will. You can apply at any time. For more information visit How To Apply.

  • What benefits are included in Health First Colorado?

    See the Benefits & Services Overview.

  • What happens to my health plan enrollment if I lose and regain Health First Colorado?

    If you lose Health First Colorado (Colorado’s Medicaid Program) and then get it back within 60 days, Health First Colorado will keep you enrolled in the health plan you had before you lost it. If you lose coverage and it takes longer than 60 days to get it back, you may have to re-enroll in the health plan you had before you lost coverage. To enroll in a Health First Colorado health plan, contact Health First Colorado Enrollment at 303-839-2120 (in Denver) or 1-888-367-6557 (outside of Denver). Hours: Monday-Friday, 8:00 a.m. to 5:00 p.m. (closed state holidays). Note: The Health First Colorado Enrollment number is not for information on benefits or to find out if you qualify.

  • What Health First Colorado health plans are offered?

    You can choose either the Accountable Care Collaborative (ACC) Program, a Managed Care Organization (MCO), or Health First Colorado Basic (formerly called regular Colorado Medicaid). See the Choose a Health Plan page for more information.

  • What is a health plan?

    Health plans are networks of physicians, hospitals, and other health care professionals who deliver medical services to health plan members. To enroll in a Health First Colorado (Colorado’s Medicaid Program) health plan, contact Health First Colorado Enrollment at 303-839-2120 (in Denver) or 1-888-367-6557 (outside of Denver). Hours: Monday-Friday, 8:00 a.m. to 5:00 p.m. (closed state holidays). Note: The Health First Colorado Enrollment number is not for information on benefits or to find out if you qualify.

  • What is a Prior Authorization Request and why do I need one?

    Some Health First Colorado (Colorado’s Medicaid Program) services and benefits require a health care provider to complete a form or make a phone call that gives permission to get extra services and supplies if you have a special health care need. If you have questions about prior authorizations please contact your health care provider or the Customer Contact Center.

  • What is Estate Recovery?

    Federal law requires states to operate an Estate Recovery Program to help pay for the costs of their Medicaid program. We recover medical assistance payments paid on behalf of former Health First Colorado (Colorado’s Medicaid Program) members from their estates. We may only recover medical assistance costs from the estates of members who received services in an institutionalized setting or for the cost of services received by members who were age 55 and older. The law also provides exceptions to estate recovery and the ability to compromise claims.

  • What is Health First Colorado Enrollment?

    Health First Colorado Enrollment (formerly called HealthColorado) is a state program that helps Health First Colorado members choose the health plan they want to get services from. Health First Colorado Enrollment sends letters to all newly enrolled Health First Colorado members letting them know about their health plan options.

    To find out more about choosing your Health First Colorado health plan, See the Choose a Health Plan page or call Health First Colorado Enrollment at 303-839-2120 (in Denver) or 1-888-367-6557 (outside of Denver). Hours: Monday-Friday, 8:00 a.m. to 5:00 p.m. (closed state holidays). The Health First Colorado Enrollment number is not for information on benefits or to find out if you qualify.

  • What is Health First Colorado?

    Health First Colorado (Colorado’s Medicaid Program) is free or low cost public health insurance for Coloradans who qualify. Health First Colorado can cover your doctor visits, emergency care, preventive care such as screenings and immunizations, and other procedures and treatments. See the Benefits & Services Overview to find out what Health First Colorado covers.

  • What is managed care?

    Managed care is a group of doctors, clinics, hospitals, pharmacies and other providers who work together to take care of your health care needs. We refer to these groups as Managed Care Organizations or MCOs. For more information please see the Accountable Care Collaborative page.

  • What is my Case Number and where do I find it?

    Your Case Number is how we identify you and members of your household in our system. Your Case Number starts with “1B.” This number is used by programs such as Health First Colorado (Colorado’s Medicaid Program), Food Assistance, Cash Assistance and/or Colorado Works to identify you. It is also on all letters we send you.

    If you do not qualify for Health First Colorado, you have other coverage options. You will need your Case Number to find out if you qualify for financial assistance to help buy private health insurance through Connect for Health Colorado.

  • What is my Health First Colorado ID Number and where do I find it?

    We give each person who qualifies for Health First Colorado (Colorado’s Medicaid Program) an ID Number. Your and your family or caretaker’s Health First Colorado ID Number is sometimes called your State ID Number. Your ID Number is on your Health First Colorado card. It is also on all letters we send you about your benefits. You can also get your Health First Colorado ID Number by calling or visiting your county of residence’s human services office or calling the Customer Contact Center.

    You can also view your Health First Colorado card from the PEAKHealth mobile app.

  • What is the nurse line?

    If you are not feeling well but are not sure if you need to go to the doctor, call the Nurse Advice Line at 1-800-283-3221. This free hotline is just for Health First Colorado (Colorado’s Medicaid Program) members and you can call it 24-hours a day, 7 days a week.

  • What long-term care services are offered by Health First Colorado?

    Health First Colorado (Colorado’s Medicaid Program) offers services including nursing facility care and Home and Community-Based Services where medical providers come into the home to render the necessary services to keep a disabled or aged individual from being placed in a nursing facility or hospital. See the Benefits & Services page for more information.

  • When will my Health First Colorado benefits start?

    After finding out you qualify for Health First Colorado (Colorado’s Medicaid Program) your benefits will start right away. Your benefits may also be backdated to the first day of the month you applied. If you applied for long-term care Health First Colorado or other special programs, your benefits start the day you meet all the requirements.

    If you are not feeling well but are not sure if you need to go to the doctor, call the Nurse Advice Line at 800-283-3221. This hotline is just for Health First Colorado members and you can call it 24 hours a day, 7 days a week.

    Your Health First Colorado card should arrive in 7-10 days. Your card will be sent to the address on your application. You can also print your Health First Colorado card through PEAK. You should always bring your photo ID with you when you see your health care provider or go to the pharmacy. You do not need a copy of your Health First Colorado card to get medical services.

    It is important to know that it may take a few extra days once you are enrolled for your health care provider to confirm in their system you are enrolled in Health First Colorado. If you have questions about your coverage or benefits, please call the Customer Contact Center.

    In an emergency, you should get care from the closest hospital that can help you. The law requires providers to examine you to determine if your medical condition is life threatening and provide you with medical care until your life is no longer in danger.

    If you need to fill a prescription, check to see if your pharmacy accepts Health First Colorado. If they do, provide a photo ID and prescription (or refill) to the pharmacy. They will try to fill it using the information you gave them. If they do not have enough information, pharmacies can give you enough medicine for 3 days. If your pharmacy does not accept Health First Colorado, call the Customer Contact Center for help finding another pharmacy.

  • Where can I get individual Health First Colorado application assistance for my unique circumstances?
  • Which doctors take Health First Colorado?

    Many types of doctors take Health First Colorado (Colorado’s Medicaid Program). Health First Colorado can cover your doctor visits, emergency care, preventive care such as screenings and immunizations, and other procedures and treatments.

    See the Benefits & Services page for benefit details and see the Find Doctors & Providers page to search for specific doctors or other medical providers in your area.

  • Why is my doctor sending me a medical bill if I have Health First Colorado?

    If you have received a medical bill from your doctor or a collection agency, and you have confirmed that you were active on Health First Colorado (Colorado’s Medicaid Program) on the date of service, first check if the date of service is within 120 days. If it is, please contact your provider and ask them to bill the medical assistance program. If they are having trouble billing, ask them to contact Provider Services at 1-800-237-0757.

    If the date of service on the bill is greater than 120 days, please contact the Customer Contact Center for further assistance.

Frequently Asked Questions