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 Member Contact Center.

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 PEAK. Get more information about your case number and where to find it.

What is a disability determination?

A disability determination checks to see if an individual’s medical condition qualifies them for benefits and services for a disability.

What is Outpatient Physical and Occupational Therapy?

Physical and Occupational Therapies (PT/OT) are services meant to help you recover from an acute injury, illness, or surgery. Some therapies are meant to help you maintain physical ability, or help children reach developmental milestones.

PT/OT is performed by licensed professionals. Health First Colorado (Colorado’s Medicaid program) limits the number of PT/OT services you can get in a year. Get more information on PT/OT limits.

How many times can I get Outpatient Physical and Occupational Therapy services?

The benefit does not have a hard-annual limit for children or adults. The benefit is limited by the number of visits which are authorized.

Your provider will be able to help answer your questions about PT/OT services and how many you are able to get in 12 months.

You can read about the PT/OT services a Health First Colorado (Colorado’s Medicaid program) member can get on the Benefits & Services page.

You can also contact the Health First Colorado Member Contact Center for more information.

Do I need a referral or a provider’s permission to get Outpatient Physical and Occupational Therapy (PT/OT)?

Yes. Your primary care doctor, or the hospital you are discharged from, may order or refer you to a physical or occupational therapist to help you recover. You may also go directly to a therapist for care, but that therapist must contact your primary care doctor to get approval for your treatment plan.

Children ages 0 to 3 may receive Outpatient Physical and Occupational Therapy (PT/OT) without a referral if it is coordinated through Early Intervention Colorado.

What happens if I no longer qualify for Health First Colorado or CHP+ coverage?

If you no longer qualify for Health First Colorado or CHP+, you have a limited amount of time to apply for other coverage. The time you have to apply for new coverage, known as a “special enrollment period,” changes depending on the coverage provider.

Other health coverage options include:

  • Coverage through your employer. Check with your employer to learn about options, rules and deadlines.
  • Coverage through a family member’s health insurance, such as a spouse, or parent if you are 25 or younger
  • Coverage through Connect for Health Colorado (Colorado’s official health insurance marketplace). You might qualify for financial assistance to reduce the cost of your premium.
    • To get free help enrolling in Connect for Health Colorado coverage, reach out to a certified assister online or by calling 855-752-6749. TTY: 855-346-3432
  • Coverage through Medicare for people age 65 or older or people under 65 with certain disabilities or end-stage renal disease. If you need help finding a plan, contact the Colorado State Health Insurance assistance Program (Colorado SHIP, a Medicare assistance program) at 888-696-7213.
  • Coverage for active or former military, naval, or air service through Tricare (active) or VA (veterans).

If you no longer qualify because you missed the deadline to respond, you can reapply for Health First Colorado. To get free help filling out an application for Health First Colorado or CHP+ coverage, or to learn about other coverage options, call and make an appointment at a certified application assistance site.