What is Presumptive Eligibility
The Presumptive Eligibility (PE) program gives children under 19 and pregnant women temporary Health First Colorado (Colorado's Medicaid program) or Child Health Plan Plus (CHP+) medical coverage right away. Effective July 1, 2022, Family Planning Services is available under the PE program.
Who Qualifies?
- a child under 19 or a pregnant woman,
- appear to qualify for Health First Colorado or CHP+
- individuals regardless of age who are not pregnant and whose income does not exceed 260% of the Federal poverty level
- You must complete an application for Medical Assistance.
Benefits and Services
If you are a child or pregnant woman who qualifies for Health First Colorado Presumptive Eligibility
- Regular Health First Colorado Benefits except:
- Inpatient (hospital) care, including labor and delivery
If you are a child or pregnant woman who qualifies for CHP+ Presumptive Eligibility
- Regular CHP+ Benefits except:
- Dental Services
If you are and individual regardless of age who are not pregnant, and income does not exceed 260% if the Federal Poverty Level
- Limited Family Planning Benefits
How to apply
You must apply at an approved PE site. PE sites are clinics, health centers, and community resource centers. To locate a PE site, visit the Application Assistance Mapping Tool.
The PE site will help you fill out the Medical Assistance Application, or you can print the application and bring it with you to the PE site. You can also apply through PEAK and print out your completed application and bring it with you to the PE site. You must complete all pages of the application.
We use your completed Medical Assistance application to see if you qualify for Health First Colorado or CHP+ or Family Planning Services ongoing. After we have decided, you will get a letter from us telling you if you qualify for Health First Colorado, CHP+, or Family Planning Services.
If you do not qualify for Health First Colorado or CHP+, your temporary coverage through the PE program will end. You may have other coverage options.
If you have more questions about this program, please call Georgann Garcia at 303-866-3544, or email hcpf_PE.Eligibility@state.co.us.
updated: 8/2/22