Children and Youth Behavioral Health

The Colorado Department of Health Care Policy and Financing (HCPF) is dedicated to improving behavioral health services for children and youth across Colorado. HCPF is working with other state agencies, advocates and stakeholders to enhance the behavioral health continuum of care.

HCPF envisions building a system of care that is family- centered, trauma-informed, and complete across the continuum for children, youth, families, and caregivers that recognizes the distinct needs of this population- from identification of need to treatment. Services for children and youth include intensive in-home and community-based mental health services, intensive care coordination, mobile crisis intervention, and stabilization services.

Key Medicaid Policies for Children and Youth

Cover All Coloradans

Effective January 1, 2025, Colorado expanded health coverage to children age 18 and younger and pregnant people regardless of immigration status. This expansion includes coverage for behavioral health services including mental health and substance use conditions. To learn more, visit the Cover All Coloradans website.

EPSDT

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit gives full health care and checkups to kids and teens who are 20 years old or younger and receive Health First Colorado (Colorado’s Medicaid program). This means that Health First Colorado covers any service that is medically necessary for children and youth 20 years old or younger. It also helps provide case management for adults who are pregnant. EPSDT makes sure children and youth get the preventive care, dental care, mental health care, developmental care, and special services they need.

All Medicaid-coverable, medically necessary, services must be provided even if the service is not available under the State plan to other Medicaid eligibles. Medical necessity is determined on a case-by-case basis and no limitations on services are allowed. You can learn more at the EPSDT website.

Waivers and Specialized Support Programs

HCPF offers multiple Home and Community-Based Services (HCBS) waivers specifically for children with complex medical, developmental, or behavioral needs. To learn more, please visit the HCBS website.

Children With Complex Home Needs (CwCHN) waiver provides Health First Colorado benefits in the home or community for children with complex health needs and/or life-limiting illnesses, and who are at risk for institutionalization in a hospital or nursing facility. Waiver services include counseling/bereavement services, expressive therapy, massage therapy, palliative/supportive care, respite, therapeutic life-limiting illness support, and wellness education benefit.

Children’s Extensive Support (CES) waiver helps children and families by providing services and supports that will help children with a developmental disability establish a long-term foundation for community inclusion as they grow into adulthood.

Children’s Habilitation Residential Program (CHRP) provides services for children and youth who have an intellectual or developmental disability, very high needs or a serious emotional disturbance. Their needs for support put them at risk of, or in need of, out-of-home placement. Waiver services help children and youth learn and maintain the skills needed to live in their communities.

Children’s Home and Community-Based Services Waiver (CHCBS) ‒ for medically fragile children at risk of hospital or skilled nursing facility placement.

Treatment Services and Programs

Colorado System of Care

The Colorado Department of Health Care Policy and Financing (HCPF) is working toward expanding and improving implementation of intensive behavioral health services, under the Colorado System of Care (CO-SOC) that include intensive in-home and community-based mental health services, intensive care coordination, mobile crisis intervention, and stabilization services. This will support Colorado Medicaid beneficiaries under the age of 21 who have been diagnosed with a mental health or behavioral disorder and for whom these services are medically necessary. The improved services will be culturally relevant, family-centered, and child-driven so that these services are provided in the most integrated and least restrictive setting.
To learn more about the CO-SOC, visit the CO-SOC website or email hcpf_co_soc@state.co.us.

Increasing Access to Treatment Foster Care

House Bill 24-1038 requires the Department of Health Care Policy and Financing (HCPF) to develop and implement a plan to increase access to treatment foster care (TFC). The Treatment Foster Care Plan outlines strategies to expand services for children and youth with complex behavioral health needs. Key components of the plan involve improving access to respite care, exploring reimbursement options for TFC providers which might include training and certification programs. By addressing the critical shortage of TFC placements, the plan aims to provide children and youth with a family-like environment that promotes better emotional and behavioral outcomes while reducing reliance on residential treatment facilities. HCPF, the Behavioral Health Administration (BHA) and the Colorado Department of Human Services (CDHS) will collaborate to fulfill the requirements of the bill.
HB 24-1038: High-Acuity Crisis for Children and Youth

Youth Residential Services

A Psychiatric Residential Treatment Facility (PRTF) is an inpatient psychiatric facility for children and youth who need intensive psychiatric care but do not require the level of care of an inpatient hospital setting. PRTFs provide comprehensive behavioral health treatment to children and adolescents (youth) who, due to behavioral health needs, or severe emotional disturbance, need treatment that can most effectively be provided in a residential treatment facility. PRTF services are provided under the direction of a physician. A Qualified Residential Treatment Program (QRTP) is a facility that provides residential trauma-informed treatment that is designed to address the needs, including clinical needs, of children with serious emotional or behavioral disorders or disturbances. As appropriate, QRTP treatment facilitates the participation of family members in the child’s treatment program, including siblings, and documents outreach to family members, including siblings.

Policy Updates and Legislative Changes

Payment Changes for Residential Treatment Services for Youth in Child Welfare or DYS Custody

Beginning July 1, 2026, authorization and payment for medically necessary residential treatment services for youth in county child welfare or Division of Youth Services (DYS) custody will move from the Health First Colorado fee‑for‑service (FFS) system to the Regional Accountable Entities (RAEs). This change marks a one‑year delay in HCPF’s original plan to align service authorization and delivery with state law by July 1, 2025 . The authority for this delay is set forth in SB25-294.

Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5™)

BHA, in partnership with HCPF and the Department of Early Childhood (DEC), has published a new memorandum regarding the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5™). Behavioral health provider organizations and clinicians who utilize the DC:0-5™ should be aware of updates from our agencies regarding billing and reimbursement. Learn more by visiting BHA's Memos page.

Reports

PRTF Actuarial Analysis

House Bill 24-1038 directed HCPF to complete an actuarial analysis to determine the appropriate Medicaid reimbursement rate for Psychiatric Residential Treatment Facilities (PRTFs). HCPF worked with Optumas, an independent actuarial vendor, to complete this analysis by June 30, 2025. View the results here.

Senate Bill 19-195

A critical component of SB19-195, Child and Youth Behavioral Health System Enhancements, directs HCPF to design and put forth recommendations for a child and youth behavioral health delivery system program that integrates funding for behavioral health intervention and treatment services across the state to serve children and youth with behavioral health disorders. HCPF contracted with the Farley Health Policy Center at the University of Colorado Anschutz Medical Center, who sub-contracted with the Colorado Health Institute, to develop the Considerations for the Design of an Aligned Funding Report in accordance with Senate Bill 19-195. View the report here and the appendices here.