The documents on this page provide an annual snapshot by fiscal year of Health First Colorado (Colorado's Medicaid program) activity including average annual caseload and top five claim types for each county. The data on the fact sheets is for fiscal year 2019-2020 unless otherwise noted and will be updated annually when new data is available. The Department also reports monthly caseload information for Health First Colorado and Child Health Plan Plus (CHP+). See our Methodology Notes for more information.
The top five claim types were done by summing expenditure by claim type and then ranking the top five claim types by expenditure. The top five claim types are a subset of all claim types (for instance there are 16 claim types for institutional, professional, and capitation claims).Capitation claim types (system generated claims for members enrolled in managed care) were excluded from the top five claim types on the fact sheets. Below are some examples of the most common headings/claim types with a description:
- Capitation - system generated claims for members enrolled in managed care, Behavioral Health Organizations (BHOs), and the Accountable Care Collaborative (ACC)
- Outpatient Hospital - a member's expenditure for service rendered at the outpatient hospital setting
- Practitioner/Physician - a member's expenditure for service rendered by a professional/physician
- Inpatient Hospital - a member's expenditure for service rendered in an inpatient hospital setting
- Pharmacy Claims - a member's pharmaceutical costs
- HCBS Waiver - costs associated with members on an HCBS (Home and Community Based Services) waiver
The percent of the population enrolled in Health First Colorado was calculated by taking the average monthly eligible members and dividing by the county/states census data located at: factfinder.census.gov.