COVID-19 Public Health Emergency FAQs

Frequently Asked Questions

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GeneralRenewalsEx ParteEligibilityUnhousedMedicare/MedicaidBuy-In ProgramsLong Term Services & Supports (LTSS)Former Foster CareMaternity and Family PlanningProvidersTransitions in CoverageAppealsReporting
 

General

How does the public health emergency continuous coverage requirement impact members??

At the beginning of the COVID-19 pandemic, the federal government declared a public health emergency (PHE). During the PHE, state agencies were required to provide health care coverage for all medical assistance programs, even if a member’s eligibility changed. This is known as the continuous coverage requirement.

In December 2022, Congress passed a bill that ends the continuous coverage requirement in spring 2023. This required states to return to normal eligibility renewal processes. 

What happens when continuous coverage ends?

Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+) will return to regular eligibility renewal processes with renewals notices going out in March 2023 for people with May renewal dates. The Department of Health Care Policy & Financing (HCPF) will take 12 months (14 months including noticing) to complete renewals for each of the approximately 1.7 million people currently enrolled. Not all members will be renewed at the same time. Each member’s renewal month will align with their already established annual renewal month. Some members will be automatically renewed based on the most recent information already on file with the state. Other members will need to go through the renewal process and take action. The Department will send renewal packets to those members in advance of their renewal dates with key information and their individual timelines to take action.
 
What can members do now to prepare for the end of the continuous coverage requirement?

• Update their contact info and communication preferences in PEAK
• Watch for and respond timely to official notices from the state
• Check the member renewal resources page.

How will HCPF work with its partners?

• We will work closely with our county and eligibility partners to redetermine members' eligibility leveraging the member’s annual renewal date and our modernized, member-centric processes and only disenroll those who are no longer eligible.
• We will properly notice all members whose eligibility changes about their benefits or enrollment status, including appeal information
• We will work closely with our partners at Connect for Health Colorado to ensure those eligible for marketplace health plans are made aware of their coverage options as well as the availability of financial subsidies that make coverage more affordable.

How can I get more information?

The Department will continue to provide messaging to members through the Health First Colorado newsletter, PEAK, the Health First Colorado mobile app, emails, text messages and social media.

We will also provide policy and operational information to our partners through stakeholder meetings, at Colorado.gov/HCPF/COVID and through our COVID-19 Public Health Emergency Updates.

Renewals

What is the renewal process?

The renewal process (sometimes called redetermination or RRR) for Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+) members occurs annually. Some members will be automatically renewed based on information we have for them from other data sources. Members may need to reply to additional letters asking for more information after the renewal process.

If we are not able to verify a member’s eligibility based on most recent information already on file (reported information from members and/or information from other data sources) they will have to go through the renewal process to see if they still qualify for coverage. These members will receive a renewal packet several weeks in advance of their renewal month. The packet will ask them if anything about their situation has changed, a signature to acknowledge review of the information, and may request verification to determine whether they still qualify to receive Medical Assistance. This is a new ask! During the PHE, members have received renewals but haven’t needed to return them to keep their coverage. This packet can be completed electronically through PEAK, the Health First Colorado mobile app, or by mail.

For more information about renewals visit the member renewal resources page.

How will members know when their renewal is due?

The Department will send a renewal packet either in the mail or to their email directing them to their PEAK inbox several weeks before their renewal due date. Members who use the Health First Colorado app, and have opted in to push notifications, will receive a push notification letting them know when it's time to take action.

Members can find out their renewal date on PEAK at any time.

If a member applies for regular Medicaid, is approved and then seeks to be on a waiver, what application is the renewal date tied to? Original Medicaid application or the waiver?

A member’s renewal date is tied to the month they applied and were approved for regular Medicaid.

What does the renewal packet look like?

Sample renewal packets are available to view and download on the Understanding the Renewal Process web page.

What does the notice that members receive after their renewal packet has been processed look like?

Samples of written notices can be viewed on pages 17-20 in the Preparing for Renewals toolkit.

What is an Authorized Representative?

An authorized representative is an individual or organization who acts responsibly on the member or applicant’s behalf during the application and renewal process and other ongoing communications. An authorized representative needs to be added to the case when it is reported to the county within the Authorized Representative screen.

Why are there blank fields in the renewal packet?

The renewal forms sent in the mail ONLY include the minimal information needed to verify eligibility for the members in that household, not everything we have on file. The information in a person’s PEAK account includes ALL information we have on file for that member or household. If we printed all the information in the renewal packets, it would add a significant amount of pages to the mailing and unnecessary burden to the member. In addition, PEAK is a real time system that may dynamically ask for more information as questions are answered (something not achievable on paper renewal packets).

Why are some members renewed via ex parte while others are sent a renewal packet? How do members know which way they will be renewed?

HCPF has made system improvements throughout the pandemic in order to increase the number of members who are automatically renewed through ex parte. Members whose information can be verified and are determined eligible, remain covered. Members who are renewed via ex parte will receive a notice advising them that their coverage has been renewed. They will not receive a renewal packet.  Everyone else will receive a renewal packet that must be completed, signed and returned by the due date. The signature is required regardless if there are or are not any changes to report. Since renewal packets are sent out for households, if one member of the household can be verified but the others cannot, a renewal packet will be sent for all members of the household. If a renewal packet is not returned, the member(s) in the household may lose coverage.

If a member is now over-income to qualify for Health First Colorado (Medicaid), can they be retroactively billed for coverage while they were locked in due to the continuous coverage requirement before their renewal date?

No, any benefits received while on Medicaid coverage, even during the continuous coverage period, can not be billed retroactively to the member.

If someone who currently has Health First Colorado coverage has a change of income before their renewal month, do they have to declare it? Could they lose their coverage if they do?

Members are required to report any changes online via PEAK, by phone, or by mail. For any changes reported for a member that was on Medicaid not due to the continuous coverage provision, after the public health emergency ends, the change can be acted upon and the member will receive advanced notice if their coverage changes as a result.

Why is a signature required for the renewal to be considered complete and how do I sign my renewal packet?

Due to a new federal requirement, members or an authorized representative must sign their renewal packet. There are several ways to do this:

• Paper: Mail, fax, or bring the completed signature page and updated renewal form pages to the member’s local county office.
• Online: Complete and sign the renewal through PEAK. If renewal was submitted to an eligibility site without the signature page, the member could upload the signed signature form via PEAK.
• Telephone: Record the member’s renewal attestation and have their telephonic signature recorded through the member’s local county office. This will include the rights and responsibilities being read to the member.

Can an adult that lives in the home, but is not listed as the head of household sign the renewal?

Yes, an adult who is listed as part of the household on the case can sign the signature renewal form.

If the member does not know how to write, is an “X” acceptable as the signature?

Yes, a member is allowed to sign with the letter “X” if the signature is witnessed by someone and that witness prints their name after the phrase “witnessed by.”

How many days does the member have to provide the signed renewal packet?

The member must complete their renewal packet, including signature, by the date listed in their letter which is generally the 5th of their renewal month. Members will have approximately 45 calendar days to review and return the packet, with any updates and the signed signature page. This packet can be completed electronically through PEAK, the Health First Colorado mobile app or by mail If the member returns the renewal packet and the signature page is missing or unsigned, but all other information is complete, the eligibility system (CBMS) will send a form requesting the member’s signature.

How long does it take to review and process a renewal?

Once the renewal paperwork is received, eligibility workers have 30 days to review and process the renewal and must begin processing within the renewal month. Some renewals are more complicated and may take longer to process. Members are encouraged to submit their renewal packets early to allow for processing times.

Can a member check the status of their renewal after they have submitted their packet?

Members who submit their renewal via PEAK or the Health First Colorado app can see if the renewal has been "submitted" or if it has been "approved or denied” by logging into their account. If members submit a paper renewal, they can contact their eligibility site/local county for a status update or wait for the decision notice to be mailed. 

What happens if a member does not submit their renewal packet in time?

If the renewal packet is received too late to process within the member’s renewal month, the member may receive a notice that their coverage is ending. This renewal may be pending to be processed at the county and the member should contact their local county eligibility worker to confirm. Renewal packets submitted after the due date may result in a gap in coverage.

Can a member return their renewal packet late?

Members can resume medical coverage if they still qualify by returning their renewal packet and any missing information to their county for processing within 90 days of losing coverage. In PEAK, an item was added to the To-Do List to indicate when a late medical assistance renewal can be submitted and processed without needing a new application. Members are encouraged to return renewal packets if they miss the deadline rather than submitting new applications.  

Can a member’s eligibility be backdated if they are disenrolled?

If a member is disenrolled for a procedural reason, they have a 90-day reconsideration period to submit their renewal packet. If they are determined still eligible during that 90-day period, coverage begins as of the 1st of the month they are determined eligible again. If there is a gap in coverage, members must ask the county to be enrolled retroactively. If a member is determined no longer eligible and they disagree with the decision, they can file an appeal.

What is the process for a member who is determined eligible during the reconsideration period to request their coverage be backdated?

Members who are determined eligible during the 90-day reconsideration period can request retroactive coverage by contacting their local county or they can request retroactive coverage in PEAK once they are approved and their new eligibility date is known.

In some circumstances, the returned mail center (CRMC) will contact members to ask them to update their address. How will a member know if the state is calling and not a scam?

Calls coming from the CRMC will show up as "Prowers County" to landlines and 719-454-xxxx to cell phones. (the last 4 digits change depending upon the line the call comes from internally). To learn more about how to recognize a scam, visit: hcpf.colorado.gov/alert

What is the good faith extension?

The Good Faith Extension is an agreement between the HCPF and counties to support all members going through the renewal process who indicate they are attempting to gather requested verifications and experiencing challenges and/or need additional time to gather documentation. County eligibility workers can use this extension to support members in taking additional time to submit the verifications and avoid an unnecessary termination.

What's the difference between a renewal period extension and the 90-day redetermination period?

Extensions are not the same as the 90-day reconsideration period. Extensions are to postpone a termination while a 90-day reconsideration period is after a termination has already occurred. All members can take advantage of the reconsideration period by turning in an existing renewal packet or supporting documents within 90 days of their renewal date to see if they still qualify. If they qualify for Health First Colorado during that 90-day period, coverage begins as of the 1st of the month they are determined eligible again. If there is a gap in coverage, members must ask the county to be enrolled retroactively. Only members with long-term care (LTC), waivered services, and buy-in recipients have a 60-day extension to act on their renewal; if a member meets this criteria, they would have an additional 60 days to complete their renewal without it being late. After that time frame, they would have 90 days to submit a late renewal during the reconsideration period, but may have a gap in coverage.

If a member has an issue with their renewal that cannot be resolved by their county, what can they do?

If a member has contacted their county and attempted to resolve the issue, but is still having trouble, they can use our online escalation form on the Health First Colorado webpage. If someone else completes the complaint form on behalf of a member, the member or authorized representative’s email address should be used as the point of contact. Please provide as much information about the issue as possible so we can work directly with the county to resolve the issue.

Ex Parte

What does ex parte mean?

Some members are automatically renewed based on the most recent information already on file for them from other data sources. This process is known as ex-parte. These members will not receive a renewal packet, but will receive a “notice of action” letter that lets them know they are still eligible for coverage. Some members renewed through ex parte may still have to respond to letters asking for additional information about their income after the renewal process.

HCPF has made system improvements throughout the pandemic in order to increase the number of members who are automatically renewed. The department continues to explore additional opportunities to improve the ex parte process.

What percentage of members are renewed through the ex parte (automatic renewal) process?

HCPF estimates approximately one third of all members (includes both MAGI and non-MAGI enrollees) could be automatically renewed and not have to complete the renewal process. When looking at “active” members- defined as those who have been determined eligible and continue to be eligible (not part of the continuous coverage)- in the last year, the automatic renewal number is expected to be higher. For example, the average active non-MAGI ex parte rate over the last six months was approximately 50%, compared to 32% for the entire population. For those members that need to take action on renewals, the non-MAGI population is more likely than other populations to return their renewal packets. * Members who are renewed through ex parte may need to reply to additional letters asking for more information after the renewal process.

How is Colorado responding to new guidance from the Centers for Medicare and Medicaid Services (CMS) for the ex parte process?

All states received guidance from CMS on August 30, 2023, that requires a change to the ex parte (automation) process for renewals.

Instead of renewing members with ex parte at the household level (all members of a household receiving Health First Colorado or CHP+ benefits reviewed for eligibility at the same time), as has been done in the past, CMS is requiring states to perform ex parte automation reviews on an individual basis, meaning each person in the household is reviewed and approved separately.

While this will increase automation and efficiencies over the long term, this new guidance will require significant changes to our eligibility system that will need to be completed through a phased approach. As a result, HCPF is implementing a temporary renewal extension for all members up for renewal in September and October until we implement a short-term system change in mid October to bring us into compliance with CMS guidance. The extension and short-term system change will not impact the member’s experience of the renewal process. Members are strongly encouraged to complete, sign, and return their renewal packet right away.

If a member with a September 2023 renewal date misses the deadline, will they lose coverage on September 30?

Members with a September renewal have until mid-October to return their packet without losing coverage while we implement a short-term fix for the ex parte process. If a member is determined to no longer be eligible for coverage during their renewal cycle, their coverage may end at the end of October. Members are strongly encouraged to complete, sign and return their renewal packet right away, not wait until the last minute.

How many members will be reinstated due to the change in ex parte guidance?

We initially identified 10,044 individuals affected by this change. The number of members may change slightly once we finalize the reinstatement process.

Will HCPF be doing ex parte at the individual level by default as of October 2023?

Yes. Renewal packets will still be sent to households, but individuals within that household who are identified as eligible during ex parte will be approved instead of disenrolled if the household fails to return their renewal packet by the deadline. 

When will members find out if they have coverage reinstated?

We will be sending letters to affected members the week of October 30, 2023.

What does the letter to members telling them they have coverage again look like?

See a sample reinstatement letter in English and Spanish.

Why does a child/someone in a household now qualify for coverage again but another person still does not?

There are different eligibility rules for people in a household depending on their situation. For example, the income limit for children to qualify for coverage is higher than the income limit for adults. So it is possible for a child to be approved and a parent to not qualify for coverage.

Are members who were disenrolled as a result of the CMS mandated change to ex parte, but later approved and reinstated guaranteed coverage until their next renewal date? 

Reinstatement in coverage does not guarantee that adults will remain covered until their next annual renewal date. Changes in circumstances such as getting a new job may result in someone no longer qualifying for Health First Colorado or CHP+. However, this does not apply to children, pregnant or postpartum people as they are guaranteed coverage until their next renewal date regardless of changes in circumstances. If a person had coverage reinstated, but then reported changes that made them ineligible, they will receive one letter telling them that they qualify for a certain date but then no longer qualify for another date and the reasons for that. The letter will provide the dates they qualify and whether or not they currently qualify.

What should a reinstated member do if they have incurred medical expenses while they had a gap in coverage? 

If a member incurs medical bills during the time we said that members of the household were not covered, let us know so we can pay them. Members can call customer service and let them know about these bills:

• Health First Colorado members, please call 800-221-3943 (State Relay: 711)
• CHP+ members, please call 800-359-1991 (State Relay: 711)

Eligibility

What are the income limits for Health First Colorado (Colorado's Medicaid program)?

You can find the most recent income limits for Health First Colorado at KeepCOCovered.com. These are set annually by the federal government.

How does someone qualify for Child Health Plan Plus (CHP+)?

Visit the CHP+ web page for more information about CHP+ including eligibility and applications.

Is there an enrollment fee for Child Health Plan Plus (CHP+)?

The enrollment fee is no longer required at intake for the CHP+ program. To remove barriers for families seeking health coverage, HCPF and the Colorado General Assembly championed HB22-1289, a health care bill which also included an amendment to eliminate the CHP+ enrollment fee at intake and renewal. 

What is a verification checklist and what does a member do if they receive one?

A verification checklist is a document asking for additional information to see if someone qualifies for Medical Assistance (such as Health First Colorado or CHP+). If a member receives a verification checklist, they should read it carefully to see what information is needed and give this information to the eligibility site. If a member has questions about the verification being requested, they should contact their eligibility site listed on the letter.

What is an income discrepancy letter and what does a member do if they receive one?

An income discrepancy letter is a letter sent to a member when there’s a difference of more than 20% between the earned income our data source shows and what the member reported on their renewal paperwork. This difference is called “reasonable compatibility.” If a member receives an income discrepancy letter, they should review the income they reported and what our data shows. If the information they submitted is wrong, they need to submit new information showing correct earned income to their eligibility site.

Can a member become ineligible prior to their renewal date?

Yes. If a member has a change in circumstance and no longer meets requirements, the program could be closed. A Notice of Action will be mailed to the member. This applies to members who were determined eligible and approved within their prior renewal. For example, a member may have had a renewal in December 2022 and was approved. A change of circumstance is reported in August 2023 and they are no longer eligible. They will terminate coverage prior to their next renewal in December 2023.

For members who were previously determined ineligible but continued coverage due to the PHE, they MUST go through their renewal process and will not terminate if there is a change in circumstance before their renewal.

See the Additional FAQs specific to eligibility and COVID-19 PHE Unwinding.

Unhoused

Do unhoused members have to complete a renewal?

Unhoused members will go through the regular renewal process, including ex parte, to see if we have enough information for them to be automatically renewed. If they are not approved this way, they will be sent a renewal packet in the mail and through the PEAK portal if they are signed up for it. Health Care Policy & Financing (HCPF) is working with shelters to ensure they are aware of the renewal process and can help point members to support to complete renewals on time. Regional Accountable Entities are also working closely with community partners and organizations that help serve unhoused members. Members can receive in-person assistance completing their renewal at a Certified Application Assistance Site or at their county office.

How will an unhoused member be reached if their signature is missing from their renewal packet? 

We will make every attempt to contact members according to the methods they have opted into and the information we have on file. A signature is still required from unhoused members and can be completed in one of several ways- see the Signatures FAQ for more information.

How do unhoused members receive their renewal packets? 

HCPF uses information on file to send notices via mail or electronically through the PEAK portal for those who are signed up for it. Unhoused members sometimes list a local shelter as their address to receive mail - if this is the contact we have on file, that is where the renewal will be sent. HCPF has been working to ensure updated contact information is in place for all members, including emails and phone numbers to ensure we can reach them when their renewals are due. Members should visit the member renewal resources page to find out more.

Medicare/Medicaid

If a member loses Health First Colorado (Colorado’s Medicaid program) coverage, will they also lose coverage for Medicare cost shares or full benefits (for people who are dually eligible) during the 60 day period following Medicaid coverage loss?

If someone no longer qualifies for Health First Colorado, they will no longer be eligible for related benefits such as Medicare premium cost shares or full Medicaid benefits if dually eligible for Medicare and Medicaid.

If a member is eligible for a Medicare Savings Program (MSP), but their income changes, will they be eligible for another MSP program if they continue to qualify for Medicaid?

When someone completes a renewal, they are assessed for eligibility to all programs administered by HCPF. For example, if an applicant is eligible for long-term services and supports and also meets criteria for a Medicare Savings Program, we will approve both programs.

Will MAGI Medicaid members who have aged have the opportunity to apply for and receive Medicare Savings Program benefits?

Yes, MAGI members who have aged or become eligible for Medicare can submit income and resource information to be determined eligible for a Medicare Savings Program category. County eligibility workers have been instructed on how to notify the state if a member does meet MSP eligibility so they can receive benefits.

Will the categories of Medicare Savings Program remain the same?

Yes. There has been no change to the eligibility for the Medicare Savings Programs.

What are the income limits for the Medicare Savings Program (MSP) and Low-Income Subsidy (LIS)?

The income limits for the MSP and LIS programs (QMB, SLMB, QI-1, QDWI and LIS) are based on federal poverty level (FPL) guidelines that are updated annually. For 2023, see OM 23-014, Medical Assistance - Medicare Savings Program and Low-Income Subsidy.

What are the resource/asset  limits for the Medicare Savings Program (MSP) and Low-Income Subsidy (LIS)?

For MSP/LIS resource/asset limits for 2023, see OM 23-001, Medical Assistance - Medicare Savings Program and Low-Income Subsidy

Buy-In Programs

Will Buy-In premiums for the Working Adults with Disabilities (WAwD) and Children’s Buy-In with Disabilities (CBwD) programs resume after the continuous coverage period ends?

No, premiums will continue to be waived at intake and renewal throughout the entire 14-month unwinding period. Health Care Policy & Financing (HCPF) will send out a formal communication before the premiums resume

When will Buy-In premiums for the WAwD, and CBwD programs start after the 14-month unwinding period ends?

HCPF is currently exploring and working with our federal partners to determine when these premiums will begin after our 14-month unwinding period ends. More information will be provided before the 14-month unwinding period ends.

Long Term Services & Supports (LTSS)

How does the state automatically renew LTSS (or Non-MAGI) members?

Ex Parte is the process by which the state reviews recent information already on file to determine eligibility- this information must be within the last six months. That information may come from a member’s renewal in another program, such as SNAP. If the information on file shows a member may not be eligible or if there is not enough information to determine if a member is eligible, a renewal packet will be sent out. Members are requested to review the information on file and make updates or provide new information. If a member needs additional documentation that cannot be automatically verified with existing data, a notice will be sent out identifying the items that require the documentation and types of acceptable documentation. *Depending on the program, a level of care assessment or other information may be needed to complete the renewal process.

How will this impact any LTSS programs a member is participating in?

During the continuous coverage requirement, members who have stopped meeting programmatic requirements for their selected LTSS program have continued to be held active in their selected LTSS program. Case Management Agencies (CMAs) will begin outreaching these members in April 2023 to inform them of the end of the continuous coverage requirement. Case managers will work with the member to identify if the member meets programmatic requirements, requires an assessment, a change of program, or service coordination. For those members who continue to no longer meet programmatic requirements, no adverse action will be taken by the CMA until after the members financial renewal date has passed. After the financial renewal date has passed, the CMA will outreach the member again to identify the programmatic requirements for their selected LTSS program. For members who continue to no longer meet requirements, a Notice of Adverse Action will be sent to the member which includes the members appeal right. For more information, please see OM 23-024: “Case Management Eligibility and Notice of Action Requirements for the Ending of the COVID-19 Public Health Emergency”

Do members in Long Term Care on waivers have to go through the renewal process?

All members will go through a renewal for Medicaid eligibility and if they do not meet requirements for the program then they could lose coverage. This includes members in Long Term Care on a waiver. If they still meet the requirements (income and resources, disability, and level of care) they should just renew for another year.

Can members with long-term care (LTC) have more time to complete the renewal process?

Yes, HCPF is leveraging guidance from CMS to extend the renewal period for people with LTC, waivered services and disabled buy-in members who have not returned their renewal packet or members who returned their renewal packet but its review has not been started by an eligibility site.

Instead of the 30-day delay CMS recommended, Colorado will be extending the renewal time frame for LTC members by 60 calendar days to allow for additional outreach and action on the renewal. This allows LTC members to have an additional 60 calendar days to return their packet or for it to be processed by the county for cases that are past due.

Do LTC members still need to complete, sign and return their renewal packets if a special extension is issued?

Yes, all members must complete, sign, and return their renewal packet to continue coverage, and they are encouraged to do so right away when it is their time to renew.

Special extensions allow extra time for more complex renewals; however, members may still risk losing coverage if renewals are not completed during the extended timeframe. Members must take action to maintain their coverage by submitting all the required information and documents.

More information on helping LTSS members through the Continuous Coverage Unwind.

Former Foster Care

Do former foster care youth who are under 26 years old and currently have Health First Colorado (Colorado’s Medicaid program) coverage need to complete a renewal?

No, they will continue to receive coverage until they turn 26 unless they move to another state. If a person is within 3 months of turning 26, they will go through the regular renewal process and may receive a renewal packet if we need more information to see if they qualify for Health First Colorado. Their county Human Services office will contact them if they need any further information.

If someone was in foster care in another state, can they qualify for former foster care youth Health First Colorado?

If someone was in foster care in another state before Jan. 1, 2023, and they turned 18 on or after Jan. 1, 2023, they may qualify for Health First Colorado. They must be living in Colorado to qualify. They need to complete the Health First Colorado Out of State Former Foster Care Youth Form and return it to their county Human Services office.

Maternity and Family Planning

Does the renewal month change for pregnant people since they have 12 months of coverage following pregnancy?

Yes. The renewal month will be 12 months after the pregnancy ends. So if a member’s pre-pregnancy renewal is due in July 2023 but their pregnancy ends in September 2023, their new renewal date will become September 2024. Members must report their pregnancy in their PEAK account or to their county to qualify for the extended 12 months of coverage. Learn more by visiting the Health First Colorado web page.

How does the renewal process and end of continuous coverage impact individuals currently enrolled for the Family Planning Limited Benefit coverage who do not have full Health First Colorado (Medicaid) coverage?

Members enrolled in Family Planning Limited Benefits have an annual renewal date and will go through the renewal process to see if they still qualify. Members who are currently receiving the family planning limited benefits must request (opt-in) through PEAK or their county when it is their time to renew to continue receiving these benefits.

Providers

Will providers be able to see the renewal due dates in the Provider portal?

The provider portal does not provide the eligibility renewal due dates. The portal will show coverage start and end dates. We encourage members to log into their PEAK accounts to see their renewal due dates.

How can providers help with the renewal process?

Providers can bring awareness about the renewal process by posting our flyers in their public areas. Flyers, social media, website content, and other outreach tools can be found on our PHE Planning page. The materials in the toolkits raise awareness on key actions for members to take: updating contact information, taking action when a renewal is due, and seeking help with renewals at community or county resources when they need it.

Providers can also educate themselves and their staff on the basics of the renewal process to assist patients who may have questions. See our Renewal Education toolkit.

Transitions in Coverage

What if a member loses their coverage?

We want all Coloradans to get covered and stay covered. If a member is no longer eligible for Health First Colorado or CHP+, they will receive:

• Notice of when their enrollment ends
• Information on how to appeal
• Information about options for purchasing other health care coverage.

If a family is no longer eligible for Health First Colorado (Colorado’s Medicaid program), is it possible for the children to qualify for Child Health Plan Plus (CHP+)?

Yes. If a child is not eligible for Health First Colorado, they may qualify for the CHP+ program. These members will receive information about the new program they qualify for in their notice of action and we will connect them to the other coverage.

If someone is no longer eligible for Health First Colorado, how long do they have before their Medicaid coverage expires?

Members will receive a letter called a Notice of Action that tells them the date their coverage stops, the reason for coverage ending and information on how to appeal if they feel the decision is incorrect. The notice also gives information on who to contact with questions as well as information on how to contact the Connect for Health Colorado, the state insurance marketplace, to determine if they may be eligible for their program.

Renewals are sent 60-70 days prior to the coverage end dates. If a member responds completely to a renewal in a timely manner they will have more time to find other coverage after they find out they are no longer eligible for Health First Colorado or CHP+ coverage. Members are encouraged to fill out their renewal packets, sign and submit them right away.

If a member loses coverage at the end of the continuous coverage period, will that be considered a Qualifying Life Change Event to enroll in another type of health insurance?

Yes, when continuous coverage ends, the loss of Health First Colorado or CHP+ coverage will be considered a Qualifying Life Change event. This will open a Special Enrollment Period for the member to enroll in another type of health coverage.  Members should sign up for coverage by the end of the month their Medicaid coverage ends in order to avoid a gap in coverage.

For more information about coverage options visit KeepCOCovered.com.

What is a Special Enrollment Period?

A Special Enrollment Period is a period of time triggered by a life event like the loss of Medicaid or CHP+ coverage in which a member can enroll in a health insurance plan outside the annual Open Enrollment Period. The COVID-19 Public Health Emergency (PHE) Unwind Special Enrollment Period lasts through July 31, 2024. For more information about coverage options visit KeepCOCovered.com.

What is Connect for Health Colorado?

Connect for Health Colorado is the state’s official health insurance marketplace. It’s the only site that provides financial help to make health insurance plans more affordable.

How is information from people who no longer qualify for Health First Colorado shared with Connect for Health Colorado to determine eligibility for other health insurance programs?

Health Care Policy & Financing (HCPF) has worked closely with Connect for Health Colorado to establish a secure transmission that will send the individual’s information to Connect for Health Colorado. People will still need to complete an application with Connect for Health Colorado to find out what financial help programs they are eligible for.

Appeals

Will individuals be able to appeal eligibility decisions once the continuous coverage period ends?

Individuals are always allowed to appeal any action taken on an eligibility decision. They can ask for a State Level Hearing (Formal), Dispute Resolution Conference (Informal), or both simultaneously. Information about the appeals process and how to appeal is part of the member letter known as a "notice of action".

How much time does an individual have to appeal their eligibility decision? 

Individuals have 60 days from the date on the notice of action to appeal their eligibility decision (the exact deadline date is printed on the notice). Coverage will be automatically continued during the appeal for individuals who appeal timely.

Reporting

When will reports be posted?

HCPF published our first set of data in June 2023 and will publish monthly reports by the end of each month throughout the unwinding.  We will post reports on the Continuous Coverage Unwind Data Reporting page and include links to this information in our monthly COVID-19 Public Health Emergency Updates newsletter. To sign up for the newsletter, see our newsletter sign-up page and select the COVID-19 newsletter

This data is available monthly. Can we get the data more frequently?

It is critically important to share accurate information with the public, including our federal and stakeholder partners. HCPF does not have resources to pull ongoing ad hoc reports which also risk inaccuracies and public confusion if the numbers are different given different point in time data pulls.

Can we get more detailed information? Is county level data available?

Yes, HCPF will be sharing demographic and regional data breakouts in our quarterly partner webinars. This will be a deeper dive than the information provided in the federal monthly reports. Looking at this information quarterly will allow us to spot any trends and share those out with community partners.

For stakeholders interested in enrollment changes by county, we currently have county level Health First Colorado (Colorado’s Medicaid program) and CHP+ enrollment data available on our website in existing monthly caseload reports. These reports are published mid-month and include enrollment information for the prior month. The caseload reports are a point in time and include historical months.

County level data is broken out by Denver Metro, Urban, Rural and Frontier. What counties are in each group?

Denver Metro counties include: Adams, Arapahoe, Broomfield, Denver and Jefferson. 

Urban counties include: Boulder, Douglas, Eagle, El Paso, Garfield, La Plata, Larimer, Mesa, Pueblo and Weld

Rural counties include: Alamosa, Chaffee, Clear Creek, Delta, Elbert, Fremont, Gilpin, Lake, Logan, Montezuma, Montrose, Morgan, Otero, Pitkin, Rio Grande, Routt, Summit, Teller

Frontier counties include: Archuleta, Baca, Bent, Cheyenne, Conejos, Costilla, Crowley, Custer, Dolores, Grand, Gunnison, Hinsdale, Huerfano, Jackson, Kiowa, Kit Carson, Las Animas, Lincoln, Mineral, Moffat, Ouray, Park, Phillips, Prowers, Rio, Blanco, Saguache, San Juan, San Miguel, Sedgwick, Washington, Yuma

How does the PHE unwinding data compare to Health First Colorado redetermination data before the pandemic?

Leaving Health First Colorado or CHP+ coverage during the renewal process is part of normal eligibility operations. Renewals conducted pre-pandemic resulted in an average of 41% of Medicaid members losing coverage annually for procedural reasons (12%) and eligibility reasons (29%). 

As we return to normal renewal processes, we anticipate a similar percentage of individuals will leave the program. Individuals can reapply for coverage at any time and could rejoin the program when they qualify. Based on pre-pandemic information, on average, about half of the members who had lost eligibility were deemed eligible for Medicaid again within two years.      

For those that no longer qualify for Health First Colorado or Child Health Plan Plus (CHP+), do you have a way of tracking if they have other health care coverage or if they are uninsured?

We anticipate many enrolled in Health First Colorado who are no longer eligible will already have other coverage through an employer, Medicare or other source. Those who do not will need to be connected to other health care coverage.

We will be tracking who is enrolled in Health First Colorado and CHP+ and publishing enrollment information monthly. There is not a centralized statewide database to provide a clear metric to see how many people lose Medicaid coverage and transition to other forms of coverage or go uninsured as a result. Further complexity is added because former Health First Colorado and CHP+ members have up to a year to enroll in a marketplace plan due to an extended Special Enrollment Period. The time frame for this Special Enrollment Period is from April 1, 2023 through July 31, 2024. So, a member may lose coverage and find alternate coverage within a month or up to a year.

Connect for Health Colorado will be reporting the number of individuals who no longer qualify for Health First Colorado or CHP+ that qualify and enroll in their plans. The federal government plans to publish information in the fall of 2023 on transitions in coverage, including information about those who were up for renewal that are now covered by Medicare.

What is a procedural denial?

A procedural denial is a denial of health care coverage because a proper eligibility determination could not be made. Examples include: someone not returning the renewal packet, not signing the signature page of the renewal packet, incomplete information/verifications not provided or could not contact the member/whereabouts unknown.

What is an eligibility denial?

An eligibility denial is a denial of health care coverage because a member is determined ineligible (does not meet the eligibility criteria). Examples include: being over the income limit, moving out of state, changes in household composition and death. Those who no longer qualify for Health First Colorado or CHP+ and who could transition to marketplace coverage are referred to Connect for Health Colorado in the reporting period.