Health First Colorado and Criminal Justice Involved Populations

Eligibility and Billing for Criminal Justice Involved Populations

The Department and the federal Centers for Medicare and Medicaid Services (CMS) have created several documents that explain the Health First Colorado (Colorado's Medicaid program) eligibility and enrollment of criminal justice involved populations.  The documents below include specific guidance to counties and providers regarding when Health First Colorado can pay for medical services for incarcerated populations and how and when they can be enrolled in Health First Colorado.

County Intersections with Health First Colorado

In addition to increased collaboration with the Department of Corrections, the Department is also working to strengthen Health First Colorado enrollment for the criminal justice involved population. Jails are overseen by the counties (incarceration does not exceed more than 365 days) and the prisons are overseen by the Department of Corrections (incarceration, at a minimum, exceeds 366 days). The Department currently engages the county jails in two manners: 1) An ongoing state-workgroup designed to provide the counties with a platform to discuss issues relating to Health First Colorado and the jail population, and 2) A toolkit for the counties to demonstrate the advantages of Health First Colorado enrollment for individuals prior to booking and those individuals leaving jail.

Intersection of Medicaid and Jails - Toolkit for Counties

This Health First Colorado enrollment toolkit is designed to explain:

  • The advantages of Health First Colorado enrollment for individuals leaving jail
  • Health First Colorado coverage for inpatient hospital services that exceed 24 hours
  • The advantages of Health First Colorado coverage prior to booking

The Health Information Office at the Department hosts a state workgroup titled: Medicaid and the Jail Involved Population

  • This workgroup's function is to serve as a consistent venue to field and address county concerns regarding the intersection of Health First Colorado and the criminal justice involved population
  • This workgroup also explores ongoing successes among counties, offers assistance to the counties in their efforts to improve care-coordination for this population, and brainstorms ideas on how Health First Colorado access can be improved for the population.

Community Corrections: Policy and Correspondence

The Centers for Medicare and Medicaid Services consider diversion clients, transition clients, and other populations residing in community corrections facilities to be inmates of public institutions and therefore ineligible for Medicaid (see Section 1905(a) of the Social Security Act).The State of Colorado believes these individuals should be eligible for Health First Colorado.  While the State continues to urge the federal government to reconsider its decision, residents of Community Corrections remain ineligible.  In contrast, individuals associated with Community Corrections facilities who do not reside in the facility may be eligible for Health First Colorado.  The correspondence below details discussions between the Department, Colorado's Congressional delegation, and federal agencies.

Correspondence between Attorney General Suthers and CMS

Correspondence between the Department and CMS


Correspondence between Representative Diana DeGette and U.S. Department of Health and Human Services

  • January 2010 Letter from Representative DeGette to Secretary Sebelius
    Representative DeGette requests formal guidance from Secretary Sebelius on whether individuals residing in a community corrections facility are eligible for Health First Colorado.
  • March 2010 Letter from Secretary Sebelius to Representative DeGette
    Secretary Sebelius clarified guidance issued in 1997 and 1998 concluding that community corrections residents were inmates of a public institution for the purpose of Health First Colorado eligibility in part because public institutions include residential placements other than traditional prisons, including placements obtained through private contractors.
  • June 2010 Letter from Representative DeGette to Secretary Sebelius
    Representative DeGette disagrees with CMS's interpretation that residents of community corrections facilities are ineligible for Health First Colorado. DeGette argues that residents are not inmates inmates and that, even if CMS considers residents of community corrections to be, they are eligible for federal Medicaid funding because they reside in private institutions.


Stakeholder letter to U.S. Department of Health and Human Services

  • January 14, 2010 Colorado Lawyers Committee Letter to Secretary Sebelius
    The Colorado Lawyers Committee argues that federal Medicaid funding should be available for residents of Colorado's private community corrections facilities. The Committee asks Secretary Sebelius to give guidance to the CMS regional office regarding the eligibility of community corrections resident

Proposed Department Policy on Community Corrections

In 2009, the Department proposed a policy concerning funding of health care services for those in Community Corrections. The Department requested that stakeholders provide comments on the proposed policy.

Suspension of Health First Colorado Eligibility for Incarcerated Populations

In 2008, the Colorado state legislature passed SB 08-006, requiring the Department to suspend eligibility for any Health First Colorado member who becomes incarcerated. The Department is actively working to fully implement this law.

Other States and Stakeholders

Inmates Receiving Care at Correctional Care Medical Facility of Denver Health Medical Center

Disproportionate Share Hospital (DSH) payments

Institutionalized Individuals