Policy Statement: Member Co-Pays and Provision of Services


To outline the Department's policy on the provision of services when a Health First Colorado (Colorado's Medicaid program) member is unable to pay a required co-pay at the point of service.


Concerns have been raised that some participating providers may be denying Health First Colorado members access to care because members are unable to pay the required co-pay.


Under the Department's rules[1], a provider may not deny services because a Health First Colorado member is unable to make a co-pay at the time of service, though the client remains liable for the co-pay at a later date.

The Department encourages Health First Colorado provider to develop strategies for working with members who have trouble making co-pays. Providers are also permitted to waive collection of member co-pays.

Services to children under age 19, pregnant women, and members residing in institutional settings (e.g. mental health institutes, nursing facilities), as well as Behavioral Health Organization, family planning, and certain preventive services, are exempt from co-pays.

Additional information on co-pays can be found in the Colorado Code of Regulations (page 35).

Health First Colorado Members with questions about this policy should call the Member Contact Center at 1-800-221-3943.

[1] 10 CCR 2505-10 8.754.6.B