Presumptive Eligibility

 

The Presumptive Eligibility (PE) program gives some individuals immediate, temporary Health First Colorado (Colorado's Medicaid program) or Child Health Plan Plus (CHP+) medical coverage.  PE covers children under 19 and pregnant people, individuals eligible for the Breast and Cervical Cancer Program (BCCP), and individuals eligible for the limited Family Planning Limited Benefit. The member must complete an application and appear eligible to get the temporary health care benefits while their application is being processed by Health First Colorado.

Eligible Populations:

PE offers immediate, temporary coverage of specific benefits for individuals who appear to meet eligibility requirements and completed an application for Medical Assistance. Eligible populations include:

  • Children under the age of 19
  • Pregnant people
  • Individuals eligible for the BCCP benefit
  • Individuals eligible for the Family Planning Limited Benefit

Benefits and Services

 

Population Eligibility Covered Benefits
Child or pregnant person that meets Health First Colorado (HFC) PE requirements HFC Eligibility Criteria All Health First Colorado benefits except inpatient (hospital) care, including labor and delivery.
Child or pregnant person that meets CHP+ PE requirements CHP+ Eligibility Criteria All CHP+ benefits except dental services
Breast and Cervical Cancer Program (BCCP) BCCP Eligibility Criteria All Health First Colorado benefits
Family Planning Limited (FAMPL) Benefit FAMPL Eligibility Criteria

Family planning and related services including:

  • Birth control 
  • STI testing and treatment
  • Cervical cancer screening and prevention
  • Related counseling and preventative services

 

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How to Apply

 Members must apply at an approved PE Site. PE sites are clinics, health centers, and community resource centers.The PE site will help members fill out the Medical Assistance Application. 

 Individuals can also apply through PEAK and print out the completed application and bring it with them to the PE site. Members must complete all pages of the application.

Once your application is completed:

The application is reviewed

  

The Member is notified of eligibility

  

If ineligible for Medicaid/CHP+, temporary coverage ends

Individual can review other coverage options

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Would you like to email the Presumptive Eligibility Manager?

How do Members learn more about Presumptive Eligibility?

How do Providers get more information about Presumptive Eligibility?