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:
|
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