OAP Program Description
The Old Age Pension (OAP) Health and Medical Care Program provides limited medical care for individuals receiving Old Age Pension grants who do not qualify for Medicaid. This Program is funded through the $10 million Old Age Pension Health and Medical Care Fund established in the State's constitution and Colorado Revised Statutes. A Supplemental Old Age Pension Health and Medical Program also funds these services; with an additional $750,000. This program is 100% State-funded program and is not an entitlement. Accordingly, the authorized cap of $10,750,000 a year (including the Supplemental Program) cannot be exceeded.
The Old Age Pension was established in 1936 by an amendment to the State constitution creating article XXIV. This article was later amended in 1956 to add the Health and Medical Care Program and Fund in section 7 of the article. The Old Age Pension benefits specified in article XXIV of the State constitution require that a health and medical program be provided to anyone who qualifies to receive an Old Age Pension cash payment and who is not a patient in an institution for tuberculosis or mental disease. Certain sources of General Fund, primarily excise taxes, must be earmarked to cover the costs of the Old Age Pension benefits.
The Department of Human Services continues to have the statutory authority to administer the Old Age Pensions, the State Old Age Pension Fund, and the Old Age Pension Stabilization Fund.
The growing demand for health care services by this client population almost caused the OAP Health and Medical Program to exceed the available spending authority four times in the last five years. Expenditure reduction actions were necessary when expenditures under the program were expected to exceed the available spending authority. The following actions have been taken since FY 1999-00 to reduce expenditures under the program:
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Effective October 1, 1999, inpatient hospital rates for all hospitals statewide were reduced to 80% of the Medicaid rate.
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Effective January 1, 2002, medical backdating was permanently eliminated.
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Effective February 1, 2002, inpatient hospital coverage and emergency medical transportation services were eliminated as a covered benefit under the program for the remainder of FY 2001-02. In addition, all other provider payments, except for pharmacy services, were reduced to 80% of the Medicaid rate and the maximum client co-pay was increased from $100 a year to $300. Pharmacy services were reimbursed at the Medicaid rate.
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Effective July 1, 2002, all providers of the OAP Health and Medical Care Program, with the exception of pharmacy and inpatient hospital services, were reimbursed 82% of Medicaid rate. Pharmacy services were paid at the Medicaid rate, while inpatient hospital services were reimbursed at 68% of the Medicaid rate.
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Effective August 30, 2002, managed care organizations discontinued coverage for OAP Health and Medical Care Program clients after the Department of Human Services advised them that the rates in FY 2002-03 would be 18% lower than the FY 2001-02 rates. Clients were no longer able to enroll in managed care options, including the Primary Care Physician (PCP) Program.
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Effective January 1, 2004, the inpatient hospital benefit under this program was suspended until October 15, 2004. In addition, on that same date the reimbursement rates for all outpatient services, expect pharmacy services, were reduced from 82% to 50% of the Medicaid rate. Pharmacy services were reimbursed at the Medicaid rate.
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Effective October 15, 2004, the inpatient hospital benefit was restored at those hospitals that participate in the Colorado Indigent Care Program (CICP). Services to the clients covered under the OAP Health and Medical Care Program would be limited to those inpatient services available under the CICP. The OAP Health and Medical Care Program reimbursed 10% of the Medicaid reimbursement for inpatient hospital services. In addition, providers were reimbursed at 82% of the appropriate Medicaid reimbursement for physician and practitioner, emergency transportation, medical supply, hospice, and home health services. Provider reimbursement remained at 50% of the Medicaid reimbursement for outpatient services (including outpatient hospitals, federal qualified health centers, rural health centers and dialysis centers), lab and x-ray, and emergency dental services. Pharmacy services were reimbursed at the Medicaid rate.
Clients are eligible to apply for the Colorado Indigent Care Program (CICP) for benefits not covered by the Old Age Pension Health and Medical Care Program. Information on the CICP can be found here for Clients and Applicants and here for Providers.
Clients should first contact their county office of Social/Human Services if the have any questions on recent changes regarding the OAP Health and Medical Care Program. The list of Social/Human Services is available at the following link: http://www.cdhs.state.co.us/servicebycounty.htm
If clients or providers need additional information on the Old Age Pension Health and Medical Care Program, Medicaid or the Colorado Indigent Care Program they should contact Medicaid Customer Service at 303-866-3513 (Metro Denver) or 1-800-221-3943 (Outside the Metro Denver Area).