Programs for Children

Snapshots are informational only. You must apply to find out what programs or waivers you qualify for.

If you are not looking to find coverage for children, please choose another category.

Behavioral Health

Health First Colorado (Colorado's Medicaid program) members are eligible for behavioral health services, including mental health and substance use disorder care. If you need mental health care and/or substance use disorder services, talk to your primary care provider or contact your regional organization.

Who Qualifies?

All Health First Colorado members can get behavioral health services.

Top Benefits: (see program information page for full list)

• Mental health services
• Substance abuse services

Co-pay Costs:

Co-pay costs vary. Learn more in the program information page.

Child Health Plan Plus (CHP+) is public low-cost health insurance for certain children and pregnant women. It is for people who earn too much to qualify for Health First Colorado (Colorado's Medicaid program), but not enough to pay for private health insurance.

Who Qualifies?

• To qualify for CHP+, applicants must be:
• Low-income children ages 18 and younger, or
• Low-income pregnant women
• Meet certain income level requirements (see the CHP+ program information page for income levels)

Top Benefits: (see program information page for full list)

• Regular checkups
• Immunizations (shots)
• Prescription medicine
• Eye glasses
• Dental care (for children)

Co-pays and Enrollment Fees:

Co-pays and enrollment fees vary. Learn more in the program information page.

The Waiver for Children with Life Limiting Illness provides a home or community-based alternative to children with a life limiting illness.

Who Qualifies?

Children who are:

• Ages 18 and younger
• Receiving hospital level of care
• Determined by case manager to be safely served in the community
• Receiving at least one CLLI waiver benefit per month while enrolled in the waiver
• Meet the medical criteria:
• Physician-certified diagnosis of a Life Limiting Illness
• Disability determination by the Social Security Administration

Meet the financial criteria:

• Income is less than 300% the Supplemental Security Income allowance per month
• Countable resources less than $2,000

Top Benefits: (see program information page for full list)

• Counseling/Bereavement Services
• Expressive therapy
• Palliative/Supportive care
• Respite Care Services

Co-pay Costs:

Children 18 and younger do not pay co-pays.

Children's Extensive Support Waiver (CES)

The Children's Extensive Support Waiver (CES) provides supports and services to children with developmental disabilities or delays who have a complex behavioral or medical condition and who require near constant line of sight supervision.

Who Qualifies?

• Children 18 years of age and younger with intensive behavioral or medical needs who are at risk of out-of-home placement and have been determined to have a developmental delay/disability through a Community Centered Board
• Child must be institutionalized or at risk of being institutionalized in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)
• Children's income must be less than 300% (3 times) the Supplemental Security Income allowance per month and countable resources less than $2000

Top Benefits: (see program information page for full list)

• Respite Care
• Behavioral Services
• Homemaker
• Specialized Medical Equipment and Supplies
• Assistive Technology

Co-pay Costs: Children ages 18 and younger do not pay co-pays.

Children's Habilitation Residential Program Waiver (CHRP)

This waiver provides services for children and youth who have an intellectual or developmental disability and extraordinary needs that put them at risk of, or in need of, out of home placement.

Who Qualifies?

In order to apply for this waiver you must:

• be 20 years of age or younger
• have an intellectual or developmental disability or developmental delay if under five (5) years of age, and extraordinary service needs
• be at risk of, or in need of, out of home placement
• be institutionalized or at be at risk for being institutionalized in an Intermediate Care Facility for individual with intellectual Disabilities (ICF-IID)

Top 5 Benefits: (see program information page)

• Habilitative Services (24-hour residential out of home)
• Respite Services
• Community Connection Services
• Intensive and Transition Support Services (wraparound)
• Professional services (such as hippotherapy, massage, and movement therapy)

Co-pay Costs:

Co-pay costs vary, learn more in the program information page

Children's Home and Community-Based Services Waiver (CHCBS)

The Children's Home and Community-Based Services Waiver (CHCBS) provides a home or community based alternative to children with significant medical needs who are at risk for acute hospital or skilled nursing facility placement.

Who Qualifies?

• Medically fragile children ages 17 and younger who are in the home and at risk of nursing facility or hospital placement
• Child must be institutionalized or at risk of being institutionalized in a nursing facility or hospital level of care
• Children's income must be less than 300% (3 times) the Supplemental Security Income allowance per month and countable resources less than $2000

Top Benefits: (see program information page for full list)

• Case management
• In-Home Support Services (IHSS) [Health Maintenance only]

Co-pay Costs:

Colorado Indigent Care Program (CICP)

The Colorado Indigent Care Program (CICP) provides discounted health care services to low income people and families. CICP is not a health insurance program. Services vary by providers.

Who Qualifies?

You must be 18 and older
You must be at or below 250% of the Federal Poverty Level (FPL)
You must be lawfully present in the United States and a legal resident of Colorado
You cannot be eligible for Health First Colorado (Colorado's Medicaid program) or Child Health Plan Plus (CHP+)

Top Benefits: (see program information page for full list)

Discounted health care services provided by participating Colorado hospitals and clinics
No premium costs
You are allowed to have primary health insurance or have Medicare
CICP ratings are good for a full year, see program information page for exceptions

Co-pay Costs:

Co-pays are based on your ability to pay. This is determined by the CICP facility.

Dental Benefits

The dental benefit provides Health First Colorado (Colorado's Medicaid program) members.

Who Qualifies?

Dental services are a program benefit for Health First Colorado members of all ages.

Top 5 Benefits: (see program information page for full list)

• Basic preventive dental exams
• Diagnostic and restorative dental services (such as x-rays and fillings)
• Extractions (tooth pulling)
• Root canals
• Crowns
• Much more (see program information page for additional benefits)

Co-pay Costs:

None. See the Health First Colorado Benefits and Services Overview for the list of co-pays per service.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services. EPSDT is key to ensuring that children and youth receive appropriate preventive, dental, mental health, developmental and specialty services.

All Health First Colorado-coverable, medically necessary services must be provided even if the service is not available under the state plan to other people who qualify for Health First Colorado. Benefits not listed are not considered to be a state plan benefit and are therefore outside of EPSDT coverage and exceptions. No arbitrary limitations on services are allowed, e.g., one pair of eyeglasses or 10 physical therapy visits per year.

Who Qualifies?

Children and Youth ages 20 and younger who are enrolled in Health First Colorado.

Top Benefits: (see program information page for full list)

• Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems
• Arrange (through referral) for corrective treatment as determined by child health screenings
• Lead Screening

Co-pay Costs:

Children under the age of 19 do not have co-pays. Co-pay costs for youth ages 19 and 20 vary, see program information page.

Emergency Medicaid

Emergency Medicaid  provides short-term health care coverage through Health First Colorado for eligible people who do not meet immigration or citizenship requirements for Medicaid and need treatment for life- or limb-threatening medical emergencies. It is sometimes called “Emergency Medical Services,” or “EMS.”

Who Qualifies?

In order to be eligible for Emergency Medicaid you must:

• Meet the Health First Colorado (Colorado’s Medicaid program) eligibility requirements, except for immigration or citizenship requirements, and
• Have a qualifying life- or limb- threatening medical emergency covered by Emergency Medicaid.

People who may qualify for Emergency Medicaid include, but are not limited to:

• Deferred Action for Childhood Arrivals (DACA) recipients
• Undocumented people (people without legal immigration status)
• Non-immigrant visa holders such as tourists and students
• Individuals granted Temporary Protected Status
• Adult legal permanent residents (‘Green Card’ holders) who have not been in the U.S. lawfully for at least five years
  • This does not apply to children and pregnant people who qualify for Medicaid with full benefits

Top Benefits: (see program information page for full list)

Health First Colorado (Colorado's Medicaid program) provides benefits for Emergency Medicaid to treat life- or limb- threatening medical emergencies such as:

• Severe symptoms from COVID-19
• Labor and delivery (not including prenatal or post-natal care)
• Dialysis for End-Stage Renal Disease at an inpatient or freestanding dialysis center
• Other life-threatening symptoms or illnesses (such as chest pain, heart attack, etc.)

Co-pay Costs:

There are no co-pays.

Health First Colorado (Colorado's Medicaid program)

Health First Colorado (Colorado's Medicaid program) is a public health assistance program for Coloradans who qualify. Children, pregnant women, parents and caretakers, people with developmental, intellectual, and physical disabilities, and adults can all potentially qualify.

Every Health First Colorado member has a primary care provider. Members and primary care providers belong to a regional organization that helps make sure Health First Colorado members get the health care and services they need. Regional organizations can also help members understand and manage physical and behavioral health benefits, find specialists or other providers, and connect members with transportation, food assistance or other social services, if needed.

Note: When you apply for Health First Colorado, you are applying for both Health First Colorado and Child Health Plan Plus (CHP+). You do not need to turn in more than one application for you or your family.

Who Qualifies?

You may be eligible if you meet one of these requirements:

• Children ages 0-18 whose household income does not exceed 142% Federal Poverty Level (FPL)
• Pregnant Women whose household income does not exceed 195% FPL
• Parents and Caretaker Relatives (applicant must have a dependent child) whose household income does not exceed 68% FPL
• Adults without dependent children whose household income does not exceed 133% FPL

Eligibility requirements can be complex. See the program information page for more information or visit PEAK to see if you qualify.

Top 5 Benefits: (see program information page for full list)

• Doctor visits
• Prescriptions
• Mental Health services
• Dental
• Lab work and x-rays
• Much more (see program information page for additional benefits)

Co-pay Costs:

You might have to pay a small co-pay. If you are age 18 and younger, pregnant or are an American Indian or Alaska Native, you don't pay co-pays. If you are 19 and older and not pregnant, you are responsible for small co-pays. If you reside in a nursing facility you typically do not have to pay co-pays. Co-pays vary depending on the service. See the Health First Colorado Benefits and Services Overview for the list of co-pays per service.

Health First Colorado Buy-In Program for Children With Disabilities (CBwD)

The Health First Colorado Buy-In Program for Children with Disabilities allows families who make too much to qualify for Health First Colorado (Colorado's Medicaid program) and Child Health Plan Plus (CHP+) to buy into Health First Colorado coverage for their child with a disability by paying a monthly premium based on the family's income.

Who Qualifies?

• Children age 19 and under, with a qualifying disability per the Social Security Administration (SSA)
• A determination of disability by the SSA is accepted as proof of disability
• Children not certified through the SSA can still be determined disabled by the State by completing the Health First Colorado Disability application
• Family income must be below 300% of Federal Poverty Level (FPL), after income disregards are calculated

Top 5 Benefits: (see program information page for full list)

If your child is enrolled in the Children's Buy-In program, they will receive full Health First Colorado benefits. Benefits include:

• Doctor visits
• Prescriptions
• Mental Health services
• Dental
• Lab work and x-rays
• Much more (see program information page for additional benefits)

Co-pay Costs:

Children ages 18 and younger do not pay co-pays.

Health Insurance Buy-In Program (HIBI)

The Health Insurance Buy-In Program (HIBI) is a premium assistance program for Health First Colorado (Colorado's Medicaid program) members who qualify. If you qualify, HIBI will send monthly payments to you for all or a portion of the cost of your commercial health insurance premiums, and in some cases also reimburses you for deductibles, coinsurance, and co-pays.

Who Qualifies?

• Being eligible for HIBI does not affect your Health First Colorado eligibility.
• You must be eligible for Health First Colorado and have access to commercial health insurance
• The annual cost of your commercial health insurance must be less than the estimated total cost of your annual medical expenses, out-of-pocket costs, and administrative costs
• Your employer must allow you to enroll in their group insurance within 60 days of when you are found eligible for HIBI, even if this occurs outside of the group insurance's usual open enrollment period
• You may choose to enroll in a health insurance policy after applying to the HIBI program

Top Benefits: (see program information page for full list)

• HIBI participants receive monthly payments for a portion of the cost of their commercial health insurance premiums.
• Program participants receive benefits from both the HIBI program and Health First Colorado at the same time.
• Program participants may also receive reimbursements for payments made toward deductibles, coinsurance and co-pays, whether visiting a Health First Colorado-enrolled provider or a provider within the network.
• In some cases, COBRA continuation health insurance is offered to recently terminated employees for up to 18 months. For more information, contact your benefits coordinator.

Co-pay Costs:

Health First Colorado co-pays vary depending on the service. If you are age 18 and younger, pregnant, or living in a nursing facility, you don't have to pay co-pays. See the program information page for the list of co-pays per service.

Pediatric Personal Care Services

Pediatric Personal Care services help Health First Colorado members with physical, maintenance and supportive needs such as bathing, dressing, meal preparation and medication reminders.

Who Qualifies?

• You must be 20 years or age and younger
• Meet the requirements in the Department defined assessment tool (PCAT)
• Require moderate to total assistance in at least three of the 17 Personal Care Tasks

Top Benefits: (see program information page for full list)

• Assistance with Pediatric Personal Care Services

Co-pay Costs:

There are no costs, pregnant woman and children are not charged co-pays.

Presumptive Eligibility (PE)

Presumptive Eligibility (PE) is a program that gives temporary medical coverage right away. The coverage starts the same day you apply and lasts for at least 45 days while we process your Medical Assistance application.

Who Qualifies?

• You must be a child under 19 or a pregnant woman,
• You must appear to qualify for Health First Colorado or Child Health Plan Plus (CHP+) and
• You must complete an application for Medical Assistance.

Top Benefits: (see program information page for full list)

• Same day coverage

Co-pay Costs:

There are no costs, pregnant woman and children are not charged Medicaid co-pays

School Health Services

School Health Services works with Health First Colorado (Colorado's Medicaid program) families to provide health services to children who are disabled or medically at risk and receiving or have been referred for services according to an Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP).

Who Qualifies?

• Enrolled in Health First Colorado,
• Enrolled in a public school or participating district,
• Under the age of 21, and
• Disabled or medically at risk and receiving or referred for services according to an IEP or IFSP.

Top 5 Benefits: (see program information page for full list)

• Physician services
• Speech-Language services
• Nursing services
• Audiology services
• Personal Care services

Co-pay Costs:

There are no co-pays for this program. Learn more in the program information page.