Member Frequently Asked Questions

To save you time, we've answered many of the most common questions about Medicaid, Child Health Plan Plus, and other topics below. If you still can't find the answer you need, get in touch with us.


Colorado Medicaid Frequently Asked Questions

What is Medicaid?

Medicaid is free or low cost public health insurance for Coloradans who qualify. Medicaid can cover your doctor visits, emergency care, preventive care such as screenings and immunizations, and other procedures and treatments. 

How do I apply for Medicaid?

 

See: How To Apply

 

Where can I get individual Medicaid application assistance for my unique circumstances?

How long will it take to find out if I qualify for Medicaid?

 

If you apply online through PEAK you may find out if you qualify immediately. If you apply by mail, it may take up to 45 days to find out if you qualify.

 

When will my Medicaid card arrive?

 

After finding out you qualify for Medicaid, you will need your Medicaid ID Number to obtain medical services. Your Medicaid ID Number can be found on your Medicaid card and on PEAK. Medicaid ID Numbers always start with a letter and are followed by 6 digits, for example: A123456. It is important that you have your Medicaid card with you each time you make an appointment and every time you go to your health care provider’s office.

 

Your Medicaid card should arrive 7-10 days after qualifying. Your card will be sent to the address on your application. You can also print your Medicaid card from PEAK. Even if you did not apply online through PEAK, you can still create an account and print your card.

 

When will my Medicaid benefits start?

After finding out you qualify for Medicaid, your benefits will start right away. Your benefits may also be backdated to the first day of the month you applied. If you applied for long-term care Medicaid or other special programs, your benefits start the day you meet all the requirements.

If you are not feeling well but are not sure if you need to go to the doctor, call the Nurse Advice Line at 800-283-3221. This hotline is just for Medicaid clients and you can call it 24-hours a day.

To make an appointment with a health care provider, you will need your Medicaid ID Number. Your Medicaid ID Number can be found on your Medicaid card. It is important that you have your Medicaid card with you each time you make an appointment with your health care provider and every time you go to your health care provider’s office.

Your Medicaid card should arrive in 7-10 days. Your card will be sent to the address on your application. You can also print your Medicaid card through PEAK. If you need services right away, or do not have access to a printer, you can use just your Medicaid ID Number.

It is important to know that it may take a few extra days once you are enrolled for your health care provider to confirm in their system you are enrolled in Medicaid. If you have questions about your coverage or benefits, please call the Medicaid Customer Contact Center.

In an emergency, you should get care from the closest hospital that can help you. The law requires providers to examine you to determine if your medical condition is life threatening and provide you with medical care until your life is no longer in danger.

If you need to fill a prescription and have not received your Medicaid card yet, check to see if your pharmacy accepts Medicaid. If they do, provide your Medicaid ID Number and prescription (or refill) to the pharmacy. They will try to fill it using the information you gave them. If they do not have enough information, pharmacies can give you enough medicine for 3 days. If your pharmacy does not accept Medicaid, call the Medicaid Customer Contact Center for help finding another pharmacy.

 

I lost my Medicaid card. How do I get another one?

 

See: How can I print a Medicaid card through PEAK?

 

What benefits are included in Medicaid?

 

See the Colorado Medicaid Benefits & Services Overview.

 

How can I check the status of my Medicaid application?

 

See: Application In Process

 

Is My Medicaid active?

 

You can check if your Medicaid is active by going to the Colorado PEAK website and clicking on the Check My Benefits button. You can also call your local County Department of Social/Human Services or the Medicaid Customer Contact Center.

 

Are state employees eligible for Medicaid?

 

Yes, if they meet the income and eligibility rules.

 

Are there co-pays or enrollment fees for Medicaid?

 

Medicaid does not have an enrollment fee but in some circumstances, co-pays may be required. Medicaid members who are pregnant, living in a nursing facility, or age 18 and younger do not have to pay co-pays. For more information on co-pays, visit our Colorado Medicaid - Benefits and Services Overview page. 

 

I suspect that my doctor may be involved with Medicaid fraud. What should I do?

 

If you suspect your doctor, medical equipment provider, or any other Medicaid provider of fraud, please report it to us.

 

I suspect that someone I know may be involved with Medicaid fraud. What should I do?

 

If you suspect someone of Medicaid fraud, please report it to us.

 

I was told Medicaid pays for services only after other types of coverage pay first. What are some of the other types of coverage that pay for my services before Medicaid?

 

Medicaid is the payer of last resort in most situations. This means Medicaid pays for services only after any other coverage you may have pays first. The following types of coverage may be required to pay for your services before Medicaid:

  • Employer-sponsored insurance
  • Workers’ compensation
  • Medicare
  • COBRA
  • Casualty insurance
  • Dental insurance
  • Vision insurance
  • Pharmacy insurance

I need to apply for Emergency Medicaid. Where can I apply?

 

Emergency Medicaid is short term coverage for immigrants without legal permanent residency or Naturalization status and only covers life and limb threatening situations, and does not cover doctor appointments or routine care. If you have questions about what Emergency Medicaid covers contact the Medicaid Customer Contact Center. See the How To Apply page to apply.

 

Can an individual qualify for Medicaid or Child Health Plan Plus (CHP+) coverage that is granted deferred action under the Department of Homeland Security’s temporary Deferred Action for Childhood Arrival process?

 

No. Individuals must be lawfully present to be eligible for Medicaid or Child Health Plan Plus (CHP+). Individuals granted deferred action under the Deferred Action for Childhood Arrival are not eligible for Medicaid or Child Health Plan Plus (CHP+).

 

Can same-sex couples who are joined by marriage in Colorado be considered in the same household for purposes of applying for Medicaid?

 

Yes, effective October 7, 2014, Colorado began to recognize same-sex marriage. When applying for Medicaid same-sex couples joined by marriage in Colorado can now apply as one household and should identify as being married. Also, same-sex couples who were married out of state in a state that permits same-sex marriage will be recognized as a married couple in Colorado for purposes of applying for Medicaid.

 

How do I get behavioral health services?

 

A Behavioral Health Organization can arrange your mental health and substance use disorder care. You do not need a referral from your doctor to go to your Behavioral Health Organization. You do not need to enroll in a Medicaid health plan to get behavioral health care. If you need mental health and/or substance use disorder services, contact the Behavioral Health Organization in your area.

 

How is Child Health Plan Plus (CHP+) different from Medicaid?

 

See: About Child Health Plan Plus and the Colorado Medicaid Fact Sheet

 

How is Medicaid different from Medicare?

 

Medicare is a federal government-sponsored healthcare program primarily for seniors. Medicaid is healthcare for low-income families and is managed by both the state and federal governments. Medicare and Medicaid differ in terms of who they cover, how they are funded and governed. To find out more about Medicare visit Medicare.gov or call Medicare Customer Service at 1-800-633-4227.

 

I am a Medicaid member. What do I do if I am out-of-state and need to go to the doctor?

 

If you are temporarily out of the state but still a resident of Colorado, you may receive some Medicaid benefits under certain conditions:

  1. It is a medical emergency.
  2. Your health would be endangered if you were required to return to Colorado for the medical care/treatment.
  3. The health care provider that treats you must enroll in the Colorado Medicaid program. For more information health care providers, visit the For Our Providers page.

If you have more questions about seeing a health care provider out of state, call the Medicaid Customer Contact Center.

 

I am enrolled in a veteran’s (VA) health care program. Can I also be enrolled in Medicaid?

 

Yes. Veterans who qualify can have both VA health care program coverage and Medicaid. To find out if you and your family qualify for Medicaid see How To Apply.

 

I changed my Medicaid health plan. When will my new health plan start?

 

If you change your Medicaid health plan then your new Medicaid health plan starts the 1st of the next month. For example, if you call HealthColorado to change your Medicaid health plan on February 6, then your new Medicaid health plan will start March 1st.

 

You are still covered by Medicaid but some health care providers may not be able to see you. Make sure you have your Medicaid card on hand when making your appointment and when you go to your health care provider’s office.

 

If you have questions about your Medicaid health plan, call HealthColorado at 303-839-2120 (in Denver) or 1-888-367-6557 (outside of Denver). Hours: Monday-Friday, 8:00 a.m. to 5:00 p.m. (closed state holidays). Note: The HealthColorado number is not for information on Medicaid benefits or to find out if you qualify.

 

I'm a Medicaid member and received a letter stating my eligibility was being redetermined. What does this mean?

 

This means your Medicaid eligibility is being reviewed to see if anything has changed. The law requires us to determine if those enrolled in Medicaid still qualify at least every 12 months. Your redetermination or renewal date is one year from the date you qualified for Medicaid. Near the date your eligibility will be redetermined and you will receive a letter asking you if anything has changed (such as your address, family size or income). If you have questions about your redetermination date please contact your local county human services office or call the Medicaid Customer Contact Center.

 

Is there an open enrollment period for Medicaid?

 

You can apply for Medicaid or Child Health Plan Plus (CHP+) at any time. Medicaid and CHP+ do not have open enrollment periods. Get more information on the How To Apply page.

 

My child is currently on Medicaid or Child Health Plan Plus (CHP+). If I think I may qualify for Medicaid do I need to apply or will I be automatically enrolled since my child is already getting benefits?

 

You will need to complete an application even if your children are currently enrolled in Medicaid or Child Health Plan Plus (CHP+) will. You can apply at any time. For more information visit How To Apply.

 

What doctors take Medicaid?

 

Many types of doctors take Medicaid. Medicaid can cover your doctor visits, emergency care, preventive care such as screenings and immunizations, and other procedures and treatments. See the Program Fact Sheets for benefit details and see the Find a Doctor page to search for specific doctors or other medical providers in your area.

 

What happens to my health plan enrollment if I lose and regain Medicaid?

 

If you lose Medicaid and then get it back within 60 days, Medicaid will keep you enrolled in the health plan you had before you lost Medicaid. If you lose Medicaid and it takes longer than 60 days to get it back, you may have to re-enroll in the health plan you had before you lost Medicaid. To enroll in a health plan, contact HealthColorado.

 

What is HealthColorado?

 

HealthColorado is a state program that helps people with Medicaid choose the health plan they want to get Medicaid services from. HealthColorado sends letters to all newly enrolled Medicaid clients letting them know about their Medicaid health plan options. To find out more about choosing your Medicaid health plan, call HealthColorado at 303-839-2120 (in Denver) or 1-888-367-6557 (outside of Denver). Hours: Monday-Friday, 8:00 a.m. to 5:00 p.m. (closed state holidays). The HealthColorado number is not for information on Medicaid benefits or to find out if you qualify.

 

What is Long-Term Care Medicaid?

 

Long-Term Care Medicaid includes nursing facility care and Home and Community-Based Services where medical providers come into the home to render the necessary services to keep a disabled or aged individual from being placed in a nursing facility or hospital.

 

What is Medicaid Estate Recovery?

 

Federal law requires states to operate a Medicaid Estate Recovery Program to help pay for the costs of the Medicaid program. We recover medical assistance payments paid on behalf of former Medicaid clients from their estates. We may only recover medical assistance costs from the estates of clients who received services in an institutionalized setting or for the cost of services received by clients who were age 55 and older. The law also provides exceptions to estate recovery and the ability to compromise claims.

 

What is my Case Number and where do I find it?

Your Case Number is how we identify you and members of your household in our system. Your Case Number starts with “1B.” This number is also used by programs such as Colorado Medicaid, Food Assistance, Cash Assistance and/or Colorado Works to identify you. It is also on all letters we send you.

If you do not qualify for Colorado Medicaid, you have other coverage options. You will need your Case Number to find out if you qualify for financial assistance to help buy private health insurance through Connect for Health Colorado.

What is my Colorado Medicaid ID Number and where do I find it?

We give each person who qualifies for Colorado Medicaid an ID Number. Your and your family or caretaker's Colorado Medicaid ID Number is sometimes called your State ID Number. Your Colorado Medicaid ID Number is on your Colorado Medicaid card. It is also on all letters we send you about your benefits. You can also get your Colorado Medicaid ID Number by calling or visiting your county of residence's human services office or calling the Medicaid Customer Contact Center

I am a Colorado Medicaid member, how can I report the birth of my baby?

If you are a woman on Colorado Medicaid when your baby is born, your baby will get Colorado Medicaid through his or her first birthday. You or your family or caretaker can report the birth of your baby to us by logging in to your Colorado PEAK website account. If you do not have a Colorado PEAK account, find out how you can Manage Your PEAK Account.

You can also report the birth of your baby to your county of residence human services office or Medical Assistance (MA) site case worker near you. It usually takes about 10 days for your baby to be added to your case and assigned a Colorado Medicaid ID Number. Once added, you are able to take your baby to the doctor. For emergencies, please use the Medicaid Add-A-Baby Emergent Request Form or call the Medicaid Customer Contact Center and they can submit one for you.

What is managed care?

Managed care is a group of doctors, clinics, hospitals, pharmacies and other providers who work together to take care of your health care needs. We refer to these groups as Managed Care Organizations or MCOs.  

What is a health plan?

Health plans are networks of physicians, hospitals, and other healthcare professionals who deliver medical services to health plan members.   

What health plans are offered?

You can choose either the Accountable Care Collaborative (ACC) Program, a Managed Care Organization (MCO), or regular Colorado Medicaid.  

  • If you choose the ACC Program, you will receive the regular Medicaid benefit package, and will belong to a Regional Care Collaborative Organization (RCCO). Your RCCO will help you choose a Primary Care Medical Provider (PCMP). Your PCMP serves as your "medical home". They will provide most of your health care and will assist you in finding specialists when you need them. 
  • If you choose an MCO, you will receive a benefit package from that MCO. When you join, you must choose a primary care physician (PCP). Your PCP is the first person you talk to whenever you need medical care. Your PCP can treat you or refer you to a specialist within the MCO network. You cannot see doctors outside of the MCO, except in emergencies or with a referral from your PCP. If you live in one of the counties below, you can choose from one of these MCO plans:
    • Denver Health Medicaid Choice Plan; available in Adams, Arapahoe, Denver and Jefferson counties. Their customer service phone number is (303) 602-2116 (Denver Metro area) or 1-800-700-8140 (toll-free).
    • Rocky Mountain Health Plan; available in Delta, Mesa, Montrose, Ouray, Rio Blanco and San Miguel counties. Their customer service phone number is (970) 244-7860 or 1-888-282-8801 (toll-free).

How do I sign up for a health plan?

First, you should review the different plans and decide which one is the best one for you. Then, call HealthColorado to sign up at (303) 839-2120 (Denver Metro area) or 1-888-367-6557 (toll free). TTY is 1-888-876-8864. You can also call HealthColorado for details about the benefits offered by each health plan. You can call HealthColorado Monday through Friday, 8:00 a.m. to 5:00 p.m.

How do I enroll in a Managed Care Organization?

See How do I sign up for a health plan? 

How do I change health plans?

You can change your health plan at any time during the first 90 days after you join. After 90 days, you can change once a year during open enrollment.  

You can also change your health plan anytime you have good cause. Some examples of good cause might be:

  • You move out of the health plan's area
  • The health plan does not cover the service you need
  • You received poor quality care in the health plan you're in now
  • You can't find a provider to treat your problem
  • Medicaid or HealthColorado made a mistake and put you in the wrong health plan

If you are on Colorado Medicaid, you can join a health plan at any time. 

To change or select a health plan, call HealthColorado at (303) 839-2120 (Denver Metro area) or 1-888-367-6557 (toll free). TTY is 1-888-876-8864. You can call Monday through Friday, 8:00 a.m. to 5:00 p.m. 

What is open enrollment?

When you choose a health plan, you are enrolled for up to one year. Open enrollment is the specific time of year when you can change your health plan. Open enrollment is always the two months before your birth month. For example, if you were born in October, your open enrollment period is in August and September. During those two months you can change from one health care plan to another. You can also choose to return to regular Colorado Medicaid. To change health plans call HealthColorado at (303) 839-2120 (Denver Metro area) or 1-888-367-6557 (toll free). TTY is 1-888-876-8864. You can call Monday to Friday, 8:00 a.m. to 5:00 p.m.  

What is a Prior Authorization Request and why do I need one?

Some Medicaid services and benefits require a health care provider to complete a form or make a phone call that gives permission to get extra services and supplies if you have a special health care need. If you have questions about prior authorizations please contact your health care provider or the Medicaid Customer Contact Center at 1-800-221-3943 / TDD 1-800-659-2656.

What is the nurse line?

If you are not feeling well but are not sure if you need to go to the doctor, call the Nurse Advice Line at 800-283-3221. This hotline is just for Medicaid clients and you can call it 24-hours a day.

I was involved in an accident that was not my fault and I don’t want Medicaid to pay for the medical bills. What should I do?

The Tort and Casualty Unit in the Benefits Coordination section of the Department recovers money from a legally responsible third party when the Department has paid claims on behalf of a Medicaid client. These circumstances commonly include payments, awards, or settlements from auto, homeowners' and malpractice insurance carriers intended to compensate the clients for their injuries. Medicaid has an automatic lien by statute in these circumstances. We are required by state and federal law to take all reasonable measures to identify parties and to seek reimbursement from those legally responsible parties. Please call the Medicaid Customer Contact Center at 1-800-221-3943.

How can I find out what medical claims Medicaid has paid for?

You can submit a written request to our Department to receive copies of medical claims paid by Medicaid.

The person making the request must be the Medicaid client or an authorized party. To become an authorized party you must fill out a Personal Representative Form. The completed Personal Representative form must be sent to Medicaid with a client’s request.

Medicaid screens and processes the request to make sure it meets the Health Insurance Portability and Accountability Act (HIPAA) requirements. This may take up to two weeks.

Please send your written request to the following address:

     Department of Health Care Policy and Financing
     Privacy Officer
     1570 Grant Street
     Denver, CO 80203        

Your request must include:

  • Dates of service requested
  • Client’s name
  • Client’s Medicaid ID Number
  • Photo copy of the Client’s Medicaid ID Card
  • Client’s last 4 of their Social Security Number
  • Client’s Date of Birth
  • A return mailing address
  • The relationship of the authorized party to the client
  • Copy of the Client’s and authorized party’s Identification or Driver’s License

Why is my doctor sending me a medical bill if I have Medicaid?

If you have received a medical bill from your doctor or a collection agency, and you have confirmed that you were active on Medicaid on the date of service, first check if the date of service is less than 120 days (4 months). If it is, please contact your provider and ask them to bill the medical assistance program, if they are having trouble billing, ask them to contact provider services (Xerox) at 1-800-237-0757.

If the date of service on the bill is greater than 120 days (4 months), please call the Medicaid Customer Contact Center at 1-800-221-3943 for further assistance with this billing matter.

I am a college student who does not live at home but my parents claim me as a tax dependent on their taxes. Do I need to include my parents’ income on my Medical Assistance application?

Yes. If you are a tax dependent of someone else, you need to include their income information on your application. If you do not know it, you will need to contact that person to get their income information.

I have Medicaid but my income has recently changed. How can I update my income?

If you are a current Medicaid or Child Health Plan Plus (CHP+) client and you need to tell us about a change in your income, log on to your PEAK Account at Colorado.gov/PEAK to report the change. This is the fastest and easiest way to tell us about the change in your income. You can get in-person help updating your income using your PEAK Account from a Certified Application Assistance Sites in your community. If you do not have a PEAK Account, you can create a PEAK Account at any time, even if you did not apply online.

If you are a current Medicaid or CHP+ client, you can also report a change in your income to your local County Human Services Office or a Medical Assistance Site in your community.

After you tell us what your new income is, we will need to see if you and your family still qualify for Medicaid or CHP+. If you do still qualify for Medicaid or CHP+, then you do not have to do anything. If you no longer qualify for Medicaid or CHP+, we’ll check to see if you and your family still qualify for a tax credit to help purchase private health insurance through Connect for Health Colorado.

How do I prove I was covered by Medicaid or Child Health Plan Plus (CHP+) when I file my 2014 taxes?

If you were covered for all of 2014 by Medicaid or CHP+, you will simply have to check a box on your tax form saying you were covered. Medicaid and Child Health Plan Plus (CHP+) members will not receive 1095-A forms. The 1095-A form is only for Coloradans who purchased a health plan through Connect for Health Colorado. If you were not covered for all of 2014, you may want to apply for an exemption through the federal government using the IRS 8965 tax form. The Colorado Department of Health Colorado Policy & Financing is not responsible for granting exemptions. Requesting an exemption must be done through the Internal Revenue Service (IRS). For more information go to IRS.gov/ACA.


Child Health Plan Plus Frequently Asked Questions

What is Child Health Plan Plus (CHP+)?

 

Child Health Plan Plus (CHP+) is low-cost health and dental insurance for Colorado’s uninsured children and pregnant women. CHP+ is public health insurance for children and pregnant women who earn too much to qualify for Medicaid, but not enough to afford private health insurance. Get more information.

 

What kind of benefits are included in Child Health Plan Plus (CHP+)?

 

See: About Child Health Plan Plus

 

When can I start using benefits for Child Health Plan Plus (CHP+)?

 

See: About Child Health Plan Plus

 

When should I apply for Child Health Plan Plus (CHP+)?

 

You can apply for Child Health Plan Plus (CHP+) at any time. CHP+ does not have an open enrollment period.

 

Are children of state employees eligible for Child Health Plan Plus (CHP+)?

 

Yes, the children of Employees of the State of Colorado may qualify for Child Health Plan Plus (CHP+). Employees of the State of Colorado must meet income and eligibility criteria for the program.

 

How do I apply for Child Health Plan Plus (CHP+)?

 

See: How To Apply

 

How is Child Health Plan Plus (CHP+) different from Medicaid?

 

See: About Child Health Plan Plus and the Colorado Medicaid Fact Sheet

 

How long will it take to find out if I qualify for Child Health Plan Plus (CHP+)?

 

See: About Child Health Plan Plus

 

Is there an open enrollment period for Child Health Plan Plus (CHP+)?

 

You can apply for Child Health Plan Plus (CHP+) at any time. CHP+ does not have an open enrollment period.

  

Are there co-pays or enrollment fees for Child Health Plan Plus (CHP+)?

 

See: Child Health Plan Plus Fees

 

Can an individual qualify for Medicaid or Child Health Plan Plus (CHP+) coverage that is granted deferred action under the Department of Homeland Security’s temporary Deferred Action for Childhood Arrival process?

 

No, individuals must be lawfully present to be eligible for Medicaid or Child Health Plan Plus (CHP+). Individuals granted deferred action under the Deferred Action for Childhood Arrival are not eligible for Medicaid or Child Health Plan Plus (CHP+).

 

My child is currently on Medicaid or Child Health Plan Plus (CHP+). If I think I may qualify for Medicaid do I need to apply or will I be automatically enrolled since my child is already getting benefits?

 

You will need to complete an application even if your children are currently enrolled in Medicaid or Child Health Plan Plus (CHP+). You can apply at any time. For more information visit How To Apply.

 

What doctors take Child Health Plan Plus (CHP+)?

 

See: The Child Health Plan Plus (CHP+) section of Find a Doctor

 


Medicare/Medicaid Frequently Asked Questions

I have Medicare (or will have Medicare soon). How do I get help with the Medicare costs?

Clients can apply for assistance with their Medicare costs at the county department of human/social services where they live.

Will I get a refund of all the Medicare premiums I paid?

A: Maybe.  If a refund is due, it will only go back to the month Buy-In began.  Some programs can be backdated up to three (3) months prior to the application date, if the client qualifies.  The Qualified Medicare Beneficiary (QMB) program begins the first of the month after the application date. QMB cannot be backdated.

When will I get my refund of paid Medicare premiums?

Usually within a month after the county approves eligibility.  If it takes longer than a month, contact your county human services office, or the State Buy-In Officer.

How will I get my refund of paid Medicare premiums?

The refund comes the same way your regular social security payment comes, direct deposit or paper check.  The refund can come any day of the month.

Will the Medicare Savings Program (MSP) pay my Medicare deductible and co-insurance?

The Qualified Medicare Beneficiary (QMB) Medicare Savings Program (MSP) will pay the Medicare deductible and co-insurance.  The other MSP programs (SLMB, QI-1, QDWI) will only pay the Medicare premiums.

How do I get help with my Medicare Part D costs?

A: Contact the State Health Insurance Assistance Program (SHIP) toll-free at 1-888-696-7213.


Colorado Medicaid Prescription Benefits Frequently Asked Questions

How much should I be charged for my prescription medications?

If your prescription is for a generic medication, your copay will only be $1.00. If your prescription is for a brand name medication, your copay will only be $3.00. Clients 18 years of age and younger, clients in a nursing home and clients in a maternity cycle or 60 days postpartum do not have a copayment.

Can I get my medication early?

Early refills are covered when there is an increase in dosage or if a client is going into or leaving a nursing home. Clients may receive up to a 100 day supply of maintenance medications and up to a 30 day supply of non-maintenance medications. If you run out of medication, contact your doctor and discuss adjusting your prescription to your current needs.

Can I get my medications early if I am going on vacation?

Colorado Medicaid does not pay for vacation supplies.

My pharmacy told me my diabetic supplies are not covered. Is that true?

Diabetic supplies such as test strips, lancets and syringes are a covered medical benefit and not a pharmacy benefit. Please ask the pharmacy to bill DME-Supplies. Pharmacies can call 1-800-237-0757 if they require additional assistance billing supplies.

My pharmacy told me my medication is denied because a prior authorization was needed. What should I do?

Some medications require your doctor to file a prior authorization request before a medication will be covered. Please ask your doctor to contact Colorado Medicaid at 1-800-365-4944 to request a prior authorization for your medication. Once the prior authorization is submitted, it will take up to 24 hours to process.

Can I get the name brand medication when a generic is available?

Through scientific testing, the Food and Drug Administration (FDA) ensures that generic drugs are safe and effective, contain the same active ingredient and work the same way as the brand name. Colorado Medicaid can pay for a name brand drug if a generic is not available, if your doctor considers the name brand to be medically necessary or if the medication is excluded from the generic mandate (e.g., medications for mental illness, cancer, epilepsy and HIV/AIDS). In cases where your doctor would like you to have the brand name when a generic is available, a prior authorization will need to be completed by your doctor and the prior authorization must be approved by Colorado Medicaid before you will be allowed to receive the brand name.

Are over-the-counter (OTC) medications covered?

Insulin and aspirin are covered without a prior authorization. All other OTCs require a prior authorization before approval unless an OTC is a preferred product on the Preferred Drug List (PDL).

Can I request an early refill if my medication was lost or stolen?

Colorado Medicaid will cover lost, stolen or damaged medications once per lifetime for each client. Stolen prescriptions will require a copy of the police report to be submitted/faxed to the state before approval will be granted. For assistance, please contact the Department at 303-866-3588 or 800-221-3943.

I am covered by Medicare and Medicaid. Why is Medicaid not paying for my prescriptions?

Once a Colorado Medicaid client is entitled to receive Medicare, Medicare Part D will cover most of your prescriptions. Colorado Medicaid will only pay for a few medications that are excluded by your Part D plan. If you need assistance to find and enroll on a Part D plan, please call 1-888-696-7213 or 303-894-2946.

Does Medicaid cover smoking cessation products (e.g. Chantix, nicotine patches and nicotine gum)?

Colorado Medicaid covers smoking cessation products with a prior authorization. Learn more about how to Quit Smoking.


Provider Search Tool Frequently Asked Questions

What is the provider search tool?

The Department of Health Care Policy and Financing website contains a provider search tool that offers a resource for Medicaid Members to search for and contact Medicaid providers including physician and dental services. Members that use this tool to search for Medicaid providers should keep in mind that they also need to contact the individual provider to confirm the provider is taking new Medicaid patients.

Why is there a need for a provider search tool?

The Department maintains all Medicaid Provider information and works to make this information accessible so that members can find providers to deliver Medicaid-covered services.

What information does the provider search tool contain?

The provider search tool search results provide a list of providers sorted by providers’ names:

  • Provider Legal Name / Doing Business As name
  • Provider Type Description
  • Specialty Description
  • Location Address, City, State, and Zip
  • Phone number

How frequently is provider information updated?

Each month, a report of providers from the MMIS is used to update the provider search tool on our website.

What other criteria are used?

Providers must have billed an electronic or paper claim in the last 12 months.

How do members use the search tool?

Members can search for providers by location, provider type, specialty, and/or name.

How do providers update their contact information?

The information in the search results is limited to what individual providers provide to the department.  Providers are encouraged to keep their contact information and Medicaid-accepting status current by using the Provider Enrollment Update Form or Web Portal, if applicable.

What if a provider does not have a member to bill on behalf of, but would like to be listed in the search results?

If a provider currently does not have a member to bill a new claim for, a previously paid claim may be resubmitted in order for the system to capture the provider information.  The claim will deny appropriately; however, the provider’s information will display in the search tool’s results.  Note: there is up to a 31-day processing delay for the search results to display new provider information.


Pregnant Women Frequently Asked Questions

If I have a health question or concern, who should I call?

Medicaid offers a free 24-hour Nurse Advice Line: 1-800-283-3221

What is the Nurse Home Visitor Program?
The Nurse Home Visitor Program is a special program for low-income women who are pregnant with their first child. The program is also for these first children up to their second birthday. NHVP offers case management and health education services to moms and their first babies in order to help them get the medical and social services that they need.

How much are my copays?

You have no copays for Medicaid-covered services and prescriptions while you are pregnant and for two months after you pregnancy ends.

Can I get help to quit smoking?

  • Contact the Colorado QuitLine at 1-800-Quit-Now (1-800-784-8669) for free coaching and support.
  • Talk with your health care provider about the benefits and risks of taking smoking cessation medications while you are pregnant. Medicaid covers two 90-day courses of smoking cessation medication with counseling to help you quit.
  • Are you committed to keeping your baby safe from second hand smoke? Find the Smoke Free Homes Pledge here: Raise Smoke-Free Kids

Are prenatal vitamins covered?

Prenatal vitamins are a free benefit for all pregnant women. Talk with your health care provider about the benefits of taking a prenatal vitamin every day. A prescription is required.

Can I get transportation to my appointments?

Free Non-Emergent Medical Transportation is available if you have no other means of transportation to get to and/or from health appointments for Medicaid-covered services. If you live in one of the following counties: Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Jefferson or Larimer, please call First Transit at 1-855-CO4-NEMT (1-855-264-6368) for transportation arrangements. If you live outside of these counties, please contact your county of residence human services office for information on how to access Non-Emergent Medical Transportation. You need to call at least two days before your health appointment.

Can I get help for depression?

Mental and behavioral health services are available to clients on Medicaid. All Medicaid-covered mental and behavioral health services are provided through Behavioral Health Organizations. Please contact the Behavioral Health Organization in your area to set up an appointment.

How do I enroll my newborn in Medicaid?

If you are a woman on Colorado Medicaid when your baby is born, your baby will get Colorado Medicaid through his or her first birthday. You or your family or caretaker can report the birth of your baby to us by logging in to your Colorado PEAK website account. If you do not have a Colorado PEAK account, find out how you can Manage Your PEAK Account.

You can also report the birth of your baby to your county of residence human services office or Medical Assistance (MA) site case worker near you. It usually takes about 10 days for your baby to be added to your case and assigned a Colorado Medicaid ID Number. Once added, you are able to take your baby to the doctor. For emergencies, please use the Medicaid Add-A-Baby Emergent Request Form or call the Medicaid Customer Contact Center and they can submit one for you.

Are breast pumps covered?

Medicaid may provide breast pumps to some clients in limited cases.

  • Manual breast pumps for premature infants and infants in critical care are available for purchase.
  • Electric breast pumps are only available for purchase for premature infants and infants in critical care, and only if the infant is expected to be hospitalized for 54 days or more. Electric breast pump rental is available if the infant is expected to be hospitalized less than 54 days. Electric breast pumps require prior approval by Medicaid.

Breast pumps must be prescribed by a physician, physician assistant or nurse practitioner. Breast pumps must be purchased from an approved supplier, which are often pharmacies.

If you do not qualify for a breast pump through Medicaid, you may be able to receive a breast pump from Colorado’s Special Supplemental Nutrition Program for Women, Infants and Children (WIC). For more information, call the WIC program at 1-800-688-7777 to see if you are eligible for the WIC program and meet qualifying criteria for the pump loan program.


Former Foster Care Youth Frequently Asked Questions

What is the former foster care youth Medicaid extension?

Qualifying former foster care youth from Colorado can now get free Medicaid coverage up until the age of 26. Former foster care youth who qualify for the Medicaid extension do not have to pay co-payments for services.

Who qualifies for the former foster care youth Medicaid extension?

Youth in foster care under the state's or tribes' responsibility and also enrolled in Medicaid qualify for the Medicaid extension.  Former foster care Medicaid extends medical assistance to age 26 for former foster care youth that were in Colorado foster care at ages 18, 19, 20 or 21 and enrolled in Medicaid.  You are considered a former foster care youth if you were under the following types of care:

  • Certified kinship care
  • Non-Certified kinship care (when the county has custody)
  • Foster home care
  • Group home care
  • Group center care
  • Children’s Habilitation Residential Program (CHRP)
  • Residential Child Care Facilities (RCCF) programs
  • Psychiatric Residential Treatment Facilities (PRTF) programs
  • Independent living programs or
  • Youth committed to the Division of Youth Corrections, living in one of the above, non-secure locations

I was in foster care but emancipated out before my 18th birthday or was permanently adopted (left foster care). Can I qualify for the Medicaid extension?

No, you must have been in foster care at ages 18, 19, 20 or 21 and enrolled in Medicaid to qualify. If you left foster care before your 18th birthday, you do not qualify for the Medicaid extension.

You may still be able to qualify for regular Medicaid. To find out how go to the How To Apply page.

I was a foster care youth in another state. Can I qualify for the Medicaid extension?

No, you must have been in foster care in Colorado to qualify.

I was in Youth Corrections until I was 18 years old. Can I qualify for the Medicaid extension?

Yes, if you were in Youth Corrections on or after your 18th birthday and were receiving Medicaid at the time, you may qualify for the Medicaid extension.

What benefits and services does Medicaid cover?

Medicaid offers the following benefits and services: doctor visits, behavioral health, hospitalization, rehabilitative services, laboratory services, outpatient care, prescription drugs, emergency care, dental care, maternity care and newborn care.

Medicaid also covers preventive and wellness services including aspirin use, blood pressure screening, breast cancer screening, cholesterol screening, depression screening, healthy diet counseling, sexually transmitted disease prevention counseling, tobacco use screening and counseling and others.

For more information see our Medicaid Benefits page or call the Medicaid Customer Contact Center at 1-800-221-3943/ TDD 1-800-659-2656.

Are dental services covered by Medicaid?

Yes, beginning April 1, 2014 all Medicaid clients will have access to dental services. For adults over the age of 21, preventive services will begin April 1, 2014 and a more comprehensive benefit will begin July 1, 2014.   Youth under 21 will be able to get additional dental services. Family Health Coordinators can tell you more about the dental service you may be able to get if you are under 21. 

I think I may qualify for the Medicaid extension for former foster care youth but have not been contacted. What should I do?

You should contact your local county Human Services office. They can help figure out if you qualify for the Medicaid extension.

As a qualifying former foster care youth, do I have to pay co-payments for services?

No, former foster care youth do not have to pay co-payments for Medicaid covered services. For more information  see our Medicaid Benefits page or call the Medicaid Customer Contact Center at 1-800-221-3943/ TDD 1-800-659-2656.

I am a qualifying former foster care youth and am attending college outside of Colorado. Can I qualify for the Medicaid extension?

If you retain residency in Colorado while you are temporarily out of the state for school, you can qualify for the Medicaid extension. Medicaid will cover services provided by out-of-state providers on a case-by-case basis. You should contact the Medicaid Customer Contact Center at 1-800-221-3943/ TDD 1-800-659-2656 for more information on seeing a provider outside of Colorado.

As a qualifying former foster care youth, do I have access to Early Periodic Screen Diagnosis and Treatment (EPSDT) services as part of the Medicaid extension?

Once you reach the age of 21, you can no longer get Early Periodic Screening, Diagnosis and Treatment services.  Adult services are provided and you do not have co-payments.  If you are a qualifying former foster care youth from age 18 through age 20, Early Periodic Screening, Diagnosis and Treatment Services will still be available to you. Check out this list of people on page 4 who can tell you more about the additional services you may be able to get if you are under 21. 

Do I need to do anything to ensure I can get my health services?

It is important to keep your address up to date with your county Human Services office. We need your up-to-date mailing address to make sure you get your Medicaid card in the mail and other important letters from us. You can also update your address online through Colorado.gov/PEAK.

Do I need to provide anything else to my county Human Services office?

Each year you will be sent a Medicaid Recertification Letter. The letter will ask you if anything has changed, such as your address or a change in your incarceration status. You will need to let us know if anything has changed. If nothing has changed, you will still get your services. You can also update your address online through Colorado.gov/PEAK.

I received a Proof of Eligibility Letter. Do I need to always use this?

A  Proof of Eligibility Letter was sent to you because your name was not in the automated Medicaid system. Your name is now in our system. You no longer need to show your Proof of Eligibility Letter to providers.

I needed to call Medicaid to get my prescriptions filled from January through April, 2014. Do I still need to do this?

No, you no longer have to call Medicaid to get a prescription filled. Your provider can now refill your prescription.

When will I receive my Medicaid card?

Medicaid cards will be sent to the last known address we have on file for you.  Make sure you update your address with your county Human Services office every time you move. You can also update your address online through Colorado.gov/PEAK.

Can I reinstate my Medicaid benefit if I resume residency in Colorado or am released from incarceration?

Yes, report your new address and status to your county Human Services office.

I am a former foster care youth who qualifies for the Medicaid extension. Can I update my address through Colorado.gov/PEAK?

Yes, if you qualify for the Medicaid extension you can create a login for Colorado.gov/PEAK and update your mailing address and other information about you online. You will need to provide the following information to set up an account on Colorado.gov/PEAK:

  • Your active Medicaid case number. You can get this number by calling the Medicaid Customer Contact Center at 1-800-221-3943/ TDD 1-800-659-2656
  • Your Social Security Number
  • Your date of birth

I am a former foster care youth who qualifies for the Medicaid extension. Can I request a new Medicaid card through Colorado.gov/PEAK?

Yes, if you qualify for the Medicaid extension you can create a login for Colorado.gov/PEAK and request a new Medicaid card online. You will need to following information to set up an account on Colorado.gov/PEAK:

  • Your active Medicaid case number. You can get this number by calling the Medicaid Customer Contact Center at 1-800-221-3943/ TDD 1-800-659-2656
  • Your Social Security Number
  • Your date of birth

Where can I get more help?

If you are under the age of 21, Medicaid has individuals in your community called Family Health Coordinators who can help you learn about what benefits you get with Medicaid.