We presented our $12.3 billion 2021-2022 fiscal year proposed budget at the Joint Budget Committee hearing last month, presented to the Senate Health & Human Services and House Public & Behavioral Health & Human Services committees as part of the SMART Act requirements, and released our 2019-20 Annual Report. The annual report illustrates the many ways we serve Coloradans each and every day, including videos in our members’ own words. We invite you to review it and celebrate all that we accomplished together this past year.  

Vaccines are now rolling out to those over 70 years of age. We appreciate your help reaching the one in four Coloradans who are Health First Colorado members to ensure they are able to get their vaccine when it’s their turn. Of course, members will not be charged a co-pay for the vaccine or for their ride to and from their appointments. We also recently communicated to providers the amount that Medicaid will pay for the administration of the first and second doses. As the vaccine rolls out, please continue to follow public health protocols by washing your hands, wearing your masks and maintaining 6-feet of physical distance from those outside your households, and please help us lead others in doing the same.  

Since the start of the pandemic, the number of Coloradans we serve has grown by more than 175,000 people. This growth is now projected to continue rather consistently all year, with the “likely extension of the Public Health Emergency” (PHE) through the end of 2021, as recently communicated by the U.S. Department of Health and Human Services. In this same spirit, and in alignment with the federal government opening the federal exchanges, Connect for Health Colorado, our state exchange, is also holding a special enrollment period from Feb. 8 - May 15. Together, our efforts are connecting Coloradans to affordable coverage, especially those who have lost their jobs during this economic downturn. Thank you for your partnership on this important work. We are here for Colorado. 

On the affordability front, we hosted the Health Cabinet Health Policy Summit virtual conference, which included five remarkable sessions and over 1,850 registrants. Agency leads, state and national experts discussed initiatives to reform our behavioral health system, get Coloradans vaccinated, help employers control their health care costs, support rural hospitals, improve the effectiveness of hospital community investments, and reduce prescription drug costs. This latter topic included a review and discussion of the top recommendations within the Department’s newly released and updated prescription drug report. In support of one of the recommendations in that report, the Department released an invitation to negotiate on drug importation, inviting domestic and foreign partners to help us import drugs from Canada, which will drive savings of over 60% on importable drugs. As part of the Summit, we also launched a new affordability webpage with tools to help communities address the many factors that contribute to rising health care costs. 

In partnership with the Colorado Hospital Association, the Colorado Healthcare Affordability and Sustainability Enterprise (CHASE) legislative report demonstrates some of the ways we are innovatively addressing costs by collecting a hospital provider fee. We invite you to review this report to learn how we disbursed $393 million in increased reimbursement to hospital providers, reduced uncompensated care costs and the need to shift those costs to other payers, while expanding coverage to an additional 502,000 Coloradans and providing $114 million in relief to the state’s General Fund. 

Last week, President Joe Biden issued an Executive Order that re-opens enrollment of the Affordable Care Act marketplaces. While the order pertains to states that use the federal exchange (healthcare.gov), Colorado’s exchange (Connect for Health Colorado) will mirror the order by also re-opening enrollment. In fact, Coloradans without health insurance will be able to enroll in coverage through ConnectforHealthCO.com between Feb. 8 - May 15, 2021. This special enrollment period is for people who are without health insurance and begins a week earlier than the federal exchange.

In that spirit, concurrent to this special enrollment period, we would appreciate your communication out to your network of contacts about this special open enrollment period, as well as our Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+) coverage programs. Due to COVID-19, our county partners have asked that communications refer applicants to our PEAK online tools. As you know, we have created a variety of materials you can use for outreach on our Here for You, Colorado website, including this helpful enrollment tool (also available in Spanish). Income eligibility information can be found here, as well.

For more information, read the related Policy Memo.

Public Health Emergency Updates

Locked-in Report Guidance

The law has changed; Health First Colorado and CHP+ members no longer need to provide proof of health insurance coverage in order to file their taxes. Therefore, the Department will not be mailing out 1095-B forms this year.

For more information, read the related Operational Memo and our FAQ.

On Jan. 1, 2021, coverage for residential and inpatient substance use disorder (SUD) services became available to Medicaid members in Colorado. We continue to enroll providers, and the Regional Accountable Entities (RAEs) are contracting with treatment providers across all available levels of care. Since Jan. 1, RAEs have approved over 208 authorizations for services, which include over 1,712 authorized days of treatment. The RAEs are working closely with providers to help them learn the authorization process.  

The Department is actively refining processes related to the benefit and welcomes stakeholder feedback to make improvements. Please reach out directly to the SUD team at hcpf_sudbenefits@state.co.us. In addition to the support RAEs are extending to providers, the Department is continuing to hold provider office hours twice per month, on the first and third Wednesdays at 2 p.m. Please see the Department’s SUD website, Ensuring a Full Continuum of SUD Benefits, for additional information.

For more information about Friday Health Plans, members can visit www.fridayhealthplans.com, or contact Friday Health Plans Customer Service by calling 1-719-589-3696 or 1-800-475-8466. 

For more information about the CHP+ program, members can visit www.cchp.org, or contact CHP+ Customer Service by calling 1-800-359-1991.  

The Department is changing the timeframe in which we will verify a Health First Colorado or Child Health Plan Plus (CHP+) applicant's income.

Beginning in February 2021, the Department will be narrowing the window for a member to provide verification for an income discrepancy from 90 to 30 calendar days, when requested. This change is based on member feedback that this timeframe reduces confusion because it better aligns with other timelines in the eligibility process.

In addition, the Department is excited to upgrade to a more timely income verification process that pulls from multiple database sources in spring 2021. We hope doing so will help us verify income automatically without needing to request additional proof of income from applicants.

Questions? Reach out to the Medicaid Eligibility Inbox.

All Memos and their attachments can be found on the Memo Series website.

PM 21-002

The purpose of this Policy Memo is to communicate to county member fraud investigators the requirement for Continuous Enrollment during the Coronavirus (COVID-19) public health emergency (PHE), and the related implications on member fraud investigations, eligibility terminations, and overpayments. This memo will be available to all county staff working on member fraud investigations.

PM 21-001

The purpose of this Policy Memo is to inform authorized individuals/entities such as counties, Medical Assistance (MA) sites, eligibility application partner sites, Presumptive Eligibility (PE) sites, and Certified Application Assistance sites (CAAS) that they may assist applicants in completing the application for Medical Assistance remotely (telephone, video conferencing, etc.) during the COVID-19 Public Health Emergency period. This guidance will exclude the disability application. Assisters should follow the existing process for the disability portion. Assisters listed above have the option to assist applicants to complete the application remotely. This interim process will not be mandatory. Please share this memo with all eligibility staff, supervisors, and outside agencies, as appropriate.

OM 21-015

The purpose of this Operational Memo is to advise eligibility sites that the Internal Revenue Services (IRS) has suspended the requirement to mail physical copies of the 1095-B form to Health First Colorado and Child Health Plan Plus (CHP+) members. The memo provides instructions on how to furnish a copy of the 1095-B form to Health First Colorado and CHP+ members if requested. This guidance is for the 2020 tax year and later, or until states receive further guidance from the Internal Revenue Services (IRS).

OM 21-005

This Operational Memo communicates to county departments of human/social services and other eligibility sites the program requirements and processes for the Department of Health Care Policy & Financing (referenced herein as “the Department” or “HCPF”), in its statutory oversight role in the administration of the Medical Assistance Program, to implement site audits through the HCPF Management Evaluation (ME) Review Program. These site reviews will occur over a multi-year cycle and aim to address county or site compliance issues discovered by the ME Review Program and routine monitoring, quality assurance, administrative desk reviews and other types of Department supervision activities.

The purpose of this Operational Memo is to document the program requirements and processes used for the HCPF ME Review Program site reviews. Non-compliance with ME Review Program requirements and processes, as determined by the Department in its statutory oversight role, can result in notification of non-compliance as found in HCPF Operational Memo 21-004, “Improvement Action and Corrective Action Plans.”

OM 21-004

The Department of Health Care Policy & Financing, referenced herein as “the Department” or “HCPF”, has the statutory responsibility for oversight of the Colorado Medical Assistance Program (Medicaid) as defined by Colorado Revised Statutes [Section 25.5-1-114(3)]. Medicaid is known as Health First Colorado. Medical Assistance also includes the Children’s Basic Health Plan known as Child Health Plan Plus (CHP+). The purpose of this Operational Memo is to document the processes used to monitor the county department of human/social services, referenced herein as “the county” or “counties” and subsequent improvement actions or corrective actions required to correct any determined deficiencies.

The process as documented in this Operational Memo shall be used by the Department until further notice.

OM 21-003

The purpose of this Operational Memo is to provide guidance to county departments of human/social services (county) on meeting Quarter 2 and Quarter 3 Quality Meeting requirements for the Department of Health Care Policy & Financing (Department), FY 2020-21 County Incentives Program, Training and Quality Incentive.

The purpose of this Memo is to inform county departments of human/social services of the processes for entering overpayments and overpayment interest into the Colorado Benefits Management System (CBMS) for Health First Colorado/Medicaid fraud investigations. This Memo will be available to all county staff working on investigations to advise on the reporting requirements for member/client fraud, county incentives for member/client fraud and how to code overpayments and interest. This Memo supersedes guidance issued in HCPF OM 19-002 and is the most current guidance available.

The term “member” and “client” will both be used in this document as “client” is the terminology used in CBMS and “member” is the term preferred by the Department of Health Care Policy & Financing (“Department”).

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