Health Coverage Programs & Eligibility

This page provides  in-depth information and resources about  affordable health insurance programs in Colorado, including eligibility for Medicaid,  Child Health Plan Plus (CHP+), and the state-based health insurance marketplace, Connect for Health Colorado. Learn more by clicking each heading. If you are an individual or family looking for health insurance, start here.

  • Medicaid

    Colorado Medicaid is a program administered by the Colorado Department of Health Care Policy and Financing (HCPF) that offers very low cost or free health coverage to Coloradans who qualify for the program. To qualify, a person typically must have low income, and/or have a disability, and must meet residency requirements.

    The first category is for people with disabilities and/or elderly adults. There are many Colorado Medicaid programs available to people living with disabilities, including long-term services and supports (LTSS), home and community based services (HCBS), breast and cervical cancer program (BCCP), Social Security Income (SSI)-related Medicaid, Medicare Savings Programs (MSP), Qualified Medicare Beneficiary (QMB), and low income subsidy (LIS), among others. For more on non-MAGI programs, please reference the program list here, and HCPF training resources, especially General Aged, Blind, and Disabled Medical Assistance User Desk Reference Guide.

    A second category of Medicaid is for children and non-disabled adults, including pregnant women and parents. This category uses an eligibility methodology to determine a family’s household income called Modified Adjusted Gross Income, or MAGI. Because these programs use MAGI to determine an applicant’s income, they are sometimes referred to as “MAGI Medicaid” programs. Although there is no enrollment fee for people applying for MAGI Medicaid, enrollees may be asked to help pay for the cost of doctor’s visits by paying small co-payments.

     

    Medicaid Eligibility for MAGI Programs

    Eligibility for MAGI programs is based on the following factors:

    Eligibility Category

    There are four categories of MAGI Medicaid programs: children, pregnant women, parents & caretaker relatives, and adults without dependent children. Learn more about each of these categories on the HCPF website, here.

    Age

    MAGI Medicaid is available to people who are ages 0 through age 64. Children’s Medicaid is available to people under age 19.

    Household Income

    To qualify for MAGI Medicaid, a person must have a family income that is below the income threshold for each eligibility category. The income thresholds are based on the Federal Poverty Level (FPL). Medicaid eligibility is based on the person’s current monthly income. For more on income thresholds, reference the MAGI Medicaid Income Thresholds – Effective April 1, 2016.

    Residency and Citizenship Status

    Medicaid requires that the person receiving benefits be a resident of Colorado, and either be a U.S. citizen, have legal permanent resident status (or other lawfully present status), or have qualified non-citizen status. Adult applicants with legal permanent resident status must have had that status for five or more years in order to qualify for Medicaid. Pregnant women and children with legal permanent resident status, or other lawfully present status, do not need to wait five years due to a Colorado rule change, effective July 1, 2015. For more about health coverage for non-U.S citizens, read the CKF fact sheet: Health Coverage Options for Immigrants in Colorado.

    Quick References for more on Medicaid
  • Child Health Plan Plus (CHP+)

    Child Health Plan Plus (CHP+) is a public health insurance program similar to Medicaid for children and pregnant women with incomes that are too high to qualify for Medicaid, but too low to afford private health insurance. CHP+ is administered by the Colorado Department of Health Care Policy and Financing (HCPF) and also uses Modified Adjusted Gross Income, or MAGI, to determine a family’s household income.

    CHP+ is only available to pregnant women ages 19 and over, and children ages 0 – 18. Unlike Medicaid, CHP+ requires that parents pay an enrollment fee to finalize enrollment for the child. The enrollment fee is based on the family’s income and how many children are enrolling. A family needs to pay the enrollment fee before the child’s CHP+ coverage is finalized. Pregnant women are not asked to pay an enrollment fee.

    Families with CHP+ may also be asked to pay a small co-payment for children’s doctor’s visits. The amount of the co-payment is based on the family income. Pregnant women do not have to pay co-payments if they are covered by CHP+.

    CHP+ Eligibility

    CHP+ eligibility is based on the following factors:

    Eligibility Category

    There are two categories of eligibility for CHP+: children (ages 0 to 18), and pregnant Women (ages 19+).

    Age

    Children’s CHP+ is available to children who are under 19, while pregnant women’s CHP+ is available to women who are pregnant aged 19 or older. (If a woman is under 19 and pregnant, she is may be eligible for children’s CHP+.)

    Household Income

    To qualify for CHP+, a person must have a family income that is above the income threshold for Medicaid, and below the income threshold for CHP+. The income thresholds are based on the Federal Poverty Level (FPL). CHP+ eligibility is based on the person’s current monthly income. For more on income thresholds for CHP+, visit: Child Health Plan Plus Monthly Maximum Income Guidelines – Effective April 1, 2016

     Residency and Citizenship Status

    Like Medicaid, CHP+ requires that the person receiving benefits be a resident of Colorado, and either be a U.S. citizen, have legal permanent resident status (or other lawfully present status), or other qualified non-citizen status. Pregnant women and children with legal permanent resident status, or other lawfully present status, no longer need to wait five years due to a Colorado rule change, effective July 1, 2015. For more, read the CKF fact sheet: Health Coverage Options for Immigrants in Colorado.

    Quick References for CHP+
  • State Based Marketplace – Connect for Health Colorado

    Connect for Health Colorado is the state’s health insurance marketplace. Connect for Health Colorado was established in Colorado by the state legislature through the Colorado Health Benefit Exchange Act in 2011.

    Individuals, families, and small businesses can use the marketplace to shop for private health insurance plans. Connect for Health Colorado is the only place where Coloradans can get reductions in the cost of their health insurance plans from federal tax credits called Advanced Premium Tax Credits (APTC) or reductions in the cost of co-insurance or co-payments through Cost Sharing Reductions (CSR).

    APTCs are available to some individuals and families based on their household income. These can be used to reduce the cost of the premium that an individual is responsible to pay to the health insurance company. Anyone can shop for private health insurance on Connect for Health Colorado, but there are eligibility criteria to qualify for APTCs.

    CSRs are also available to some individuals and families based on their household income. CSRs can reduce the amount of out-of-pocket costs an individual or family is responsible to pay when they visit the doctor. A silver-level plan needs to be selected in order to receive CSRs.

    Individuals and families who want to buy private insurance need to do so during the national open enrollment period, or if they have a qualifying life event, they can purchase health insurance during a special enrollment period.

    APTC Eligibility

    APTC eligibility is based on the following factors:

    Tax Filing Status

    Because APTCs are a tax credit, it is necessary for a person to either file taxes, or be the dependent of someone filing taxes. Married couples must file jointly, except in special circumstances like domestic violence cases.

    Offers of other affordable insurance

     APTCs are not available if the person has an offer of other affordable health insurance. This could include an offer of affordable health insurance from an employer, or eligibility for Medicaid, or CHP+.

    Household Income

    APTCs may be available for people whose household income is between 100 percent of the Federal Poverty Level (FPL) up to 400 percent FPL. Income is based on Modified Adjusted Gross Income (MAGI) similar to the formula used for Medicaid and CHP+. The amount of APTC a person can receive is larger for people with lower incomes, and smaller for people with higher incomes. APTCs are adjusted for the state every year, based on the cost of the second lowest cost silver plan offered on the marketplace. As a result, APTCs may not be offered to all incomes up to 400 percent FPL. Income for APTCs is based on the tax filer’s projected annual income.

    Citizenship/Residency Status

    To receive APTCs, the tax filer must be either be a U.S. citizen, have legal permanent resident status, or other qualified non-citizen status. Unlike requirements for Medicaid and CHP+, legal permanent residents do not need to have been legally present for five or more years in the U.S. to qualify for APTCs, and they may qualify for APTCs if their incomes are between 0 to 400 percent FPL. For more on health coverage options for non-U.S. citizens, view CKF’s fact sheet: Health Coverage Options for Immigrants in Colorado.

    Quick References for private health insurance