Health Coverage Programs

CKF’s work focuses on three main health coverage programs: Health First Colorado, CHP+, and financial assistance through Connect for Health Colorado. See our primer on these programs below.

Health Coverage Programs

CKF’s work focuses on three main health coverage programs: Health First Colorado, CHP+, and financial assistance through Connect for Health Colorado. See our primer on these programs below.

Health First Colorado

Health First Colorado is Colorado’s Medicaid program. Medicaid is a program administered by the state of Colorado, through a state-federal partnership. This means the state must follow some federal rules, but there is also state flexibility in how the program is administered. A portion of the cost of care that people receive when covered by Medicaid is paid for by state funds, and while the other portion is covered by federal funds. The Colorado Department of Health Care Policy and Financing (HCPF) is Colorado’s Medicaid agency. Health First Colorado offers low or no-cost health coverage for low income children, pregnant women, and adults, and to people living with disabilities. To apply for Health First Colorado an individual can fill out the online PEAK application, or they can get in-person help. In-person help is offered in several ways: by the county health and human services department, medical assistance sites, or community-based organizations. To qualify for Health First Colorado, individuals need to meet certain income requirements, must be lawfully present in the U.S., be a resident of Colorado, and meet other qualifications.

Child Health Plan Plus (CHP+)

Child Health Plan Plus (CHP+) is Colorado’s Children’s Health Insurance Program (CHIP). CHP+ is administered by HCPF through a state-federal partnership. CHP+ is only available to children (ages 0-18) and pregnant women who make too much money to qualify for Medicaid. To qualify for CHP+, individuals need to meet certain income requirements, must be lawfully present in the U.S., be a resident of Colorado, and meet other qualifications. There is an annual enrollment fee for children which must be paid within 30 days in order to complete enrollment. People can apply for CHP+ in the same ways they can apply for Health First Colorado.

Connect for Health Colorado

Connect for Health Colorado Financial Assistance is available to people whose income is too high to qualify for Health First Colorado or CHP+. Financial assistance is available to people who qualify for one or both programs: Advanced Premium Tax Credits (APTCs) and Cost Sharing Reductions (CSRs). APTCs are a federal tax credit which reduce the cost of the monthly premium for private health insurance. APTCs may be available to people who are income eligible, with household incomes below 400 percent of the Federal Poverty Level (FPL). CSRs are available for people who are income eligible (below 250 percent FPL). CSRs reduce the costs of co-payments and deductibles. Health insurance carriers who offer plans on the marketplace must offer CSRs. CSRs are only available if the consumer purchases a silver level health insurance plan. These financial assistance programs are administered by Connect for Health Colorado, our state’s health insurance marketplace established under the Affordable Care Act.

Health First Colorado

Health First Colorado is Colorado’s Medicaid program. Medicaid is a program administered by the state of Colorado, through a state-federal partnership. This means the state must follow some federal rules, but there is also state flexibility in how the program is administered. A portion of the cost of care that people receive when covered by Medicaid is paid for by state funds, and while the other portion is covered by federal funds. The Colorado Department of Health Care Policy and Financing (HCPF) is Colorado’s Medicaid agency. Health First Colorado offers low or no-cost health coverage for low income children, pregnant women, and adults, and to people living with disabilities. To apply for Health First Colorado an individual can fill out the online PEAK application, or they can get in-person help. In-person help is offered in several ways: by the county health and human services department, medical assistance sites, or community-based organizations. To qualify for Health First Colorado, individuals need to meet certain income requirements, must be lawfully present in the U.S., be a resident of Colorado, and meet other qualifications.

Child Health Plan Plus (CHP+)

Child Health Plan Plus (CHP+) is Colorado’s Children’s Health Insurance Program (CHIP). CHP+ is administered by HCPF through a state-federal partnership. CHP+ is only available to children (ages 0-18) and pregnant women who make too much money to qualify for Medicaid. To qualify for CHP+, individuals need to meet certain income requirements, must be lawfully present in the U.S., be a resident of Colorado, and meet other qualifications. There is an annual enrollment fee for children which must be paid within 30 days in order to complete enrollment. People can apply for CHP+ in the same ways they can apply for Health First Colorado.

Connect for Health Colorado

Connect for Health Colorado Financial Assistance is available to people whose income is too high to qualify for Health First Colorado or CHP+. Financial assistance is available to people who qualify for one or both programs: Advanced Premium Tax Credits (APTCs) and Cost Sharing Reductions (CSRs). APTCs are a federal tax credit which reduce the cost of the monthly premium for private health insurance. APTCs may be available to people who are income eligible, with household incomes below 400 percent of the Federal Poverty Level (FPL). CSRs are available for people who are income eligible (below 250 percent FPL). CSRs reduce the costs of co-payments and deductibles. Health insurance carriers who offer plans on the marketplace must offer CSRs. CSRs are only available if the consumer purchases a silver level health insurance plan. These financial assistance programs are administered by Connect for Health Colorado, our state’s health insurance marketplace established under the Affordable Care Act.

Health Coverage Systems

Health Coverage Systems

The programs are accessed through several intertwined technology systems. See our primer on these systems below.

Colorado Benefits Management System

Colorado Benefits Management System (CBMS) is the state’s technology system which is programmed with eligibility rules for health coverage programs, and which determines if a person qualifies for Health First Colorado or CHP+. CBMS also determines eligibility for other public programs including Food Stamps, state financial assistance, and other programs. The Governor’s Office of Information Technology (OIT) manages CBMS, and partners with state agencies like HCPF, and the Colorado Department of Human Services.  A person’s information is entered into CBMS when an eligibility technician at a county health and human services office enters the information directly into CBMS, or when an applicant submits information through PEAK. CBMS also connects to several electronic verification systems which can verify a person’s identity, income, and citizenship or lawful immigration status.

PEAK

PEAK is Colorado’s online application for public assistance programs. Individuals and families can use it to apply at home, or they may use it if they visit a community-based organization for help. PEAK interfaces with CBMS. If a person enters their information in PEAK, their information is input into CBMS, which makes the eligibility determination. In many cases, a person’s eligibility for Health First Colorado can be determined quickly, within a few minutes to 24 hours. This means that person can often receive a “real time” eligibility determination through PEAK.  PEAK is managed by OIT.

Connect for Health Colorado Eligibility System

Connect for Health Colorado Eligibility System is planned to come online in October 2018. This new eligibility system for the state marketplace will determine if a person is eligible for APTCs or CSRs. (Prior to October 2018, eligibility for APTCs and CSRs was determined in CBMS.) If a person is eligible for APTCs or CSRs, the new eligibility system will then connect the consumer with the opportunity to shop for a qualified health plan with APTC and CSR discounts. Connect for Health Colorado will administer this eligibility system, working closely with state agencies.

interChange

interChange is the state’s Medicaid Management Information System (MMIS). This is the portal that care providers use to report the services they provide to a Medicaid client, and request payment from HCPF for those services. The interChange interfaces with CBMS to receive a person’s Health First Colorado eligibility information. Providers can verify a patient’s Medicaid eligibility by searching in the interChange’s Provider Portal.

Colorado Benefits Management System

Colorado Benefits Management System (CBMS) is the state’s technology system which is programmed with eligibility rules for health coverage programs, and which determines if a person qualifies for Health First Colorado or CHP+. CBMS also determines eligibility for other public programs including Food Stamps, state financial assistance, and other programs. The Governor’s Office of Information Technology (OIT) manages CBMS, and partners with state agencies like HCPF, and the Colorado Department of Human Services.  A person’s information is entered into CBMS when an eligibility technician at a county health and human services office enters the information directly into CBMS, or when an applicant submits information through PEAK. CBMS also connects to several electronic verification systems which can verify a person’s identity, income, and citizenship or lawful immigration status.

PEAK

PEAK is Colorado’s online application for public assistance programs. Individuals and families can use it to apply at home, or they may use it if they visit a community-based organization for help. PEAK interfaces with CBMS. If a person enters their information in PEAK, their information is input into CBMS, which makes the eligibility determination. In many cases, a person’s eligibility for Health First Colorado can be determined quickly, within a few minutes to 24 hours. This means that person can often receive a “real time” eligibility determination through PEAK.  PEAK is managed by OIT.

Connect for Health Colorado Eligibility System

Connect for Health Colorado Eligibility System is planned to come online in October 2018. This new eligibility system for the state marketplace will determine if a person is eligible for APTCs or CSRs. (Prior to October 2018, eligibility for APTCs and CSRs was determined in CBMS.) If a person is eligible for APTCs or CSRs, the new eligibility system will then connect the consumer with the opportunity to shop for a qualified health plan with APTC and CSR discounts. Connect for Health Colorado will administer this eligibility system, working closely with state agencies.

interChange

interChange is the state’s Medicaid Management Information System (MMIS). This is the portal that care providers use to report the services they provide to a Medicaid client, and request payment from HCPF for those services. The interChange interfaces with CBMS to receive a person’s Health First Colorado eligibility information. Providers can verify a patient’s Medicaid eligibility by searching in the interChange’s Provider Portal.