Program & Rule Changes

A summary of changes affecting the health coverage of Coloradans

TopicEffective DateDescriptionReference
CHIP ReauthorizationJanuary 22, 2018 (retroactive to October 1, 2017), and February 9, 2018.A six-year funding extension was passed on January 22, and an additional four years were added on February 9, 2018.
Medicaid and CHP+ Income GuidelinesApril 1, 2018Adjusted income guidelines for MAGI programsAgency Letter
Children with Autism Waiver sunsetJune 30, 2018The Children with Autism Waiver sunset; the therapies provided under the waiver are available through EPSDT.Children with Autism Waiver website

TopicEffective DateDescriptionReference
Medicaid and CHP+ Income GuidelinesApril 1, 2017Adjusted income guidelines for MAGI programs2017 CHP+ Income Chart

2017 Medicaid Income Chart
Updates to citizenship eligibilitySeptember 30, 2017Updates were made to rule to include eligibility for children who have a pending Special Immigrant Juvenile status. Work quarters were also removed for CHP+ eligibility.MSB 17-05-22-A
CHP+ enrollment date adjustmentOctober 30, 2017Enrollment begin date in a CHP+ MCO changed from the first day of the month following eligibility determination that occurs on or before the 21st of the month, to a determination that happens on or before the 16th of the month.MSB 17-06-08-A
Medicaid Asset Verification ProgramDecember 17, 2017For non-MAGI categories, assets can now be verified electronically.Agency Letter


MSB 17-08-21-B

TopicEffective DateDescriptionReference
Retro closing and exceptions to 10-day noticingMarch 20, 2016Changes were made to the policy and logic in the Colorado Benefits Management System for retroactive, or retro-closing, and noticing for ongoing cases and redeterminations. Clients with the following circumstances will be terminated without 10-day noticing: not requesting assistance, not in the home, not a Colorado resident, or whereabouts unknown.FAQ
Income guidelines updatedApril 1, 2016Income guidelines for program eligibility were updatedMedicaid
Medicaid coverage extended to people residing in Community Corrections facilities (half-way homes)June 1, 2016Medicaid-covered services became available to residents of Community Corrections facilities (half-way homes) who would otherwise be Medicaid eligible, including individuals who reside at the facility involuntarily.Policy Statement
Colorado’s Medicaid program name updated to Health First ColoradoJune 27, 2016Medicaid, Colorado’s public health insurance program for low-income Coloradans who qualify, is now called “Health First Colorado.”Resources
Annualized IncomeJuly 1, 2016As of July 1, 2016, the Colorado Benefits Management System is programmed to use an applicant’s annualized income for Health First Colorado and Child Health Plan Plus (CHP+) eligibility determinations when the person has income from self-employment, commission-based employment, and/or seasonal employment, and is found financially ineligible for all Modified Adjusted Gross Income (MAGI) Medicaid Assistance programs based upon their current monthly income.FAQ
Additional updates to the removal of the five-year bar for children and pregnant womenJuly 1, 2016The removal of the five-year bar was extended to all Health First Colorado children eligible for non-MAGI programs, and some immigration codes were added.FAQ
Health First Colorado and CHP+ eligibility appeal timeline extended to 60 daysSeptember 1, 2016Health First Colorado applicants and members now have 60 days, as opposed to the previous 30 days, after the eligibility determination date on the Notice of Action to file an eligibility appeal with the Office of Administrative Courts.Agency Letter
HB 16-1277
Connect for Health Colorado eligibility appeal timeline extended to 60 daysOctober 1, 2016Connect for Health Colorado extended the time limit for a customer to file an appeal from 30 days to 60 days to align with the changes to HCPF’s appeals process (listed above).Appeals Information
Minimum Essential Coverage for Dependent Children of Parents and Caretaker RelativesOctober 1, 2016Parents and caretaker relatives who have incomes between 69 and 133 percent of the Federal Poverty Level are required to attest that any dependent children who live with them, under the age of 19, are enrolled in Minimum Essential Coverage in order to be eligible for the Health First Colorado MAGI-Adult category.FAQ
Eligibility for refugees and other immigrantsDecember 30, 2016 (going back to September 2015)Under the revised policy, individuals who are refugees will no longer be found ineligible for Health First Colorado and CHP+ based upon individuals not changing their status after seven years. Although the rule is effective December 30, 2016, the policy will be applied to applicants who lost coverage going back to September 2015.Agency Letter
MSB 16-07-05-A

TopicEffective DateDescriptionReference
Medicaid eligibility income change for Parent and Caretaker RelativesApril 1, 2015To align with federal requirements and to fully implement the Modified Adjusted Gross Income (MAGI) income conversion for this population, MAGI Parent/Caretaker income threshold was reduced from 107% of the Federal Poverty Level (FPL) to 68% FPL. Parents with incomes above 68% FPL were transitioned to the Adult MAGI Medicaid category.MSB 15-02-06-A

Parent/Caretaker Relative Federal Poverty Level Changes Frequently Asked Questions (HCPF)
Elimination of the five year waiting for lawfully present children and pregnant women applying for Medicaid and Child Health Plan Plus (CHP+)July 1, 2015Colorado eliminated the five year waiting period for lawfully present children otherwise eligible for MAGI Medicaid and CHP+, and for lawfully present regnant women otherwise eligible for CHP+ in July 2015. State legislation authorizing the elimination of the five year bar was passed in 2009, and funding to fully implement the bill was provided in July 2014. Systems changes were implemented July 2015.MSB 15-02-23-A

House Bill 09-1353

Elimination of Five-Year Bar for Lawfully Residing Pregnant Women and Children Frequently Asked Questions (HCPF)

Did you know you might now qualify for Medicaid or CHP+? (CKF Fact Sheet for Clients – English)

¿Sabía que ahora podría calificar para el Medicaid o CHP+? (CKF Fact Sheet for Clients – Spanish)
1115 Demonstration Waiver Extension for Prenatal Medicaid CoverageAugust 1, 2015 – July 31, 2020Colorado requested to maintain its existing authority under a 1115 demonstration waiver to provide Medicaid coverage using title XXI funding for uninsured pregnant women with income above 141 percent through 195 percent of the Federal Poverty Level (FPL). The renewal period will be effective from August 1, 2015 until July 31, 2020Centers for Medicare & Medicaid Services Approval Letter
12-month Continuous Eligibility extended to children’s non-MAGI Medicaid programsOctober 18, 201512-month continuous eligibility was expanded to children enrolled in non-MAGI programs including children eligible for
Supplemental Security Income (SSI) mandatory, Pickle, Disabled Adult Child (DAC), Medicaid Buy-In Program for Children with Disabilities and children in Long-Term Care programs such as Children’s Home and Community Based Services (HCBS) waiver and
the Children with Autism Waiver (CWA). Continuous eligibility also applies to children
under the age of 19 who are no longer eligible for Foster Care Medicaid.
MSB 15-05-27-D

Continuous Eligibility: Frequently Asked Questions (HCPF)
Medicaid eligibility rule review and updatesNovember 1, 2015Several updates were made to the Medicaid eligibility regulations set forth in section 8.100.4 to align rule with federal regulations. These updates were made as part of a five-year rule review process. Clarifications were made to rules concerning verifications, MAGI methodology for income calculation, income disregard, household composition, presumptive eligibility, needy newborns, and transitional Medicaid.MSB 15-07-08-B

TopicEffective DateDescriptionReference
Medicaid expansion for adultsJanuary 1, 2014Medicaid eligibility threshold expanded to 133% of the Federal Poverty Level (FPL) for Adults without Dependent Children, and for Parents and Caretaker relatives.Senate Bill (SB) 13-200

Parent/Caretaker Relative Federal Poverty Level Changes Frequently Asked Questions (HCPF)
Implementation of 12-month continuous eligibility for kids in MAGI programsMarch 1, 2014Children ages 0-18 will remain eligible and enrolled in one program (either MAGI Medicaid or CHP+) for 12 continuous months regardless of changes to family size or income.House Bill 09-1293
Adult dental Medicaid benefit addedApril 1, 2014Medicaid clients ages 21 and older (including pregnant women) gained access to limited dental benefits in April 2014. Full dental benefits, including restorative procedures and services requiring prior authorization, became available on July 1, 2014.Senate Bill 13-242
Extension of reasonable opportunity period to 90 DaysMay 1, 2014The state responded to federal guidance by defining and aligning the reasonable opportunity period for citizens and non-citizen applicants to 90 days.
CHP+ children’s dental benefit expandedJuly 1, 2014The state responded to federal guidance by expanding benefits to include periodontic care, orthodontic care, prosthodontic care, and an increased annual maximum per member from $600 to $1,000.

TopicEffective DateDescriptionReference
Removal of Medicaid “stair step” for kidsJanuary 1, 2013Children between six and 18 with family incomes at or below 133 percent FPL gained Medicaid eligibility.Senate Bill 11-008

MSB 12-07-03-A
Increase in Medicaid eligibility for pregnant womenJanuary 1, 2013Increased the Medicaid eligibility threshold for pregnant women to 185 percent FPL allowing them to access dental benefits and lower cost sharing.Senate Bill 11-250

MSB 12-07-03-A
CHP+ expanded to dependents of state employeesJanuary 1, 2013CHP+ became a health coverage option for dependents of state employees, making their dependents eligible for CHP+ benefits, lower enrollment fees, and fewer out-of-pocket costs.
Implementation of CHP+ health plan automatic enrollmentJanuary 1, 2013Health Maintenance Organization selection for new CHP+ enrollees is automated to streamline enrollment. CKF continues to recommend that further changes be made to protect family choice.
CHP+ “opt in” options for children of families who have submitted food stamps or a Colorado Works application.April 30, 2013MSB 13-01-08-A
Express lane eligibility for children who have submitted an Free/Reduced Lunch application will have the option to “opt-in” for Medical Assistance eligibility determination at participating school districtsMarch 3, 2013MSB 12-07-27-A
Removal of CHP+ three-month waiting periodMay 1, 2013Eliminates the three-month waiting period that required children who were covered by health insurance to wait three months before applying for CHP+ if the insurance was through an employer who contributed at least 50% of the premium cost.Senate Bill 13-008
MSB 13-04-04-A
Funding Colorado Health Benefit ExchangeEliminates the three-month waiting period that required children who were covered by health insurance to wait three months before applying for CHP+ if the insurance was through an employer who contributed at least 50% of the premium cost.House Bill 13-1245
Transfer Developmental Disabilities to HCPFHouse Bill 13-1314

TopicEffective DateDescriptionReference
CHP+ Enrollment FeeJanuary 1, 2012CHP+ Enrollment Fee increased for families between 205-250% FPLMSB 11-08-30-A
CHP+ Co-pay increasesJuly 1, 2012MSB 11-08-30-A
Medicaid Buy-In Program for Working Adults with Disabilities (Adult Buy-In)March 1, 2012House Bill 09-1293
Electronic Identity VerificationFeb. 27, 2012Department of Motor Vehicles Electronic Interface with the Colorado Benefits Management System for Identity VerificationsMSB 11-12-09-C
Adults without Dependent Children (AwDC)April 1, 2012Medicaid Expansion to Adults without Dependent Children under 10% of FPLHouse Bill 09-1293
Medicaid Buy-In Program for Children with Disabilities (Children’s Buy-In)July 1, 2012Families earning up to 300 percent of the Federal Poverty Level (FPL) can “buy-in” to Medicaid benefits for disabled children via a monthly premium.House Bill 09-1293
Colorado Benefits Management System ProjectHouse Bill 12-1339
Medicaid Payment Reform and Innovation Pilot ProgramHouse Bill 12-1281

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