In Colorado, Managed Care Organizations (MCOs) manage services for people enrolled in Child Health Plan Plus (CHP+). Historically, children enrolled in CHP+ would start in the State Managed Care Network (SMCN), and then transition to their MCO. Pregnant people enrolled in CHP+ would remain in the SMCN for their entire time enrolled in CHP+. The SMCN was administered by Colorado Access. On July 1, 2021, the Department of Health Care Policy and Financing (HCPF) dissolved the SMCN and transitioned all CHP+ members to one of the five CHP+ MCOs based on their county of residence.
Who is impacted by this change and how do they know about it?
This transition impacts all members enrolled in the CHP+ SMCN, including pregnant people, kids, and people with presumptively eligible. Impacted members should have received communication from HCPF about this change and will receive an updated insurance card and onboarding materials from their new MCO.
Can my client still see their current physician?
MCOs contract with providers and have a network of providers that members can see. This means that a provider could have been “in-network” for the SMCN, but not “in-network” for a person’s new MCO. Patients are required to find a new provider that is “in-network” for their MCO. The only exception is pregnant people in their second or third trimester, who are allowed stay with their original provider.
Does this change any benefits my clients will receive?
No, members will receive the same benefits and cost-sharing requirements; however, they may need to switch to a provider within their new MCO’s network.
My client still has questions, who can they contact?
There are a few options:
- For questions about the SMCN transition: SMCN phone number – (800) 414 6198. This phone line will be open until January 2022.
- For benefits-related questions: MCO Customer Service lines
- For CHP+ enrollment questions: (800) 359 1991
- Health First Colorado Enrollment number: (303) 839 2120 or (888) 367 6557