What is O&E and Why is it Important?What is Health First Colorado, CHP+, and Connect for Health Colorado?
Welcome to the Colorado Covering Kids and Families (CKF) Outreach & Enrollment (O&E) Toolkit. CKF staff assembled the following resources to help O&E professionals begin or expand O&E efforts to individuals and families who may qualify for Health First Colorado (Colorado’s Medicaid Program), Child Health Plan Plus (CHP+), and financial assistance to purchase private health insurance through Connect for Health Colorado, Colorado’s health insurance marketplace.
The toolkit is organized in several sections. Click on the section heading to learn more about each topic.
This toolkit is updated regularly, so check back often! If you have comments, questions, or suggestions related to the toolkit, email Liz Tansey at firstname.lastname@example.org or click here to provide feedback using our short evaluation.
CKF would like to thank our funders, the Colorado Health Foundation, Caring for Colorado Foundation, and Rose Community Foundation, and toolkit contributors. Without your knowledge and input, this toolkit would not have been possible!
O&E includes activities to help Coloradans gain and keep health insurance coverage. This includes activities to identify individuals and families who may be eligible for Health First Colorado, CHP+, and private health insurance through Connect for Health Colorado and educate them about their options, screen for potential eligibility, and facilitate enrollment and reenrollment through application assistance. Outreach also includes helping Coloradans access health care services.
What is Health First Colorado, CHP+, and Connect for Health Colorado?
Health First Colorado is Colorado’s Medicaid program. It provides free or low cost public health insurance for Coloradans who qualify. Health First Colorado covers doctor visits, emergency care, preventive care such as screenings and immunizations, and other procedures and treatments. Health First Colorado does not have enrollment fees or monthly premiums but in some circumstances, co-pays may be required.
CHP+ is low cost public health insurance for Colorado children age 18 and under and pregnant women age 19 and over who earn too much to qualify for Health First Colorado, but not enough to afford private health insurance. CHP+ covers regular checkups, immunizations, prescriptions, hospital services, eye glasses, hearing aids, and dental care for children. To enroll children in CHP+ families must pay an enrollment fee. Monthly premium payments are not required but in most circumstances, small co-pays are required.
Connect for Health Colorado is Colorado’s health insurance marketplace. The marketplace opened in October 2013 to help individuals, families, and small employers across Colorado purchase health insurance and apply for federal financial assistance to reduce the cost of private insurance and cost sharing. Connect for Health Colorado is the only place where Coloradans can apply for advanced premium tax credits (APTC) and cost-sharing reductions (CSR) to help pay for private insurance coverage. For more information on Connect for Health Colorado, click here.
If your organization has not provided O&E services to your community before, one of the first steps is to ensure you have funding to support your efforts. Several local foundations focus on the health of Coloradans.
The Colorado Health Foundation’s goal is to make Colorado the healthiest state in the nation. The Foundation plans to achieve this by funding organizations focused on healthy living, health coverage, and health care. The health coverage focus is to ensure all Coloradans achieve stable, affordable, and adequate health care. Learn more about the Foundation’s funding opportunities and how to apply here.
The Caring for Colorado Foundation’s mission is to promote health and improve health care for the people of Colorado in order to make Colorado the healthiest state in the nation. They plan to achieve this by funding organizations focused on building health care capacity, linking people to care, strengthening health systems, promoting prevention, and other long term special initiatives. To learn more about how to apply, click here.
The Rose Community Foundation’s mission is to make the Greater Denver community a better place for all people. The Rose Community Foundation’s program areas are aging, child and family development, education, health, and Jewish life. Learn more about submitting a proposal here.
The Denver Foundation’s mission is to inspire people and mobilize resources to strengthen the community. Learn more about the Denver Foundation’s community grants here.
The Grantsmanship Center based out of California offers in person training across the U.S. on a variety of topics such as “Competing for Federal Grants,” “Grant Management Essentials,” and “Essential Grant Skills.” On the resources page are a variety of resources, such as Funding Sources by State, publications, a blog, webcasts, podcasts, and an e-publication. Finally, they have a Frequently Asked Questions page that answers questions like in an “application introduction, what should be included?”
JVA Consulting offers trainings and short presentations on particular grant-related topics. They also have a blog and an e-digest that includes information about their trainings, as well as potential grant opportunities. Lastly, they offer consulting services and can be hired to help with fund development, grant writing, or similar services.
Charity How To offers services and resources beyond grant writing, including webinars related to growing funding for nonprofits. Some webinars are free and some have a fee to attend.
Community Resource Center is similar to Charity How To; the Community Resource Center is focused on more than just grant-related resources. They offer a variety of courses and trainings.
How Do I Know if My Community Needs O&E Support
In addition to the U.S. census’ American Community Survey of health insurance, the Colorado Health Institute collects data to inform the Colorado Health Access Survey (CHAS). The CHAS is completed every two years and includes information about health insurance coverage, access to health care, and health care utilization in Colorado. The most recent survey was completed between April and July 2013, with the report released in December 2013.
Getting Trained and Certified to Help Coloradans
The Colorado Department of Health Care Policy and Financing (HCPF) oversees Health First Colorado and CHP+. Connect for Health Colorado is Colorado’s state-based health insurance marketplace, which allows Coloradans to apply for and receive financial assistance to purchase private health insurance. HCPF and Connect for Health Colorado offer certification training for organizations interested in assisting community members in completing applications for Medicaid, CHP+, and private health insurance through Connect for Health Colorado:
To understand more about getting trained and certified, click here for CKF’s fact sheet, Roles in Outreach and Enrollment.
Certified Application Assistance Site
A Certified Application Assistance Site (CAAS) assists individuals and families in completing applications for Colorado Medicaid and CHP+, and are certified to verify citizenship and identity documentation on behalf of HCPF.
To become certified, organizations must submit a CAAS application for each location to email@example.com. Approved organizations will receive a letter of approval, certification number, and training materials within seven days of application.
Presumptive Eligibility Site
Presumptive Eligibility (PE) is a Colorado Medicaid and CHP+ program that provides temporary medical coverage to eligible children under the age of 19 and pregnant women. PE allows eligible children and pregnant women receive access to immediate medical care through Colorado Medicaid or CHP+ while full eligibility is being determined.
Organizations that wish to become a PE site must first receive certification as a CAAS. CAAS interested in becoming a PE site can contact the PE site administrator to apply.
Medical Assistance Site
Medical Assistance (MA) sites are designated by HCPF to accept and process Colorado Medicaid, CHP+, and Connect for Health Colorado applications using the Colorado Benefits Management System (CBMS). CBMS is the system used to determine eligibility for public assistance in Colorado, including Colorado Medicaid, CHP+, and subsidized private insurance through Connect for Health Colorado.
To become a MA site, organizations must submit a letter of intent to HCPF, including why the organization is interested in becoming an MA site, what population and/or communities will benefit from the organization becoming an MA site, if the organization is currently functioning as an active CAAS, PE site, and/or medical assistance provider, the anticipated staffing levels and location(s) if the organization becomes an MA site, and how the organization going to fund the functions of an MA site.
Certified Application Counselor Site
Certified Application Counselor (CAC) sites provide in-person assistance to Coloradans applying for health coverage, including financial assistance and health insurance through the marketplace.
To become certified, organizations must complete and submit a designated organization application, including all backup documentation, during an announced open application period. Applications are only accepted from organizations, not individuals. Funding is not available to CAC sites. Approved organizations will receive a letter of approval and information about mandatory training within 10 days of submitting a complete application.
Health Coverage Guide Assistance Site
Health Coverage Guides (HCGs) work in organizations that have received Assistance Site funding to provide in-person assistance to individuals and small businesses shopping for private health insurance through Connect for Health Colorado. HCGs serve local communities by helping individuals, families, and small employers evaluate health plan options, apply for financial assistance, and enroll in health insurance through the marketplace. Assistance Site organizations are responsible for engaging in outreach and education about federal tax assistance and qualified health plans available through Connect for Health Colorado. They also serve as a community-based location for people to receive one-on-one assistance with the application process, distinguishing between health plan choices, and enrollment.
Other Training Resources
In addition to being trained and certified through HCPF or Connect for Health Colorado, the following resources are designed to help understand enrollment in Colorado:
TrainColorado.com is managed by the Health Care and Economic Security Staff Development Center (SDC). The SDC is made up of staff from HCPF, the Colorado Department of Human Services, and the Governor’s Office of Information Technology to train the 64 county departments of social/human services, as well as MA, PE, and CAAS sites, on Colorado Medicaid and CHP+ eligibility. The SDC’s Documents and Resources library provides information about Colorado Medicaid and CHP+ eligibility in Colorado.
Colorado.gov/health is a website with information from HCPF, Connect for Health Colorado, and the Colorado Division of Insurance. It covers a broad spectrum of topics related to the Colorado.gov/health is a website with information from HCPF, Connect for Health Colorado, and the Affordable Care Act (ACA) and health care programs in Colorado.
The PEAK Outreach Team is the public face of the Colorado Program Eligibility and Application Kit (PEAK) and creates outreach materials, develops training for community partners, and produces resources to help community partners and counties assist applicants. The PEAK Outreach Team offers in-person training, live webinars, and pre-recorded webinars. To learn more about PEAK and access the PEAK Outreach training calendar and webinar recordings, visit the PEAK Outreach website here.
Basic Steps to Enrollment in Medicaid, CHP+, and Connect for Health ColoradoApplication AssistanceOther Resources for Families
Basic Steps to Enrollment in Colorado Medicaid, CHP+, and Connect for Health Colorado
The steps an individual or family must take to apply for and enroll in Colorado Medicaid, CHP+, or private plans through Connect for Health Colorado can be complicated.
Outreach and Enrollment (O&E) professionals and application assistors help families navigate each step to ease the way through the process. Here are the basic steps to getting enrolled in Colorado Medicaid, CHP+, and Connect for Health Colorado:
- Apply for coverage: Coloradans interested in health coverage can apply online, in-person, by mail, or by phone.
- In-person application help is provided at local county health/human services office, Certified Application Assistance Sites (CAAS) and by Health Coverage Guides, Certified Application Counselors, and brokers.
- Online applications are provided on the PEAK and Connect for Health Colorado websites. Application information provided on either website is processed through a shared eligibility system that will first check the applicant’s eligibility for Medicaid or CHP+, and then for eligibility for Advanced Premium Tax Credits (APTCs) and Cost Sharing Reductions (CSR) to reduce costs for private insurance through Connect for Health Colorado.
- Paper applications are available here. The single purpose application (SPA) is the application is for health care coverage, food assistance, and cash programs. The SPA is available in English and in large print English.
- To apply by phone, call the Medicaid customer contact center (1-800-221-3943) or the Connect for Health Colorado call center (855-PLANS-4-YOU).
- Application is processed: How the application is processed depends on how the application was submitted. Many applications submitted online will be processed automatically, and applicants may receive an eligibility determination right away. If the electronic system is not able to make a determination right away, the application information will be sent to the local county health/human services office or a Medical Assistance site where the application will be processed by a case worker. Applications that are not submitted online will be processed at the local county health/human services office or a Medical Assistance site. Applications must be processed within 45 days by a case worker.
- Applicant(s) may be asked for additional information: While the application is being processed, an individual or family may be asked for additional information to verify their eligibility for Colorado Medicaid or CHP+. Typically the applicant has 10 days to provide additional information to the county case worker.
- Eligibility determination made: After the individual or family provides all of the necessary information, their eligibility for Medicaid, CHP+, APTCs, and CSRs is made, and they will receive a letter notifying them of their eligibility. If an applicant is approved for Medicaid they will receive their Medicaid card through the mail, or can print their card through PEAK. They can begin using their benefits immediately. If an applicant is approved for CHP+, they will need to pay the annual enrollment fee if applicable. If an applicant is eligible for APTCs or CSRs, the letter will list how much APTC and CSR the household is eligible for. After the applicant finds out they are eligible for APTCs or CSRs, they must shop for a private health plan on the Connect for Health Colorado website.
- Opportunity to Appeal: If the applicant believes that they are incorrectly denied or approved for Colorado Medicaid, CHP+, APTCs, or CSRs, they can appeal to HCPF or Connect for Health Colorado. Information about how to appeal is included in all approval or denial correspondence.
- Enroll in a health plan: Coloradans who are determined eligible for Colorado Medicaid and CHP+ can choose to enroll in a health plan. A health plan is a way for individuals to receive Colorado Medicaid and CHP+ benefits. There are different health plans available depending on Colorado Medicaid and CHP+ eligibility. Enrollment in a Colorado Medicaid health plan is managed by HealthColorado. Enrollment in a CHP+ health plan is managed by the state CHP+ enrollment vendor. If an individual or family is denied for Colorado Medicaid and CHP+, they can shop for a private health insurance plan through Connect for Health Colorado. Coloradans can search plans on the marketplace or receive assistance selecting a plan from a HCG, agent, or broker.
In-person application help is provided at local county health/human services office, Certified Application Assistance Sites (CAAS) and by Health Coverage Guides, Certified Application Counselors, and brokers.
Colorado Medicaid and CHP+ have year-round enrollment so eligible applicants can enroll at any time throughout the year. Purchasing private health insurance through Connect for Health Colorado follows the national open enrollment period to apply for health insurance. For 2016 coverage, the open enrollment period began on November 1, 2015, and ended on January 31, 2016.
Applicants can fill out the PEAK application themselves or you can help them apply using the PEAK online application. There are several resources available to help you learn about PEAK.
The PEAK Outreach Team is the public face of the Colorado Program Eligibility and Application Kit (PEAK) and creates outreach materials, develops training for community partners, and produces resources to help community partners and counties assist applicants. The PEAK Outreach Team offers in-person training, live webinars, and pre-recorded webinars. Click here to listen to their pre-recorded webinars, and here to see their training calendar.
To keep up-to-date with the latest PEAK information, you can sign up to receive PEAK’s monthly newsletter, PEAK View, here.
Other Resources for Families
Many individuals and families who qualify for Colorado Medicaid and CHP+ are eligible for other assistance programs. The following resources offer assistance, referrals, or information that may help your community members.
Federally qualified Community Health Centers (CHCs) provide primary and preventive care regardless of a patient’s ability to pay. CHCs offer a full range of medical care, including diagnosing and treating illness, routine check-ups, vaccinations and screening tests, and counseling to help patients maintain a healthy lifestyle. CHCs also offer dental care, mental health care, and other services. To find a CHC in Colorado, click here.
Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Assistance Program, provides food benefits to low-income households. Electronic Benefit Transfer or SNAP cards are issued and are used like cash at most grocery stores to buy food. Learn more about SNAP here. Individuals and families can apply for SNAP using PEAK.
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional education, breastfeeding support, healthy food, health referrals, and other services free of charge to Colorado families who qualify. Learn more about WIC here. Individuals can learn if they are eligible for WIC using PEAK.
Cash assistance, also called Colorado Works or Temporary Assistance to Needy Families (TANF) is a federal program that provides employment services and cash assistance to families who meet the eligibility criteria. Learn more about Colorado Works/TANF here. Individuals and families can apply for Colorado Works/TANF using PEAK.
Connect for Health Colorado sends periodic email updates related to changes in the marketplace. Sign up here.
The PEAK Outreach Team sends a monthly newsletter, PEAK View. PEAK View provides updates on PEAK features and system functionality and is designed to provide updates to community partners who assist clients with accessing benefits online through PEAK. To sign up, click here.
CKF Coalition and Work Groups
CKF supports a statewide coalition of O&E professionals, health care advocates, state policy makers, health care providers, and others interested in health care. Membership in the CKF coalition is not limited — all those with an interest in affordable health coverage for Coloradans are invited and encouraged to join.
To join the CKF coalition, sign up here. By signing up, you will receive monthly updates on Colorado Medicaid, CHP+, and Connect for Health Colorado policy and O&E, and are invited to attend quarterly coalition meetings.
The All Kids Covered (AKC) Initiative is a coalition of more than 40 organizations throughout Colorado that work to make it easier for eligible children to enroll in public health insurance programs, improve the quality of services received, and expand public programs to serve more kids. Along with the Colorado Children’s Campaign and Colorado Coalition for the Medically Underserved, CKF helps lead the initiative. AKC meetings occur the first Friday of every month and are open to any interested organizations. Meetings typically address high-level issues that affect kids’ ability to enroll and stay enrolled in health coverage. When needed, AKC also leads efforts to organize and encourage legislative changes. Click here for a comparison of AKC and CKF. Click here to learn more about AKC, and sign up to receive meeting notifications at the bottom of the AKC homepage.
Helping Immigrants Enroll
To qualify for health coverage through Health First Colorado (Colorado’s Medicaid Program), Child Health Plan Plus (CHP+), and Connect for Health Colorado, certain immigration and citizenship status criteria must be met.
While citizenship eligibility rules for Health First Colorado and CHP+ have not been changed by the Affordable Care Act (ACA), the ACA expands eligibility for marketplace coverage to additional categories of immigrants. This section of the O&E Toolkit provides an overview of immigration related resources and information.
Below is an brief overview of different immigration categories and their eligibility for health insurance affordability programs. For a more detailed list, see CKF’s Job Aid on Immigration Status Eligibility for Health Insurance Affordability Programs.
The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 established a category of “qualified immigrants” who may be eligible for Medicaid and the Children’s Health Insurance Program (CHIP, known as CHP+ in Colorado). Certain qualified immigrants, such as Lawful Permanent Residents (LPRs) are subject to a five year waiting period (also known as the five year bar) before they can become eligible for Medicaid and CHIP. However, in Colorado since July 2015, pregnant women, and children under the age of 19, are not subject to the five year bar for Health First Colorado and CHP+. In addition, some immigration statuses, including refugees and asylum grantees, are never subject to the five year bar regardless of age or pregnancy status.
Lawfully Present Immigrants
The ACA made it possible for lawfully present immigrants who may not be eligible for Medicaid or CHIP, to be eligible to purchase private health insurance with tax subsidies and cost sharing reductions in the health insurance marketplaces. For example, those who have been lawfully present in the U.S. for less than five years and who are not eligible for Health First Colorado or CHP+ can shop for private insurance and apply for Advanced Premium Tax Credits (APTCs) and Cost Sharing Reductions (CSRs) through Connect for Health Colorado.
Undocumented and Deferred Action Childhood Arrival (DACA) Grantees
Undocumented immigrants and DACA grantees are ineligible for most health insurance affordability programs. Other options for these individuals and families include:
- Community Health Centers (CHCs) where patients are seen regardless of their immigration status on a sliding-fee-scale. To find a CHC, click here.
- Purchasing health insurance outside of the marketplace, which may now be more accessible because of greater consumer protections such as guaranteed coverage regardless of pre-existing conditions.
- Kaiser Permanente’s Colorado Bridge charitable health coverage program, which does not include immigration status in its qualifications criteria. Visit findyourplan.org for more information.
- Emergency Medicaid, which covers life and limb threatening emergencies, including labor and delivery. For more information, contact your local county human services office or Medical Assistance Site.
Resources for Assisters
- Slides from Immigrant Eligibility Session at Building Better Health: Immigrant Eligibility – October 2016
- Connect for Health Colorado: Immigration Deep Dive – August 2014
- Connect for Health Colorado: Understanding the Needs of Refugees – August 2014
- Health Reform Beyond the Basics: Eligibility and Enrollment Process for Families that Include Immigrants – November 2014
These job aids can be used as reference guides when working with immigrant families:
- CKF: Immigration Status Eligibility for Health Insurance Affordability Programs – July 2016
- CKF: Images of Commonly Used Immigration Documents – January 2015
- National Immigration Law Center (NILC): Documents Typically Used by Lawfully Present Immigrants – October 2013
- PEAK: Entering LPR Information In PEAK – January 2015
- NILC: “Lawfully Present” Individuals Eligible Under the Affordable Care Act – July 2016
- NILC: Health Care Resources
- Health Reform Beyond the Basics: Key Facts You Need to Know About Immigrant Eligibility for Health Insurance Affordability Programs – December 2015
- Health Reform Beyond the Basics: Key Facts: Helping Families That Include Immigrants Apply for Health Coverage – January 2016
- Kaiser Family Foundation Report: Key Facts on Health Coverage for Low-Income Immigrants Today Under the Affordable Care Act – March 2013
Resources for Clients
- CKF Infographic: Health Coverage for Immigrants in Colorado – August 2015
- Also available in:
- Colorado Consumer Health Initiative Fact Sheet: Affordable Health Insurance for Immigrant Families – September 2014
- Refugee Health Technical Assistance Center (RHTAC) Fact Sheet: Expanding Health Insurance Access, Benefits and Protections Download in English, Arabic, Burmese, or Nepali
- RHTAC Fact Sheet: Expanding Health Insurance Coverage for Refugee Children, Families and Young Adults
Download in English, Arabic, Burmese, or Nepali
Refugees and the ACA (RHTAC 2014)
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