Healthy Communities is the case management program for children, youth under age 21, and pregnant women enrolled in Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+). Our goal is to improve child health by helping families make the most of their medical benefits and ensuring they get the services they need.
Call Boulder County Healthy Communities’ Family Health Coordinators for help with:
Choosing a doctor, finding specialists, and scheduling appointments
Learning about Medicaid and CHP+ benefits
Finding other community resources that you may needEmail: HealthyCommunities@bouldercounty.org
Phone: 303-678-6141 or 303-413-7518
Health First Colorado (Colorado’s Medicaid Program)
|Check-ups and doctor visits||Home health care services||Occupational therapy|
|Dental care||Hospice services||Physical therapy|
|Dialysis||Hospital inpatient/outpatient services||Prenatal and maternity care|
|Expanded benefits for children (EPSDT)||Immunizations||Prescription drugs|
|Emergency services||Laboratory and radiology||Smoking cessation|
|Eye exams/glasses (limited for adults)||Medical equipment and supplies||Speech therapy|
|Family planning services||Mental and behavioral health services||Substance abuse treatment|
|Hearing services||Nursing facilities||Transplants|
Need a Ride? Call 1-855-264-6368
Health First Colorado offers free transportation to non-emergency medical visits or services.
Need Medical Advice? Call 1-800-283-3221
The free nurse advice line is open 24 hours a day, 7 days a week to answer your medical questions.
|Children (ages 0-20)||Dental: Exams, cleanings, x-rays, sealants, space maintainers, fluoride treatments, fillings, crowns, root canals, gum and oral surgery; Braces may be covered in certain cases||Vision: Eye exams, glasses, and contact lenses|
|Adults (ages 21-64)||Dental: $1,000 limit per year; Basic preventative exams, x-rays, fillings, extractions, root canals, crowns, partial or complete dentures (not subject to the $1,000 per year limit)||Vision: Medically necessary eye exams; Glasses and contact lenses only following eye surgery (surgery may have been performed at any time during your life)|
What is Emergency Medicaid?
Emergency Medicaid is a Health First Colorado program that provides short-term coverage for immigrants without Legal Permanent Residency or Naturalization status. Emergency Medicaid only covers life or limb threatening situations (including labor and delivery), and does not cover doctor appointments or routine care. For more information, call the Medicaid Customer Contact Center at 1-800-221-3943.
Health First Colorado (Colorado’s Medicaid Program) is low or no cost health insurance. Your only out-of-pocket costs will be your co-payment and not all Health First Colorado members have them. Visit colorado.gov/hcpf for more information on costs. If you receive a bill for Health First Colorado covered services, call the Health First Colorado Customer Contact Center at 1-800-221-3943.
|Everyone (ages 0-64)||No monthly premiums or enrollment fees*|
|Children (ages 0-18) and Pregnant Women||No co-payments|
|Adults (ages 19-64)||Co-payments between $0 and $10|
*The Health First Colorado Buy-In Program for Children With Disabilities and the Health First Colorado Buy-In Program for Working Adults may require a monthly premium depending upon income. Visit colorado.gov/hcpf for more information.
Health First Colorado is the payer of last resort in most situations. This means Health First Colorado pays for services only after any other health insurance you may have pays first. If you have health insurance other than Health First Colorado, you should report that information. Report other health insurance at Colorado.gov/PEAK or call the Health First Colorado Customer Contact Center at 1-800-221-3943.
You may be interested in the Colorado Health Insurance Buy-In Program (HIBI) if you already have health insurance when you qualify for Health First Colorado. Health First Colorado members who qualify for HIBI get monthly payments for all or part of the cost of their commercial health insurance premium and in some cases are also reimbursed for deductibles, co-insurance, and co-payments. Visit mycohibi.com or call 1-855-692-6442 for more information.
Health First Colorado Health Plans
When you are on Health First Colorado you will get care either through Health First Colorado Basic or the Accountable Care Collaborative. Both offer the same basic benefits, but the choices of doctors and some services may be different. Call Health Colorado at 303-839-2120 for help picking the option that’s best for you.
Health First Colorado Basic
Go to any doctor, clinic, hospital, pharmacy, or other provider who accepts Health First Colorado.
Accountable Care Collaborative
You receive the same benefits as members in Health First Colorado Basic and belong to a Regional Care Collaborative Organization (RCCO). The RCCO for Boulder County residents is Colorado Community Health Alliance (CCHA). CCHA can help you fi nd a wide range of other services and supports. For more information, visit cchacares.com or call 303-256-1717.
Additional help finding health care providers for children and pregnant women can be found by calling Healthy Communities. Our bilingual Family Health Coordinators can be reached at 303-678-6141 or 303-413-7518 or email firstname.lastname@example.org.
Getting Care Away From Home
If you are temporarily in another state, but still a Colorado resident, Health First Colorado may pay for medical care in certain circumstances. If you have questions about getting care in another state, call the Health First Colorado Customer Contact Center at 1-800-221-3943.
Services May Need to Be Pre-Approved
Some services need to be approved by Health First Colorado before you receive them. Your doctor will submit a Prior Authorization Request (PAR) for you and Health First Colorado will decide if the service is medically necessary. You will get a letter that tells you if your request is approved or denied. You have 30 days to file an appeal if the request is denied.
Problems With Your Health Care
If you are having problems that cannot be resolved by talking with your doctor’s office, call the Health First Colorado Customer Contact Center at 1-800-221-3943 or the Ombudsman for Health First Colorado Managed Care at 303-830-3560.
The Ombudsman is independent from all of the Health First Colorado health plans and can help you:
- Solve problems with your Health First Colorado Managed Care health plan
- Solve problems with your Health First Colorado Behavioral Health Organization
- Solve problems with the quality of care you receive
- File a grievance or appeal
PEAKHealth is a mobile app that you can use to find a doctor, view your Health First Colorado card, report changes, pay premiums or enrollment fees, find out about your benefits, and get tips to stay healthy.
- Ask your current doctor if they accept Health First Colorado
- Use the PEAKHealth Mobile App
- Visit Colorado.gov/hcpf click on “Find Doctors ” or call the Health First Colorado Customer Contact Center at 1-800-221-3943
- Members of the Colorado Community Health Alliance call 303-256-1717 or visit CCHAcares.com and click on “Find a Great Doctor in Your Area”
- Follow the steps for finding a doctor
- Call DentaQuest at 1-855-225-1729 or visit DentaQuest.com
Child Health Plan Plus (CHP+)
For children ages 0-18 and pregnant women
|Behavioral Health||Family planning (birth control)||Mental health services|
|Case Management||Hearing services||Nursing facilities|
|Check-ups||Home health care services||Nutritional services (limited)|
|Chemotherapy and radiation||Hospice services||Occupational therapy|
|Dental services ($1,000 per year per child. No dental benefit for pregnant women)||Hospital inpatient and outpatient services||Physical therapy|
|Doctor visits||Immunizations (shots)||Prescription drugs|
|Dialysis (for patients with kidney disease)||Laboratory and radiology||Substance abuse treatment|
|Eye exams and glasses||Medical equipment and supplies||Urgent care|
CHP+ Dental Benefits
Delta Dental of Colorado provides dental benefits for children enrolled in CHP+. You do not need to do anything to enroll and you will get a separate card in the mail for your child’s dental benefits. If you have any questions about CHP+ dental benefits or to find a dentist call Delta Dental at 1-800-610-0201 or visit deltadentalco.com/CHP.aspx.
CHP+ is low or no cost health insurance. Depending upon your income and the number of children enrolled, you might owe an annual enrollment fee of up to $105. Enrollment fees are due 30 days from when your child qualifies. Pay enrollment fees online through your PEAK account. Visit Colorado.gov/PEAK, then “Manage My Account” or mail them to Department of Health Care Policy and Financing, PO Box 17549, Denver CO 80217.
There are no co-payments for well-child services. Pregnant women, children in families that include a pregnant woman, Native Americans and Alaskan Natives do not have enrollment fees or co-payments. Visit colorado.gov/hcpf/programs-children, then “Child Health Plan Plus (CHP+)” for more information.
The most you will pay for medical costs during a year is 5% of your income but it’s up to you to keep track! For more information, call CHP+ customer service at 1-800-359-1991.
CHP+ Health Plans
All children enrolled in CHP+ receive their care through a health plan known as a Health Maintenance Organization (HMO). Each health plan has its own network of doctors. All plans off er the same benefits although some offer additional benefits and services. The health plans serving Boulder County are Colorado Access and Kaiser Permanente. To compare health plans see the Child Health Plan Plus Comparison Chart at colorado.gov programs-children, then “Child Health Plan Plus (CHP+).”
Before your child’s health plan enrollment is in effect, your child will be in a pre-HMO period. During this time he or she can receive all CHP+ benefits through the State Managed Care Network (SMCN), except for dental services. Not all doctors participate in the SMCN, so be sure to ask before you get care. Pregnant women are not enrolled in a health plan and can only get services through the SMCN. You will receive an insurance card from the SMCN.
CHP+ Health Plan Contacts
|State Managed Care Network
Choosing a CHP+ Health Plan
Once your child is approved for CHP+, you’ll need to choose a health plan. Call Health Colorado at 303-839-2120 within 90 days of getting CHP+ to select your child’s health plan.
Some services need to be approved by your CHP+HMO before you receive them. This includes procedures, testing, durable medical equipment (examples include wheelchairs and hospital beds), home health services, home IV services, medications and hospital stays (except in an emergency). Your doctor will submit the request for you and your HMO will determine if the service is medically necessary.
Getting Care Away From Home
If you are temporarily away from home, CHP+ may cover the costs of your care in an urgent or emergency situation at an out-of-network provider. Have the hospital or urgent care center send the bill to your HMO. If the provider will accept payment from your HMO, you will be responsible for the co-payment. For more information, contact your HMO.
Finding Health Care Providers
Each CHP+ health plan has its own network of doctors and dentists that your child can see. Make sure that any doctor or dentist you see is in your plan’s network.
- Ask your current provider if they accept CHP+
- Visit your health plan’s website to search for local providers
- Call your Healthy Communities Family Health Coordinator for help at 303-678-6141 or 303-413-7518
Health First Colorado provides a comprehensive set of benefits and services for children through the Early and Periodic Screening, Diagnostic and Treatment program (EPSDT) that are different from those offered to adults. All medically necessary services must be covered, even if they’re not covered for adults ages 21 and older. Sometimes these services may require a prior authorization.
Early and Periodic Screening, Diagnostic (EPSDT): What the Terms Mean
|Early||Identifying problems early, starting at birth|
|Periodic||Checking children’s health at periodic, age-appropriate intervals|
|Screening||Doing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems|
|Diagnostic||Performing diagnostic tests to follow up a risk is identified|
|Treatment||Treating the problems found|
How Often Do Kids Need Check-ups?
A well-child check-up includes a health and developmental history, an unclothed physical exam, appropriate immunizations, laboratory tests, and health education.
|Under Age 1||7 per year|
|1 – 2 years||3 per year|
|2 – 3 years||3 per year|
|3 to 21 years||1 per year|