Medicaid

What is Medicaid?
Medicaid comprises a group of programs that provide health insurance to Colorado residents who meet the income and resource criteria for eligibility. Medicaid provides coverage for among others, physician services, prescription drugs (not covered by Medicare Part D), inpatient/outpatient hospitalization, durable medical equipment, laboratory and x-ray serves, medical supplies, medical transportation, podiatry, hospice, immunization and home health care.

How is Medicaid different than Medicare?
Medicaid goes to persons of all ages who meet low income and other guidelines. It provides a broader range of services than Medicare.

Medicare covers most people over age 65, regardless of income. The primary benefits are doctors’ office visits and hospitalization. Home health and nursing home coverage are extremely limited.

Who Qualifies for Medicaid?
Recipients of Supplemental Security Income (SSI), and Temporary Assistance to Needy Families (TANF), automatically receive Medicaid. Childless adults between 19 and 64 can receive Medicaid if they have income of less than 133% of the Federal Poverty Level. After age 65, most individuals will be eligible for Medicare as their primary insurance. Individuals who have not worked enough under Social Security to receive Medicare Part A can apply for the Medicare Savings Program, and have the state pay the monthly premiums for both Medicare Parts A and B.

For 2015 the established income per month and total resource criteria are:

Program Single Income/Resource Limits*** Married Income/Resource Limits***
Supplemental Security Income (SSI) $733 / $2000 $1,466 / $3000
Old Age Pension (OAP) $771 / $2000 $1,542 / $3000
Qualified Medicare Benefit (QMB) $1,001 / $8,780 $1,348 / $13,930
Special Low Income Medicare Benefit (SLIM-B) $1,197 / $8,780 $1,613 / $13,930
Medicare Qualifying Individual 1 (QI-1) $1,345 / $8,780 $1,813 / $13,930
Home and Community Based Services (HCBS) $2,199* / $2000 $3,000** if both spouses apply / $115,920 if one spouse stays in the community
Nursing Home $2,199* / $2000 $3,000** if both spouses apply / $115,920 if one spouse stays in the community
Program for All-Inclusive Care for the Elderly (PACE) $2,199* / $2000 $3,000** if both spouses apply / $115,920 if one spouse stays in the community

* Individuals can apply for a Medicaid Qualifying Trust if income is more than this amount.

** Couples applying together and living in the same room in the long-term care facility can have resources of up to $4,000.

*** Exempt resources include the following:

  • The home (first $525,000 of assessed value)
  • Term life insurance policy
  • Irrevocable burial policy (any value)
  • One automobile
  • Any property that is owned in joint tenancy (although transfer with fair consideration rules may apply depending on when title was taken in joint tenancy)

Applying for Medicaid
Individuals who are not currently receiving Medicaid may apply. They will need to meet the financial qualifications to be eligible for Medicaid. To apply, complete the financial application and submit to the county department of human services . To determine if an individual is functionally eligible to receive HCBS including consumer directed attendant support services (CDASS), nursing home care, or PACE, the Single Entry Point case manager will conduct an interview using the ULTC 100.2 and other associated forms .

You will need to attach the following documents to the Medicaid application:

  • Proof of age (such as birth certificate or baptismal certificate
  • Proof of US Citicenship (such as birth certificate, citizenship records or Social Security card
  • Proof of Colorado Residency (such as self-written statement testifying that you are a resident of Colorado or photo ID with you address or a copy of your telephone bill
  • Proof of income and spouse’s income (if appropriate) including two payroll stubs (if appropriate; verification of Social Security, pensions, or Supplemental Security Income; proof of other income such as interst
  • Proof of Resources including bank statements, registration papers for motor vehicles, deeds and mortgages for real property including the house, life insurance policies, and burial funds or policies

For Medicaid applications, assistance in filing applications or counseling on Medicaid benefits, call 303-333-3482.

Click here for Medicaid rules.

For more information on specific Medicaid programs, please select one of the pages below.

Behavioral Health Organizations

Colorado Medicaid provides mental health services to recipients through a sub-contracted, capitated managed care program. There are five subcontractors who administer these services, who are known as Behavioral Health Organizations (BHO). Each BHO is responsible for managing the delivery of mental health services to Medicaid-eligible individuals in its’ assigned geographic services area. BHO’s must directly provide or arrange for the ...

Consumer Directed Attendant Support Services (CDASS)

Medicaid offers a program called Consumer Directed Attendant Support Services (CDASS) that allows individuals to have an extremely high level of control over their Medicaid funded home health services. CDASS is open to individuals who are eligible for Home and Community Based Services (HCBS). What this means is individuals who receive CDASS will be assigned an individualized monthly allocation of ...

Estate Recovery Act

Medicaid is required by federal law to engage in an estate recovery program to recoup the costs of providing medical coverage to individuals who are 55 or older, own property and receive Medicaid. Colorado has exempted estates where there is a surviving spouse or a child under 21 or a blind or disabled dependent. In addition, the home may be ...

Medicaid Home Health

Any person receiving Medicaid can receive home health care services, provided the individual meets the eligibility requirements. To receive home health services, the individual must need medically necessary services (as defined by a physician) for the treatment of an illness, injury or disability (including mental disorders); the amount, duration and frequency of service must be reasonable; the services must be ...

Home and Community Based Services (HCBS)

Home and Community Based Services (HCBS) is the umbrella under which Medicaid pays for medical care and services for those who are not eligible for straight Medicaid, but are unable to afford the needed services. When HCBS is referenced in context to seniors, usually it means the Elderly, Blind and Disabled (EBD) program, though HCBS programs exist for children, the ...

Managed Care Program and Primary Care Physician Program

Individuals who are receiving Medicaid may enroll in a Medicaid Managed Care Organization or the Primary Care Physician Program. Individuals who receive both Medicare and Medicaid are not required to enroll in a Medicaid Managed Care program. 1. Medicaid Managed Care Organization (MCO). Colorado offers individuals who are on Medicaid, the option to enroll in a Medicaid Managed Care Organization. ...

Options for Long Term Care (OLTC or Single Entry Point)

Medicaid’s Options for Long Term Care agencies (also known as Single Entry Points) are the administrative agencies responsible for approving functional requests for long term care, including nursing home placement, Home and Community Based Services, Home Care Allowance, Adult Foster Care, assisted living placement and Consumer Directed Attendant Support Services. There are 23 such agencies in Colorado, each responsible for ...

Pre-Admission Screening and Resident Review (PASRR)

When Medicaid recipients enter a nursing home, the Pre-Admission Screening and Review (PASRR, pronounced pay-sar) assessment is done to determine whether they have been appropriately placed for care. It is often done in conjunction with the ULTC 100.2 and other associated forms for long term care planning by the Options for Long Term Care agency. Most individuals will only undergo ...

Preferred Drug List

All Medicaid beneficiaries are eligible for prescription drug coverage. Colorado has implemented a preferred drug list (PDL), a formulary that establishes what drugs are covered and for what purposes. Some drugs are excluded from the PDL or require prior authorization. These include agents for anorexia/weight gain, fertility, cosmetics or hair growth, symptomatic cough/cold relief, smoking cessation, prescription vitamins and minerals, ...

Program of All-inclusive Care for the Elderly (PACE)

The Program of All-inclusive Care for the Elderly (PACE) is a program designed to offer comprehensive health services and in-home care, including supportive services to help individuals maintain independence in the community for as long as possible. It is only open to dual eligible individuals, receiving both Medicare and Medicaid who are over age 55 (including those disabled Medicare beneficiaries ...

Medicaid Qualifying Trust

An Income or Medicaid Qualifying Trust provides a means for individuals with monthly income greater than $2130 in 2013 to receive Medicaid assistance with the cost of nursing home care or home care. To qualify, the individual must have resources of less than $2000 (couples $3000) and income less than $5991 per month (this number may be slightly flexible based ...

Spousal Protection

Spousal protection is a program designed to allow a married individual to receive long term care from Medicaid (in PACE, CDASS, HCBS or a nursing home), without requiring the spouse to divest of all income and resources for ongoing living expenses. To get Medicaid services for long term care, an individual must have income less than 300% of the federal ...

Transfers Without Fair Consideration

In order to keep individuals who cannot afford care but are not eligible for Medicaid from simply giving away their resources to become eligible, Medicaid has implemented the Transfers Without Fair Consideration rules. The “Look Back Period” In layman’s terms, if an individual gives away an asset, sells it for below market value or does not access an available resource, ...

Medicare Savings Programs

The Medicare Savings Programs consist of of three programs that will at a minimum pay the monthly Medicare Part B premium for eligible seniors; it will also pay the higher premium for other reasons such as late enrollment. For those with lower incomes, coverage may also include Medicare Part A and B deductibles, co-payments and co-insurance. Individuals are also automatically ...