Individuals who are receiving Health First Colorado (Medicaid) may enroll in Health First Colorado Basic (“regular” Medicaid), a Managed Care Organization (MCO) or an Accountable Care Collaborative (ACC).
1. Health First Colorado Managed Care Organization (MCO).
Colorado offers individuals who are on Health First Colorado, the option to enroll in a Managed Care Organization. Individuals are required to use a network of physicians, clinics, and other health care providers that offer routine and preventive care, as well as acute care when the individual is sick or injured. If the individual needs a specialist, the MCO will refer the individual to providers in the network. If the individual needs home care or nursing home care, the individual will use the same procedure as for “regular” Health First Colorado. Individuals who need mental health services must use the designated Behavioral Health Organization that serves the county in which they are residing.
Individuals who are newly eligible for Health First Colorado may voluntarily enroll within 30 days. The minimum enrollment is 12 months, unless there is good reason for disenrollment. If this is the first time the individual has enrolled in the managed care program, the individual may disenroll within 90 days. To disenroll, call 303-839-2120 or 1-888-367-6577.
Individuals may not be required to make a co-payment for services.
The only MCO currently offering coverage in Colorado as of 2017 is Denver Health’s Medicaid Choice Program for residents of the Denver Metro Area.
2. Accountable Care Collaboratives
The Accountable Care Collaborative model is available to Health First Colorado recipients who want to choose their own primary care medicare provider physician (PCMP). Individuals can change PCMPs once a year and during open enrollment. Individuals are entitled to a second opinion.
Eligible persons must live in the service area. Individuals may pay a lower co-payment if they are in the ACC program. In this model, individual PCMPs are members of a Regional Care Collaborative Organization (RCCO) which will provide referral care including specialists, rehabilitative services, care management and coordination between providers.
Individuals who are high utilizers of this program may be monitored. Counseling and assistance are offered to ensure that the most appropriate care is provided.
3. Health First Colorado Basic
Health First Colorado Basic (“regular Medicaid”) allows the individual to go to any provider that accepts Health First Colorado for acute care, preventive care, and specialist care. The State of Colorado maintains a list of physicians and clinics that accept Medicaid.
Individuals are required to pay a higher co-payment for services. Individuals who are in nursing homes do pay a co-payment; while assisted living residents must make co-payments.
For questions about these programs should call 303-839-2120 or 1-888-357-6557.