Member FAQs

Your covered Health First Colorado (Colorado’s Medicaid Program) benefits and services are not changing. You can continue getting physical and behavioral health care. Your Health First Colorado eligibility has not changed.

RSV is a common, highly contagious infection. Most of the time, it will cause a mild, cold-like illness. Sometimes it will cause respiratory issues for your baby, including severe lung infections. Babies’ immune systems are still developing, so they may get infections more easily.

A medication called Beyfortus can help protect babies against serious lung infections from RSV and other types of infections. Beyfortus is an RSV vaccine that can boost your baby’s immune system to help them fight RSV. It is typically given as a shot in your baby’s thigh. Beyfortus is approved by the Food and Drug Administration (FDA). It is also recommended by the American Academy of Pediatrics (AAP).

Talk to your doctor about getting Beyfortus to help protect your baby from RSV. If you don’t have a doctor, we can help you find one. Call us at 800-511-5010. TTY users should call 888-803-4494. Click here to find a doctor online.

We issue ID cards for members enrolled in the CHP+ State Managed Care Network and the CHP+ offered by Colorado Access programs. Health First Colorado issues cards for members enrolled in Health First Colorado (Colorado’s Medicaid program).

You may have to pay have a copay. This is what you pay when you get a covered health care service. The amount is based on the service.

If you have Health First Colorado, you may have a copay unless you are:

• Age 18 and younger.
• Age 18 to 25 and enrolled in former foster care.
• Pregnant
• Living in a nursing facility.
• Getting hospice care.
• An American Indian or Alaska Native.

Click here to learn more.

If you have CHP+, you may have a copay unless you are:

• Pregnant.
• Up to 12 months postpartum.
• An American Indian or Alaska Native.

Click here to learn more.

You don’t need a referral. Some services, however, may require a prior authorization. It’s always a good idea to discuss your physical and behavioral health needs with your PCP.

Some CHP+ offered by Colorado Access members pay a co-pay for prescription medications. If you have a copay, the amount will be listed on your CHP+ card. If you have a copay, you will need to pay it before you can pick up the medication. If you are filling more than one prescription, you will need to pay the copay amount for each medication. If the retail price of the medication is less than your copay price, you will pay the retail price.

We can help you find a psychologist. Please call us at 866-833-5717 or 800-511-5010, Monday through Friday from 8:00 a.m. to 5:00 p.m. You can also find a psychologist online.

Please call our Customer Service team at 800-511-5010, Monday through Friday from 8:00 a.m. to 5:00 p.m. We’re happy to help answer any questions you may have.

To make the change permanent in your file, please call the Colorado Medical Assistance Program at 800-359-1991. You can also log into your Colorado PEAK account to change your address.

We can help you change your primary care provider. We are happy to help you find one that works better for your needs. Please call us Monday through Friday from 8 a.m. to 5 p.m. To change your PCP, call Health First Colorado Enrollment at 303-839-2120 to let them know the name of your new PCP.

If your family qualifies for CHP+, here is how you can apply.

• Apply online: Visit colorado.gov/PEAK. Click on the blue box titles “Apply for Benefits.” This may take 30 to 60 minutes.
• Apply by phone: Call 800-221-3943 or use State Relay 711. Call Monday through Friday from 8:00 a.m. to 4:00 p.m.
• Apply by mail: Download and print a paper application here.
• Apply in person: Visit your local county office. Or a local application assistance site.

When you apply, be sure to include all required documents. Click here to see what’s required.

You’ll get auto-assigned to an HMO. This is based on where you live. If you don’t get assigned to us and you want to be on our plan, you may change your health plan. You have to change your health plan within 90 days after you are first approved for CHP+. Call 888-367-6557 to change your health plan.

After you apply, you may check the status of your application online. If you applied by mail, in person or over the phone, you can still create a Colorado PEAK account to find out the status of your application online. Note: It may take 45 days from the date your application was received for a case number to be assigned. You need this number to check your status and benefits online.

Please call us at 866-833-5717. Monday through Friday from 8:00 a.m. to 5:00 p.m. We’re can connect you to one of our care coordinators.

We’re happy to help you find a provider who accepts Medicaid. You can search for a provider online using our provider search. You can also call us and we’ll help you find a primary care medical provider or a specialist. Please call us Monday through Friday from 8 a.m. to 5 p.m.

We’re happy to help you find a provider who accepts Health First Colorado (Medicaid) or Child Health Plan Plus (CHP+). You can search for a provider online using our provider search. You can also call us and we’ll help you find a primary care medical provider or a specialist. Please call us at 800-511-5010, Monday through Friday from 8:00 a.m. to 5:00 p.m.

If your family earns under the monthly maximum income guidelines, you might qualify for CHP+. Visit Colorado PEAK to find out if you qualify. If you would like help finding out if you and your family qualify, you may call us. We have a team who can help.

If you meet the financial requirements for CHP+ but your child has a significant illness or disability, they may qualify for Health First Colorado (Colorado’s Medicaid Program). Click here to learn more.

You can find information about services that require prior authorization in your member handbook. If you have:

• CHP+ through the State Managed Care Network, visit CHP+ State Managed Care Network Members Benefits Handbook or you may call us Monday through Friday from 8 a.m. to 5 p.m.
• CHP+ offered by Colorado Access, visit Colorado Access CHP+ HMO Members Benefits Handbook or you may call us Monday through Friday from 8 a.m. to 5 p.m.

Some health services require prior authorization. You can find information about services that require prior authorization on the Health First Colorado (Colorado’s Medicaid Program) website.  You can also call us Monday through Friday from 8 a.m. to 5 p.m.

If you need help with your daily activities because of a disability or a chronic illness, you may benefit from long-term services and supports. You may call us to apply.

Your copays will be listed on the CHP+ member ID card. You can find copay information in the member handbooks. If you have:

• CHP+ through the State Managed Care Network, you can read about the copays for various services in your Members Benefits Handbook.
• CHP+ offered by Colorado Access, you can read about the copays in your Members Benefits Handbook .

You may also call us during normal business hours, from 8 a.m. to 5 p.m. Monday through Friday.

You can find information about copay fees on the Health First Colorado (Colorado’s Medicaid Program) website. You can also call us Monday through Friday from 8 a.m. to 5 p.m.

Long Term Services and Supports is paid for through private funds, long-term care insurance, or Medicaid. To qualify for Medicaid Long Term Services and Supports, you must have:

• Financial need. You must have limited income. You should apply at the Department of Human Services in the county where you live to determine qualifying income levels.
• Physical need. You must need help with daily tasks like bathing, dressing or eating. You should apply at the Single Entry Point agency in the county where you live.

We understand it’s not always easy to find a ride to your appointment with your doctor. Please call us Monday through Friday from 8 a.m. to 5 p.m. We’re happy to provide information on resources.

If your child is on CHP+ offered by Colorado Access, you should receive ID cards within 30 days of enrollment. If you haven’t, please call us Monday through Friday from 8 a.m. to 5 p.m.

If you or your child has Health First Colorado (Colorado’s Medicaid Program), you may request an ID card through your Colorado Peak account or by contacting Health First Colorado at 800-221-3943.

If you qualify for the Long Term Services and Support program and live in Adams, Arapahoe, Denver, Douglas or Elbert counties, we are your designated Single Entry Point (SEP) agency. We help people find their way through the long-term services system. This system is made up of organizations that help individuals with daily activities like eating, bathing, cooking, dressing and other routine tasks. They can be arranged at home, in an assisted living facility, or in a nursing facility. We are Colorado’s largest Single Entry Point agency for people who need long-term assistance through Medicaid. The services are available on a self-pay, insurance reimbursement, low-cost or Medicaid basis. If you qualify depends on your individual situation, but in any case we can help. Call us if you have questions.

We’d be happy to help you figure out if you need to pay the bill you received. Please call us Monday through Friday from 8 a.m. to 5 p.m. if you have billing questions.

Your enrollment into a regional organization is based on the location of your primary care provider (PCP). You should have received a letter from Health First Colorado to let you know about the enrollment into a regional organization. Your regional organization can help you coordinate both your physical and behavioral health care needs.

If you live in the northeast part of Colorado, you may call Northeast Health Partners at 800-804-5040 for help with your care beginning July 1.

If you are a CHP+ member, you may change your health plan within 90 days after you are first approved for CHP+. After the first 90 days, you are locked in for the year. You can change your health plan each year within the 90 days after you again qualify for CHP+. You may call 888-367-6557 to change your plan.

We understand this can be frustrating. Please call us Monday through Friday from 8 a.m. to 5 p.m. We’re happy to research and provide information.

Pre-HMO

If you paid for a prescription while you had CHP+, but before you enrolled in your health plan, you may ask for a refund.

Talk to the pharmacy where you got the prescription. Give them your receipt, state ID number, BIN (018902), and PCN (P303018902). If you don’t know your state ID number or if you need help, call the pharmacy liaison. Call them at 303-866-3588.

You have 120 days from the date the prescription was filled to ask the pharmacy for a refund. Refunds are not promised.

HMO

There may be times when you do not have your ID card at a pharmacy and you are charged for the full cost of a prescription medication. You may ask us to refund the cost of the prescription medication if you went to a pharmacy that is in our network and if you did not use another form of insurance or a discount card to pay.

If you pay the full cost for a covered prescription medication, please:

• Ask for an itemized receipt. This will show that you paid for the medication.
• Mail the itemized receipt, your name and address, and this this form to:

Colorado Access
Reimbursements
P.O. Box 17950
Denver, CO 80217-0950

We will look at what you send to us. We may ask for more details if we need them. This could be if the medication that you paid for is not on the formulary. Or if it needs preauthorization. This is also called preapproval.

This request must be done within 120 days from when you paid for the medication. If we need more details, we will ask the doctor who prescribed the medication. If your request is approved, you will be reimbursed. The amount will be based on the cost of the covered medication, minus any applicable copay.

Attribution is the method used to link Health First Colorado members to their medical home, or PCP.

Members of Health First Colorado do not have to do anything to enroll in a regional organization. Your enrollment is automatic, and it is primarily based on where you see your primary care provider (PCP).

A primary care provider (PCP) is your main contact and source of support for your health care. This is also called your medical home. You’ll get most of your medical services, health screenings, immunizations and education about health conditions at your medical home.

A regional organization is a managed care plan. Colorado Access is a regional organization. Your managed care plan can help you with your Health First Colorado physical and behavioral health needs. The benefit to you is you won’t have to work with two separate groups anymore to get help with your physical and behavioral health care.

Long Term Services and Supports is a Colorado network of organizations that helps people of any age who have a chronic illness or are limited and cannot care for themselves for long periods of time. These services can be both medical and non-medical. They can be provided at home, in the community, in an assisted living facility or in a nursing care facility. We are Colorado’s largest Single Entry Point (SEP) agency for people who need long-term assistance through Medicaid.

Synagis is a prescription shot of antibodies. It is given monthly to help protect high-risk infants from respiratory syncytial virus (RSV). Synagis is approved by the U.S. Food and Drug Administration (FDA).

The RSV season is from October 2022 to April 2023. You can get Synagis with CHP+. A home health agency can give it to you at home. If you have questions about this, talk to your doctor. They can find a Synagis form here.

The Accountable Care Collaborative (ACC) is Health First Colorado’s primary health care program. It is designed to improve your health and help you get the services you need to stay healthy. As an ACC member, you get the regular Health First Colorado benefit package and choose a primary care medical provider.

You have a right to complain (also called a grievance) or file an appeal. You cannot lose your benefits for doing either. For detailed information about the complaint and appeal process, please visit this page.

Colorado Access is a separate entity contracted by the state to administer different health plans and benefits. We administer:

• Health First Colorado (Colorado’s Medicaid Program) (including both physical and behavioral benefits)
• CHP+ State Managed Care Network program
• CHP+ offered by Colorado Access program (we are one of six health plans who offer an HMO plan)

The CHP+ State Managed Care Network is a plan members are placed on for:

• The pre HMO period: This is the span of time from a member’s original enrollment until the member is enrolled in a CHP+ participating HMO.
• Prenatal plan: This is the plan for pregnant women (Colorado residents) age 19 and older that covers all pregnancy care, including labor and delivery and visits after you deliver.
• Presumptive eligibility: The Presumptive Eligibility program gives children under 19 and pregnant women temporary Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus (CHP+) medical coverage right away. Temporary medical coverage lasts for at least 45 days while your medical assistance application is processed.

Children placed on the CHP+ State Managed Care Network program generally are on it for 30-60 days. Then you can choose an HMO. Colorado Access is one of six HMOs in the state. Your options depend on where you live. To choose an HMO, contact Health First Colorado Enrollment at 800-259-1991.

The goal of the ACC 2.0 is to combine physical health and behavioral health into one entity. This way the same regional health organization will manage both your physical health and behavioral health benefits. This will strengthen coordination of services and improve health outcomes for members.

A care coordinator can assist you in coordinating physical and behavioral health services, and other related services, such as transportation for medical appointments. Call us and we can tell you more.

Learn more about your vision benefits on the Health First Colorado website. You can also call us at 866-633-5717 to learn more.

CHP+ covers a 30-day supply of a prescription medication and a 90-day supply of approved maintenance medication from an in-network pharmacy. For a list of medications covered by CHP+, please refer to the formulary list. CHP+ also covers over 200 over-the-counter medications, like Tylenol and vitamins, with a prescription from your doctor. For certain prescription medications, we might ask your doctor to send additional information to determine medical necessity.

Your ID number is located on the member ID card mailed out to the address on file. If you’re having trouble finding it or have any more questions, please call us.

As a CHP+ offered by Colorado Access member, you have prescription medication benefits. To get a prescription medication, go to an in-network retail pharmacy. Give the prescription from your provider and your CHP+ ID card to the pharmacist. Remember, your provider needs to be in-network for the prescription to be covered. If you need help finding a pharmacy, feel free to call us.

We do not determine who qualifies. Health First Colorado (Colorado’s Medicaid Program) determines what program your child is on. If you have questions about if you qualify, please contact the Colorado Medical Assistance Program at 800-359-1991.

If you have CHP+, you can find the primary care provider on the ID card. If the provider listed on your child’s ID card is incorrect or if you’ve lost or misplaced your ID card, please call us Monday through Friday from 8 a.m. to 5 p.m so we can help you change to the PCP of your choice within the network.

If your child has Health First Colorado (Colorado’s Medicaid Program), you can call us Monday through Friday from 8 a.m. to 5 p.m. to find out your child’s primary care provider.

We understand this situation might be frustrating to you. Unfortunately, we do not determine eligibility. Health First Colorado (Colorado’s Medicaid Program) determines your child’s coverage. For CHP+ inquiries, please contact the Colorado Medical Assistance Program at 800-359-1991. If you have Health First Colorado (Colorado’s Medicaid Program), please contact Health First Colorado at 800-221-3943, or your county’s human services office.

We understand your frustration. Unfortunately, we do not determine who qualifies for benefits. If you have Health First Colorado (Colorado’s Medicaid Program), please contact Health First Colorado at 800-221-3943 or your county’s human services office. If you’re a CHP+ member, please contact the Colorado Medical Assistance Program at 800-359-1991.