In January 2020, the U.S. Department of Health and Human Services (HHS) responded to the COVID-19 pandemic by declaring a public health emergency (PHE). Congress passed legislation to ensure that anyone enrolled in Medicaid (Health First Colorado (Colorado’s Medicaid program) in Colorado), as well as children and pregnant people who were enrolled in the Children’s Health Insurance Program (Child Health Plan Plus (CHP+) in Colorado), was guaranteed to keep their health coverage during the PHE. This is the continuous coverage requirement. Congress passed a bill that ended the continuous coverage requirement in the spring of 2023.
Health First Colorado and CHP+ members have returned to normal eligibility renewal processes. Members due in May 2023 were notified in March 2023. The Colorado Department of Health Care Policy & Financing (HCPF) will take 14 months, including noticing, to go through and complete renewals for each of the approximately 1.7 million people enrolled.
Understanding the renewal process will help you to best support your Health First Colorado eligible patients through this transition. Click here to learn more about what they must do for their renewal, including determining eligibility and how to re-enroll.
- We are informing our members about the end of continuous coverage. Our care management team is contacting them on behalf of primary care medical providers (PCMPs), and they are prioritizing high-risk members.
- We created free informational flyers, brochures and other materials for you to give your patients. You can request these free materials be delivered to your office through our new online ordering system. Currently the materials are available in English and Spanish.
- We created educational videos for you to share with your staff and members. These are available in English and Spanish.
- We added member’s renewal dates to the monthly attribution report (PEPR) so that you can filter your report for engaged and non-engaged members, high risk members, and members with upcoming renewal dates. Ask your practice facilitator for instructions.
- We created step-by-step instructions for how you can check member eligibility on the State Web Portal.
- If you have questions about checking eligibility please contact your provider network manager for additional support.
- To find out who your provider network manager is please email email@example.com
- We created FAQ for you to review questions that have come up from your peers. Please scroll to the bottom of this page to view an FAQ.
- They threaten members and applicants with loss of health coverage
- They demand money
- They ask for sensitive personal information and may even threaten legal action
HCPF does not ask members or applicants for money or sensitive personal information like complete social security numbers over phone or text; HCPF does not threaten legal action over phone or text.
HCPF and county departments of human services may contact members by phone to ask for current contact information including phone number, email address, and mailing address. You can update this information in PEAK at any time.
Members, applicants and partners should visit the State’s website for more information and report potential scam messages to the Attorney General Consumer Protection Unit.
How can providers help?
- Make sure that your staff is familiar with Health First Colorado eligibility and re-enrollment processes so they can answer any questions your patients may have.
- To ensure that you get properly reimbursed, you must check the Health First Colorado eligibility of each of your patients:
- At the time their appointment is scheduled
- When the patient arrives for their appointment
- Ask your practice facilitator any questions you may have.
- View our monthly attribution lists. These lists will help you understand which patients are due for renewal and when. These lists will show:
- Your patients’ respective renewal dates
- Your patients who are engaged and unengaged
- Any of your patients who are qualified as high risk
- Enhanced clinical partners (ECPs) are outreaching engaged members.
- You can help raise member awareness about Medicaid renewals by sharing the messaging in the HCPF toolkits and by posting flyer and brochures in public areas and on reception desks.
- Inform your patients they must take action to keep their health coverage, and how they can do so. HCPF has developed partner toolkits to aid in the return to regular renewal processes. Update Your Address and Take Action on Your Renewal toolkits all include resources to help members take action to keep their coverage. These materials identify key actions for members to take including; updating their contact information, taking action when a renewal is due, and seeking help with renewals at community or county resources when they need it.
- Educate yourself and your staff on the renewal process so you can effectively help your patients. View HCPF’s Renewal Education toolkit. Frequently Asked Questions (FAQs) about the end of the continuous coverage requirement and return to regular renewal processes are available in the PHE Planning Resource Center.
- Send members with questions about the renewal process to Health First Colorado’s renewal webpage which is available in English and Spanish.
- Direct any of your patients who no longer qualify for Health First Colorado to affordable health care coverage resources.
We value your partnership and encourage you to share feedback on best practices, new tools, and meaningful metrics with us at firstname.lastname@example.org.
HCPF estimates that more than 325,000 current members will no longer be eligible for Health First Colorado after their annual eligibility review. These reviews will be done in the anniversary month of when the member enrolled, meaning that if a member enrolled in July 2022, their eligibility review will be done in July 2023.
If a current member’s circumstances have changed since they enrolled in Health First Colorado, such as starting a new job that might put them over the income limit, they should find other health insurance coverage options to avoid the potentially devastating consequences of becoming uninsured.
As of April 2023, income eligibility limits increased to account for inflation. While a household may be over the income limit for Health First Colorado, it’s possible that children in that household could qualify for CHP+. CHP+ also covers pregnant people through their pregnancy and delivery, and for 12 months postpartum. Click here to see the updated eligibility limits.
Those who are no longer eligible for Health First Colorado coverage can find alternative health care coverage options on Connect for Health Colorado, the state of Colorado’s official health insurance marketplace.
- Phone and video visits will continue to be covered for all Health First Colorado and CHP+ members. This excludes well child visits.
- Telemedicine will still be a benefit, we are removing the Well Child Check codes from telemedicine effective May 12, 2023. Affected procedure codes include 99382, 99383, 99384, 99392, 99393 and 99394. Learn more here. If you have any questions, please email Morgan Anderson at email@example.com and Naomi Mendoza at firstname.lastname@example.org.
- Health First Colorado and CHP+ members can use phone and video visits for routine medical care, therapy and other visits. Not all providers offer telehealth services though, so members should check that their provider offers telehealth. This was a change in policy made in response to COVID-19 that Health First Colorado has made permanent.
What will happen with providers that have closed their doors and are fully operational doing telehealth?
Providers can still operate and bill in the same manner after the PHE. A provider specialty, e-health entity, for clinics and non-physician provider groups that deliver services exclusively by telemedicine will be available soon. When it is available, these providers will update their current enrollment to indicate that they are providing services only by telemedicine.
For fee-for-service behavioral health telemedicine visits, there is no anticipated rate change due to the PHE. Payment parity between in-person and telemedicine visits is still in place. There will be no change to how the RAEs pay for behavioral health telemedicine benefits.
The provider portal does not provide the eligibility renewal due dates. The portal will show coverage start and end dates. We encourage members to log into their PEAK accounts to see their renewal due dates.
The weekly data files from HCPF do not contain a specific field to indicate the status of a member’s renewal. It is not possible to determine if a renewal has been submitted by the member or is in the process of being reviewed by an eligibility worker. However, using the renewal date field users can determine if a renewal is not yet approved.
Currently, the HCPF files do not include a field that indicates auto renewals. However, once ex-parte processes take place monthly, member's renewal dates will be updated to the next year.
We have not been able to get clarity from HCPF concerning why we are seeing these dates. However, any renewal date from the last three years of the PHE that is before 5/31/23 would fall under continuous coverage. Members who receive a renewal packet with a renewal date of May 2023 or later need to complete that packet in order to retain benefits.
If a member does not have an email address or phone number, how can they create an account on the PEAK website?
The PEAK account set up does not offer another option other than a phone number or email address. The only way around this currently is to help the member set up an email address in order to create the account.
Will children who are in foster care or those who were formerly in foster care be automatically renewed?
Children in foster care will receive a renewal packet to update demographic information. However, if the member does not take action then they will still be auto-renewed. Children who are currently in foster care and under the age of 18 will be auto-renewed and will not receive a packet. Those who were formerly in foster care will continue to be automatically renewed until they are 26 years old.
Will counties have sufficient staffing support to keep up with the volume of Medicaid member renewals?
HCPF is currently investigating how they can support eligibility workers to address workload backlogs. HCPF will also invest $15 million in additional appeals resources.
What will the process be if a renewal is submitted within the appropriate timeframe, but the county does not process it before the end of a member’s enrollment date?
When a member renewal is submitted through PEAK, the renewal is considered submitted on that date. There will be a grace period between the 5th and 15th of each month for that month’s member renewals. As long as PEAK “acknowledges” a member’s renewal by the 15th of the month in question, it will be considered complete for renewal purposes.
Providers can bring awareness about the renewal process by posting our flyers in their public areas. Flyers, social media, website content, and other outreach tools can be found on our PHE Planning webpage. The materials in the toolkits raise awareness on key actions for members to take: updating contact information, taking action when a renewal is due, and seeking help with renewals at community or county resources when they need it.
Providers can also educate themselves and their staff on the basics of the renewal process to assist patients who may have questions. See our Renewal Education toolkit.
Additional frequently asked questions about the end of the continuous coverage requirement can be found here.