Mountain Family column: Are you eligible for Medicaid or Child Health Plan Plus?
Under the Affordable Care Act (Obamacare), the state of Colorado has invested significant resources into the expansion of two types of public insurance, Medicaid and Child Health Plan Plus (CHP+). This expansion has greatly increased the number of adults and children who are eligible for coverage; however, in this region, there are large numbers of people who are eligible but not enrolled in these programs. Are you eligible for Medicaid or CHP+?
Medicaid and CHP+ are public insurance programs with generous coverage for most health needs and conditions. They are an excellent option for qualified individuals and families who cannot afford health insurance. (A third public option, Medicare, is federal health insurance for persons ages 65 and older and certain younger people with disabilities.)
For adults, 15 percent of the residents of Garfield County who are eligible for Medicaid are not enrolled, as is the same for more than 25 percent of eligible residents of Eagle and Pitkin counties. For children, the number who are eligible but not enrolled in Medicaid in each county is relatively small (0.2 percent, 3 percent and 9 percent respectively). However large numbers of children who are eligible for CHP+ are not enrolled, including 21 percent in Garfield, 45 percent in Eagle and 63 percent in Pitkin Counties (Colorado Health Institute).
What is Medicaid?
Medicaid, now known in Colorado as Health First Colorado, is health insurance for lower income adults and children who meet certain criteria. Persons who fall under one of the following categories and meet the income guidelines may qualify for Medicaid or CHP+:
• Children ages 0-18 with household income under 260 percent of the Federal Poverty Level (FPL) ($30,000 for an individual and $63,000 for a family of four)
• Pregnant women, over the age of 19, whose household income is under 260 percent FPL
• Parents and caretaker relatives who have a dependent child and whose household income does not exceed 133 percent FPL ($16,152 for an individual and $33,384 for a family of four)
• Adults without dependent children whose household income does not exceed 133 percent FPL
For those eligible for Medicaid, the health care benefits are broad, and they include: primary medical care, behavioral health (mental health and substance use disorders) care, dental services, emergency care, family planning, hospitalization, laboratory services, maternity care, newborn care, outpatient care, prescription drugs, preventive and wellness services and rehabilitative services.
What is Child Health Plan Plus (CHP+)?
CHP+ is public low-cost health insurance for certain children and pregnant women. It is for people who earn too much to qualify for Medicaid but not enough to pay for private (also known as commercial) health insurance. CHP+ has category and income guidelines as well. Applicants must be legal residents of Colorado and not be eligible for Medicaid or have private insurance. They must also be children age 18 and under or pregnant women age 19 and over who have a household income under 260 percent of the Federal Poverty Level (FPL). CHP+ enrollment fees and co-pays are very low cost — $0 to $105 for enrollment and $1 to $50 for co-pays, depending on household size and income.
Benefits under CHP+ are like those of Medicaid except adults are not eligible for dental care.
How can I apply for Medicaid or CHP+?
There are five ways you can apply for either of these programs. The fastest way is to visit Colorado.gov/PEAK, which provides information on the programs and how to apply in all of these manners. You can also apply locally, at your county human services department or at a Mountain Family Health Centers clinic. Mountain Family is the Connect for Health Colorado designated application site in all three counties. Lastly, you can apply by phone or mail and the directions for doing so can be found on the website listed above. (For those who are not eligible for these programs and wish to purchase insurance through the exchange, Mountain Family enrollment specialists are also the Connect for Health assisters for this program.)
Not all medical, behavioral and dental health providers accept Medicaid and CHP+, however, so it is important to ask if they do when making an appointment. Mountain Family Health Centers accepts both at all their health centers (Basalt, Glenwood Springs, Edwards, Avon, Rifle and the SMILES and mobile dental van dental-only sites). Another way to find out who accepts Medicaid and CHP+ is to contact your county public health department who maintains an up-to-date list of providers who do.
If you think you or your children might be eligible for Medicaid or CHP+, please consider contacting Mountain Family or your county human services department soon to obtain coverage for preventative, treatment and wellness medical, dental and behavioral health services so you can achieve optimal health.
Carolyn Hardin is a development consultant for Mountain Family and other nonprofits, with 30 years of experience in public health and human services in the Roaring Fork Valley. She can be reached at firstname.lastname@example.org.