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Care. and Health in Colorado. Connecting A GUIDE TO SERVICES FOR THE UNINSURED CONSUMER INITIATIVE

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1536 Wynkoop St. #101 Denver, CO 80202 t: (303) 839-1261 f: (303) 839-1263 www.cohealthinitiative.org info@cohealthinitiative.org

I N I T I AT I V E

CONSUMER

COLORADO

A GUIDE TO SERVICES

FOR THE UNINSURED

Care

and

Health

in Colorado

Connecting

A PUBLICATION FROM THE I N I T I AT I V E CONSUMERCOLORADO Connecting

Car

e

and

Health

in Colorado: A GUIDE TO SER

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THE COLORADO CONSUMER HEALTH INITIATIVE

is a unified, statewide organization of consumers and consumer advocates whose goal is quality affordable health care for all Coloradans.

Our mission is to ensure barrier-free access to quality healthcare

for all Coloradans.

Our Members

The Initiative is a coalition of over 200 consumer advocacy organizations and individuals committed to increased access to health care.

Current Programs and Activities

The Initiative is engaged in a wide variety of projects focusing on issues relating to healthcare financing (public and private), the uninsured, state-level health insurance reforms, and the impact of changes in the healthcare market on consumers. The Initiative has addressed the roll-back of consumer protections in Colorado’s health insurance laws, prevented cuts to vulnerable populations in the Medicaid program, worked to maintain and increase federal funding for Medicaid and CHP+, organized the faith community, and worked to improve access to healthcare for Colorado’s most at-risk populations.

For additional information, contact the Colorado Consumer Health Initiative at 303.839.1261 or inform@cohealthinitiative.org.

This report was prepared with grants from the following foundations:

A special thanks to Colorado Community Health Network (CCHN), Caring for Colorado Foundation, Inner City Health Center, and Dental Aid for the use of photos.

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ACKNOWLEDGEMENTS

The Colorado Consumer Health Initiative (CCHI) wishes to acknowledge

Pilar Ingargiola & Barbara Yondorf

for the research and writing of this guide.

Approximately 750,000 of Colorado’s residents have no health insurance. This represents 16.7% of the population and 1

in 5 adults. Being uninsured can result in serious consequences, ranging from lack of preventive care to higher likelihood of chronic diseases and increased mortality rates.

There are many reasons for high rates of uninsurance. 84% of the uninsured in Colorado are members of working families; however, many people are not offered health insurance through their workplace or if offered, cannot afford their share of the premiums.

Coloradans without health insurance are vulnerable to increased health problems and economic loss. In some cases, the cost of care for the uninsured is passed on to the state or to those with insurance.

The purpose of this guide is to let uninsured families, health care providers, and other social services workers know what health care options are available for the uninsured in our communities.

The guide will provide information about

• Programs that pay for health care, including: Medicaid, Baby Care/Kids Care and 1931 Family Medicaid; the Child Health Plan Plus (CHP+); the Colorado Indigent Care Program; Cover Colorado; and the Health Care Program for Children with Special Health Care Needs.

• Programs that provide health care, including: community health centers; school-based health centers; public health programs; family medicine residency programs; community and migrant health services; dental health programs; and mental health programs.

• Programs that provide food assistance, including: the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); Food Stamps Program; and other food

assistance programs; and • Other related programs

The next time you run across someone who needs access to low-cost health care services and programs, refer to this guide, to see if you can help them find the care they need and deserve.

In addition, the Family Healthline is a hotline with operators available to help screen families for free and low-cost health care programs and assist families with problems in applying for these programs. Call 303.692.2229 in metro Denver, or toll free at 1-800-688-7777, elsewhere in Colorado.

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HOW TO USE THIS GUIDE

This is a guide for consumers, consumer advocates, health care providers, policymakers, and other professionals working to help consumers:

• Understand the complex maze of health and human services programs in Colorado • Identify for which programs and services

consumers might be eligible, and

• Locate safety net programs and resources throughout the state.

Within this guide,

users will find 3 major sections:

SECTION ONEincludes eligibility and other program tables, and program summaries. Section One may be used by consumer advocates, policymakers, providers and other professionals for:

• An understanding of the changing healthcare enviro-me nt and its effe cts on the saf ety net • Quick identification of program eligibility and

populations served

• A summary of programs throughout the guide, and • Determining where to find more information

on programs.

SECTION TWOincludes information on health care programs, providers and other resources. Section Two may be used by consumer advocates, providers, and other pro-fessionals trying to identify more in-depth information on:

• Available medical and public assistance programs and public health programs

• Health, dental, mental, and long-term care providers, and

• Other resources and programs for assistance with food, energy, legal, housing, interpretation, environmental, transportation, and other related issues.

SECTION THREEincludes a listing of safety net agencies and providers. Section Three may be used by consumers, consumer advocates, and professionals trying to locate agencies, departments and safety net providers and clinics in their local communities where consumers can obtain assistance with eligibility determination or receive services.

This is an updated and expanded version of a previous

To all readers please note:

• The information on these pages may have changed since the directory was published. Please contact the Colorado Consumer Health Initiative at 303.839.1261 with updates and corrections. A copy of the directory can be found on the CCHI website: www.cohealthinitiative.org.

• Some of the providers in this directory may cap the amount of indigent care they provide. Consumers should call first to see if a particular clinic they are interested in going to has a waiting list or is otherwise limiting its care to indigent patients.

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TABLE OF CONTENTS

SECTION ONE

: Update, Summaries & Tables

• Changes in Colorado’s Health Care Safety Net Since 2000 PAGE 9

• Summary Table of Programs, Populations Served & Page Numbers PAGE 11

Income Eligibility Charts and Standards PAGE 14

Eligibility At A Glance Table PAGE 15

Federal Poverty Guidelines PAGE 16

Income Guidelines PAGE 17

SECTION TWO:

Health & Other Programs, Providers & Other Resources

• Medical Benefits and Public Assistance Programs PAGE 19

Programs Accessed Through the Colorado Benefits Management System (CBMS) – over 34 programs can be accessed through CBMS, some include:

Medicaid

Presumptive Eligibility Child Health Plan Plus Old Age Pension Program Adult Foster Care Food Stamps SSI

Aid to the Blind

Aid to the Needy Disabled Home Care Allowance

Temporary Assistance for Needy Families/Colorado Works

Other Programs PAGE 34

Colorado Indigent Care Program

Medicaid Breast and Cervical Cancer Program Ryan White AIDS Program

Kaiser Connections

Early Childhood Connections

` Early & Periodic Screening, Diagnosis & Treatment Older Americans Act Program

• Public Health Programs PAGE 41

Public Health Nurses

Health Care Program for Children with Special Needs Ryan White AIDS & Related Programs

Nurse Home Visitor Program

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• Health Care Providers PAGE 45

Health Centers Hospitals Private Providers

• Long-Term Care PAGE 51

Long-Term Care Agencies and Providers Long-Term Care Programs and Services Long-Term Care Resources

• Mental Health PAGE 57

Payers of Mental Health Care Services Providers of Mental Health Care Services Mental Health Care Resource Agencies

• Dental Health PAGE 60

Payers of Dental Care Services Providers of Dental Care Services Dental Programs for Special Populations

• Indian Health Services PAGE 63

• Other Resources and Programs PAGE 64

CoverColorado Food

Energy Legal

Housing and Transportation Interpretation

Environmental Justice Transportation

Other Resources and Programs

SECTION THREE:

Agency & Provider Listing

• Appendix I. Agency & Department Listing PAGE 75

List of Local/County Departments of Social/Human Services List of Local/County Health Departments & Services

List of Single Entry Point Agencies List of Community Centered Boards List of Local Area Agencies on Aging

• Appendix II. Listing of County Depts of Social Services PAGE 76

• Appendix III. Safety Net Provider Listing by County PAGE 89

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SECTION ONE:

Update,

Summaries & Tables

SECTION ONE

includes an update on the health care

safety net, eligibility and other program tables, and

program summaries.

SECTION ONE

may be used by consumer advocates,

policymakers, providers and other professionals for:

• Changes in Colorado’s Health Care Safety Net Since 2000

• Summary Table of Programs, Populations Served &

Page Numbers

• Eligibility At A Glance Table

• Income Eligibility Charts and Standards

• Summary of Programs by Population

• Program Summaries.

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Since 2000, there have been significant changes to health care and other safety net programs for Coloradans.

The economic downturn resulted in increases in unemployment and underemployment and indirect increases in the num-bers of uninsured and underinsured individuals and families in Colorado. The impacts on the health care system, public health infrastructure and the safety net have resulted in:

• An increase in the demand for services on an already overburdened system;

• A reduction in state funding to public programs and reimbursement to private providers serving low-income popula-tions in Colorado;

• Overburdening of the healthcare system, including core and general safety net providers, such as emergency rooms, Community Health Centers, Rural Health Clinics, public health departments and community clinics, which cannot always meet the demand;

• An increased burden on other businesses and sectors as the costs are to meet the demand shifted across the sector. The impact of these changes on the state’s economy and budget have made it progressively more challenging to meet the demand for services for individuals and families and has made it increasingly difficult for individuals and families to find needed health care and other public assistance services.

As a result, the landscape of programs available to low-income populations has changed since 2000. Several changes have taken place in the past few years that impact some of the key public assistance and medical programs. This guide will provide a summary of these changes and then will provide a broad overview of the low-cost programs and resources that are currently available for Colorado children, adults, families, disabled persons and seniors.

CHANGES IN COLORADO’S HEALTH CARE SAFETY NET SINCE 2000

Colorado Benefits Management System (CBMS)

In September 2004, the Colorado Benefits Management System (CBMS) was implemented as the new comprehensive computerized eligibility and payment system that issues benefits to qualified clients throughout the State of Colorado. CBMS was developed by the Colorado Department of Human Services and the Colorado Department of Health Care Policy and Financing to determine eligibility and benefit amounts for a variety of social services programs. CBMS was designed to replace several separate systems and with the purpose of enabling individuals and families to have a single point of contact and entry/application for health and social services programs. However, there have been many problems and com-plications with the implementation of CBMS. The new system requires more information so the application and eligibility interview is longer than in the past. The client should call the hotline at 1.800.536.5298, if they have a pending appli-cation that has gone beyond the processing timelines or if they have already been determined eligible but are not receiv-ing benefits.

Public Health Per Capita Funding

Over the past five years, state and local-public health budgets have continued to decline while federal funds have become increasingly categorical (especially the increase in funding pertaining to bioterrorism and public health preparedness). The result has been the increasing difficulty of local public health departments and agencies to provide core public health services to meet the needs of their communities. In 2002, the Governor vetoed the per capita line item in the state budget to support discretionary funding to local public health departments. These funds supported basic public health infrastructure and services. The elimination of the per capita discretionary funding and the increase in categorical funding has made it increasingly difficult for public health departments and agencies to respond to the community’s basic public health needs, resulting in the transfer of much of the public health burden on to the already fragile and over-burdened safety net.

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SECTION ONE:

Update,

Summaries & Tables

CHANGES IN COLORADO’S HEALTH

CARE SAFETY NET SINCE 2000

2004 Tobacco Tax

In November 2004, a ballot initiative to raise the tax on tobacco products was passed by the voters of Colorado. This raised the excise tax on cigarettes by 64 cents -bringing the total to 84 cents per pack and putting Colorado closer to the national average. This tax is expected to generate approximately $175 million per year in new state revenue, to be used to fund: public health insurance expansion for Colorado families through the Child Health Plan Plus and Medicaid; comprehensive pri-mary care through Community Health Centers and other clinics serving a high portion of uninsured; tobacco edu-cation, prevention and cessation programs; and preven-tion, early detection and treatment of cancer, cardiovas-cular and pulmonary diseases. During the 2005 legisla-tive session, legislation was enacted to make the follow-ing changes and expansions to safety net and public health programs in Colorado, including:

• Expand Medicaid (see page 19) to parents from 33% to a minimum of 60% of the federal poverty level (FPL) by no later than July 1, 2006

• Expand the Child Health Plan Plus (CHP+, see page 26) for pregnant women and children from 185% to 200% FPL

• Provide Medicaid coverage to legal immigrants; • Remove waiting lists for Home and Community Based

Services (HCBS) programs and Children’s Extensive Support Waivers (CES) (see pages 23-34) • Restore Presumptive Eligibility in Medicaid for

pregnant women, but not for undocumented women. • Removal of Medicaid asset test for all children and

1931 Medicaid (TANF, see page 31) families. These changes and program expansions will occur starting on July 1st, 2005 and should all be implemented no later than July 1st, 2006.

Health Insurance Flexibility

Accountability (HIFA) Waiver

In 2003, the State of Colorado’s Department of Health Care Policy and Financing (HCPF) initiated research into the development and implementation of a Health Insurance Flexibility and Accountability (HIFA) waiver application to the federal government that would allow for the coordination and streamlining of Medicaid, the Child Health Plan Plus (CHP+), and the Colorado Indigent Care Program (CICP) into a single, healthcare program that provides comprehensive benefits to all participants, including the expansion of services to children who require more extensive care. In designing this streamlined program, HCPF seeks to increase the ease with which children receive appropriate and necessary benefits while decreasing the incidence of “bouncing” between the Medicaid and CHP+ programs due to small changes in family finances that causes disruptions in service delivery. HCPF is moving forward to develop more concrete and specific plans on how the state would implement such a waiver by:

• Designing a benefits package for physical, oral and behavioral health services

• Designing a delivery system that can provide services to the maximum number of eligible children and families

• Identifying potential expansion populations; • Developing actuarially sound rates for children,

families, and expansion populations

• Developing a system of purchasing health care for children and families

• Developing a partnership between employer-spon-sored insurance and publicly-funded insurance, and • Designing a business model that can support the

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SUMMARY OF PROGRAMS AND POPULATIONS SERVED

PROGRAM SUMMARIES

Medicaid

GO TO PAGE 19

Medicaid is a joint federal and state financed program that helps pay for health and long-term care costs for low-income and special needs Coloradans. The Colorado Department of Health Care Policy and Financing (HCPF) administers the state’s Medicaid program. Medicaid programs described in this guide include: 1931 Family Medicaid, Transitional Medicaid, Four-Month Extended Medicaid, Baby Care Kids Care, Home and Community Based Services, and other Medicaid programs. For more information on Medicaid programs or to apply, contact the local county departments of social/human services or selected Medical Assistance sites listed at

www.cbms.state.co.us/ links/Clientinformation/ Clientinformation.asp, go to Appendix II, or contact Medicaid customer service at 303.866.3513 (metro Denver) or 1.800.221.3943 (outside the metro Denver area).

Child Health Plan Plus

GO TO PAGE 26

Child Health Plan Plus (CHP+) is health insurance cover-age for low-income children under 19 years of cover-age, who are not eligible for Medicaid, and whose families have incomes at or below 205% of federal poverty level (see page 16). Coverage includes a comprehensive package of benefits designed specifically for children and youth. The Colorado Department of Health Care Policy and Financing manages the program through a contract with ACS State Healthcare L.L.C. For more information about CHP+ in the Denver Metro area, contact 303.692.2960 or the toll-free number 1.800.359.1991 or go to www.cchp.org. For more information about applying for CHP+ through CBMS, go to www.cbms.state.co.us/links/

Clientinformation/ Clientinformation.asp.

Old Age Pension Program

GO TO PAGE 27

The Old Age Pension program was established in 1937 to provide basic retirement income, health care coverage, and cash benefits to individuals aged 60 years and older. There are 3 categories of assistance for the program –

A, B, and C. In addition to the 3 Old Age Pension program categories, individuals may be eligible for the Health & Medical Program or the Dental Program. For more information on the OAP program, contact the local

county department of social/human services or go to

www.cbms.state.co.us/links/Clientinformation/ Clientinformation.asp or Appendix II. For questions regarding the OAP Health and Medical Care Program, contact Medicaid customer service at 303.866.3513 (metro Denver) or 1.800.221.3943 (outside the metro Denver area).

Adult Foster Care

GO TO PAGE 28

The Adult Foster Care program provides care on a 24-hour basis to frail elderly, physically or emotionally disabled adults, 18 years of age and over, who do not require 24-hour medical care in licensed Assisted Living Residences. For more information,

contact the local county department of social/human services listed at www.cbms.state.co.us/links/

Clientinformation/ Clientinformation.asp or in Appendix II.

Food Stamps

PAGE 29

The Colorado State Food Stamps Program assists low-income individuals and families who need assistance pur-chasing food. Individuals and families should apply for food stamp benefits at their local county department of social services. The Food Stamp Program is offered in at least one location in all Colorado counties. The county worker will interview applicants and determine the house-hold eligibility for benefits. They will provide the appli-cant with a Quest card that can be used to purchase gro-ceries at any participating grocery store or other retailer. For more information about Food Stamps, contact the local county department of social/human services (Appendix II), or go to

www.cbms.state.co.us/links/Clientinformation/ Clientinformation.asp.

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SUMMARY OF PROGRAMS AND

POPULATIONS SERVED

SECTION ONE:

Update,

Summaries & Tables

Supplemental Security

Income Program

GO TO PAGE 29

The Supplemental Security Income program makes cash assistance payments to aged, blind and disabled people (including children under 18) who have limited income and resources. For more information on the Supplemental Security Income program or to locate local Social

Security offices, call Social Security at 1.800.772.1213.

Aid To The Blind/Aid To The

Needy Disabled

GO TO PAGE 30

The Aid to the Blind (AB) program provides limited assistance to low income persons who are blind. The Aid to the Needy Disabled (AND) program provides assistance to persons with a medical disability until determined eligible for Supplemental Security Income Program. For more information or to apply, go to the local county department of social services, Appendix II, or www.cbms.state.co.us/links/Clientinformation/ Clientinformation.asp.

Home Care Allowance

PAGE 31

The Home Care Allowance (HCA) is a state program that provides direct monthly payments to eligible individuals for the purchase of services related to activities of daily living, which are necessary to enable the client to remain at home and does not qualify for home and community based services. For more information on the Home Care Allowance, contact the local county department of social/human services by going to Appendix II or

www.cbms.state.co.us/links/

Clientinformation/Clientinformation.asp.

Temporary Assistance For Needy

Families/Colorado Works

PAGE 31

Colorado’s TANF Program is known as Colorado Works and is designed to assist participants to become self suffi-cient by providing cash assistance and other supports, job preparedness and developing strategies and policies that focus on ensuring that participants are in work activities. For more information about TANF/Colorado Works, con-tact the local county department of social/human services (Appendix ___), or go to www.cbms.state.co.us/links/ Clientinformation/ Clientinformation.asp.

Colorado Indigent

Care Program

PAGE 34

Individuals and families who are not eligible for health and medical services through any of the CBMS programs, may be eligible to receive limited services through a Colorado Indigent Care Program (CICP) provider. The program requires copays of enrolled individuals and families and currently covers families to 250% FPL or less. For more information on CICP or to check on current levels of eligibility or to find a local provider, go to HCPF’s website at www.chcpf.state.co.us and click on the CICP link.

Medicaid Breast &

Cervical Cancer Program

PAGE 35

The Breast and Cervical Cancer Program provides full Medicaid benefits to eligible uninsured women below the age of 65 that have been screened at a Colorado

Women’s Cancer Control Initiative (CWCCI) Service Delivery Site - to find a screening site go to

www.chcpf.state.co.us/HCPF/Acute/cwcci.asp. For more information on the Medicaid Breast and Cervical Cancer program, call 303.866.2693 or Fax 303.866.2573 or go to www.chcpf.state.co.us/HCPF/Acute/bccpindex.asp.

Ryan White

AIDS Program

PAGES 36 & 43

The federal Ryan White CARE Act provides primary health care and support services for people with HIV/AIDS. Enacted in 1990, it fills gaps in care faced by those with low-incomes and little or no insurance. For more informa-tion or for contact informainforma-tion on the Ryan White AIDS program, go to page 36.

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Kaiser Connections

PAGE 38

Kaiser Permanente’s community service program, Connections, provides low-cost health care coverage for families who otherwise could not afford health care. For more information on Kaiser Permanente’s

Connections program, call 303.338.3490 or go to www.kaiserpermanente.org.

Early Childhood Connections

PAGE 39

Early Childhood Connections for Infants, Toddlers, and Families is a program under the Individuals with

Disabilities Education Act (IDEA - Part C) that provides a system of supports, services and rights for families who have infants or toddlers, from birth to age three, with disabilities or a condition associated with delays in their development. For more information on the program or to find a local office, call 1.888.777.4041 or go to

www.cde.state.co.us/earlychildhoodconnections.

Early & Periodic Screening, Diagnosis

& Treatment (EPSDT)

PAGE 39

The EPSDT Program helps families access early identification and treatment of medical, dental, vision, hearing, mental health, and development problems for their children.

Older Americans Act Programs

PAGE 40

The Older Americans Act was established in 1965 to improve the quality of life for all older Americans by helping them to remain independent and productive. The Older Americans Act was created to provide community-based services to persons age 60 and over to assist them to be economically self-sufficient or to live in their own homes and communities for as long as possible. For more information on these programs or to locate a local Area Agency on Aging, contact 303.866.2800 or go to:

www.cdhs.state.co.us/ADRS/AAS/aaas.htm or see Appendix I. In addition, information is available through the state Long-Term Care Ombudsman (see page 56) at 303.722.0300 x 217.

Health Care Program For Children

With Special Needs

PAGE 42

The Health Care Program for Children with Special Needs serves as a focal point at the state and local level to build a system of health care services and supports for all families of children with special needs in Colorado. The Health Care Program for Children with Special Needs serves to assess the needs of families, to report health status of this population, and to develop coordinated rograms and community-based systems of care to meet the needs of families. These programs can have limits on the number of children that can be enrolled. For more information on the program, call 303.692.2370.

Nurse-Family Partnership

PAGE 44

Through a partnership of local counties and the Colorado Department of Public Health and Environment, the Colorado Nurse Home Visitor Program provides grants to public or private organizations in Colorado to provide regular, in-home, visiting nurse services to low-income, first-time mothers, with their consent, during their preg-nancies and through their children’s second birthday. For more information on the Nurse Home Visitor Program or to locate a participating agency in local communities, call 303.692.2943, or go to

www.cdphe.state.co.us/ps/nursehome/nursehomevisithom. asp.

Women, Infants And Children’s

Nutrition Program (WIC)

PAGE 64

The Women, Infants and Children’s program is a nutrition program for pregnant women; breastfeeding women (up to one year post partum); non-breastfeeding, postpartum women (up to six months postpartum); infants, and chil-dren up to 5 years of age. For more information on the program and to find a local provider, contact the local county public health agency or department (see Appendix I) or the Colorado Department of Public Health &

Environment at 303.692.2400 or 1.800.688.7777, or go to www.cdphe.state.co.us/ps/wic/wichom.asp.

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INCOME ELIGIBILITY CHARTS & STANDARDS

SECTION ONE:

Update,

Summaries & Tables

Summary of Programs by Population

Based on the summary tables of programs and eligibility, below is a list of programs available by population category:

1931 Family Medicaid X X X 21

Medicaid Baby Care Kids Care X X 22

Medicaid Home &

Community Based Services X 23

Other Medicaid X X X X 25

Child Health Plan Plus X X 26

Old Age Pension X 27

Adult Foster Care X X X X 28

Supplemental Security Income X X 29

Aid to the Blind/ Aid to

the Needy Disabled X X X 30

Home Care Allowance X X 31

TANF/Colorado Works X X X X X 31

Colorado Indigent Care Program X X X X X X 34

Medicaid Breast &

Cervical Program 35

Ryan White AIDS X 36, 43

Older Americans Act Programs X 40

Kaiser Connections X X X 38

Early Childhood Connections X X 39

Health Care Program for

Children with Special Needs X 42

Nurse Home Visitor Program 44

Women, Infants and

Children Program X X 64 PREGNANT WOMEN NON-DISABLED CHILDREN & YOUTH LOW INCOME CHILDLESS ADULTS

SENIORS DISABLED PARENTS PAGE

NUMBER

For women with cancer only

Pregnant women and children up to age 2

INCOME ELIGIBILITY CHARTS & STANDARDS

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P R O G R A M I N C O M E PA G E F O R M O R E I N F O R M AT I O N

1931 Family Medicad 37% Federal Poverty Level (FPL) or

less

14 Call local county department of

social/human services (Appendix II) or 303.866.3513 or 800.221.3943

Transitional Medicaid 185% FPL 21 same

Four-Month Extended Medicaid AFDC Need Standard

(disregarding child/spousal support income)

22 same

Baby Care Kids Care (BCKC) Qualified Child & Pregnant Women

AFDC Need Standard 22 same

Baby Care Kids Care (BCKC) Expanded Child & Pregnant Women - pregnant women and children 6 and younger

133% FPL 22 same

Ribicoff BCKC - children over the age of 7 through the age of 18

100% FPL 23 same

Expanded Prenatal & Needy Newborn BCKC - pregnancy through the age of 1

133% FPL 23 same

Home & Community Based Service (HCBS) Waivers

3 times the SSI limit 23 same

Other Medicaid Programs Varies 25 same

205% FPL 26 303.692.2960 or 800.359.1991

Old Age Pension Program SSI Income 27 Call local county department of

social/human services (Appendix II) or 303.866.3513 or 800.221.3943

Adult Foster Care Varies 28 Call local county department of

social/human services (Appendix II)

Supplemental Security Income Varies 29 800.772.1213

Aid to the Blind/Aid to the Needy

Disabled Varies 30

Call local county department of social/human services (Appendix II)

Home Care Allowance Varies 31 Call local county department of

social/human services

Eligibility At A Glance Table

Child Health Plan Plus - pregnant women and children through the age of 18.

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INCOME ELIGIBILITY CHARTS & STANDARDS

SECTION ONE:

Update,

Summaries & Tables

0% 50% 100% 150% 200% 250% Medicaid Long-Term Care (Community & nursing facility) Colorado Indigent Care Program (CICP) Child Health Plan Plus (CHP+) Medicaid (Acute care & community mental health care)

Elders and disabled Adults Pregnant women Children 6-18 Children 0-5

>250% No subsidy for care or coverage

L P F f o % s a e m o c ni yli m a F 219% 205% 133% 100% 60% 73% 250% 133% 4 8 C O N T I G U O U S S T A T E S & D C PERSONS IN FAMILY 1 2 3 4 5 6 7 8 EACH ADDTL. ADD: 60% FPL 73% FPL 100% FPL 133% FPL 205% FPL 219% FPL 250% FPL $6,126 $7,453 $10,210 $13,579 $20,931 $22,360 $25,525 $8,214 $9,994 $13,690 $18,208 $28,065 $29,981 $34,225 $10,302 $12,534 $17,170 $22,836 $35,199 $37,602 $42,925 $12,390 $15,075 $20,650 $27,465 $42,333 $45,224 $51,625 $14,478 $17,615 $24,130 $32,093 $49,467 $52,845 $60,325 $16,566 $20,155 $27,610 $36,721 $56,601 $60,466 $69,025 $18,654 $22,696 $31,090 $41,350 $63,735 $68,087 $77,725 $20,742 $25,236 $34,570 $45,978 $70,869 $75,708 $86,425 $2,088 $2,540 $3,480 $4,628 $7,134 $7,621 $8,700

2007 Annual Poverty Guidelines (Effective April 1, 2007)

For more information visit www.aspe.hhs.gov/poverty/07poverty.shtml

Income Eligibility for State Health Programs

Source Chart: Colorado

Health Institute

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# CHILDREN 0 1 2 3 4 5 6 7 8 EACH ADDITIONAL

0 ADULTS 1 ADULTS 2 ADULTS

$117 $245 $368 $490 $587 $678 $756 $830 $67 $253 $331 $421 $510 $605 $697 $770 $844 $920 $67 $357 $439 $533 $628 $716 $787 $861 $928 $1009 $67

AFDC Need Monthly Standard Income Guidelines (Effective April 1, 2005)

For 1931 Family Medicaid & Qualified Pregnant Women & Children 1931 Need Standard (based on old AFC Need Standard from 7/16/96

INDIVIDUAL IN OWN HOME $ 579

INDIVIDUAL IN HOME OF ANOTHER $ 386

COUPLE IN OWN HOME $ 869

COUPLE IN HOME OF ANOTHER $ 580

ISM MAXIMUM CHARGE $ 213

300% LIMIT $ 1,737

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SECTION TWO:

Health & Other Programs,

Providers & Resources

SECTION TWO

includes information on health care programs,

providers and other resources.

SECTION TWO

may be used by consumer advocates, providers, and

other professionals trying to identify more in-depth information on:

• Medicaid

• Presumptive Eligibility

• Child Health Plan Plus

• Old Age Pension Program

• Adult Foster Care

• Food Stamps

• SSI

• Colorado Indigent

Care Program

• Medicaid Breast and

Cervical Cancer Program

• Public Health Programs

• Long term Care

• Mental Health

• Dental Health

• Indian Health Services

• Other resources,

programs and services

for assistance including

energy, legal, housing,

interpretation,

environ-mental and transportation

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SECTION TWO:

Health & Other Programs, Providers & Resources

MEDICAL BENEFITS AND PUBLIC ASSISTANCE PROGRAMS

Colorado’s children, adults, families, disabled and elderly may be eligible for a wide range of health insurance, medical benefits and/or other public assistance programs in Colorado.

This section outlines the programs that different individuals may access, including the programs being supported by the Colorado Benefits Management System (CBMS) and other programs not accessed through CBMS.

Programs Accessed Through The

Colorado Benefits Management System (CBMS)

The Colorado Benefits Management System is an information technology eligibility and payment system that issues benefits to qualified clients throughout the State of Colorado. CBMS was developed by the Colorado Department of Human Services and the Colorado Department of Health Care Policy and Financing to determine eligibility and benefit amounts for a variety of social services programs administered by county departments of social/human services and select Medical Assistance (MA) sites (see Appendix II, back of guide for local contact information).

CBMS represents a significant shift in the way that benefits are granted and managed in Colorado. CBMS enables individ-uals and families to have a single point of contact for all of the programs supported by CBMS and eliminates the need for on-site, hand determinations through memorization of rules and manuals to determine eligibility.

Application/Eligibility

The goal of CBMS is to improve applicants’ ability to access public assistance and medical benefits. There have been and may continue to be significant problems that impact the processing of applications and delivery of benefits. Individuals and families may apply for benefits at all county departments of human/social services and selected Medical Assistance (MA) sites - for a list of these providers go to Appendix II or go to: www.cbms.state.co.us/links/clientinformation/pdfs/ CountyDSSandMADirectory.pdf, hit client information, then hit directory.

From the date of the signed application, the agency must act on the application: • within 7 days for Expedited Food Stamps

• within 30 days for Food Stamps

• within 45 days for Medicaid, CHP+, Colorado Works and Old Age Pension • within 60 days for Aid to the Blind/ Aid to the Needy and Disabled

Medicaid eligibility begins effective the date of the application or up to 3 months prior if the individual has medical bills and was otherwise eligible. The client will continue to receive benefits for 12 months, if the client and household meet the above stated criteria.

Applicants should receive a letter informing them whether they qualified and for which programs. If applicants do not qualify, they should be sent a letter explaining why they are not eligible and how to appeal if they feel they were denied wrongly.

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How to Apply

Individuals applying for Medicaid, public assistance, and other medical programs through CBMS may need to pro-vide proof or documentation before being determined eli-gible for programs and services. These may include: proof of age, proof of income, proof of residency, proof of resources, other medical documents. Please check with your county department of human/ social services (go to Appendix II) to find out what documentation you will need to bring.

Families and individuals should report any changes in their address or income to their county department of human/social services.

For More Information

For more information on CBMS or to apply for benefits for one of the public assistance or Medicaid programs, indi-viduals and families may go to www.cbms.state.co.us/ links/Clientinformation/Clientinformation.aspor Appendix II to locate their local county department of human/social services.

Medicaid

Medicaid is a joint federal and state financed program that provides for health and long-term care coverage for low-income children and their parents, seniors and indi-viduals with disabilities. The Colorado Department of Health Care Policy and Financing (HCPF) administers Colorado’s Medicaid program.

Eligibility

Financial eligibility is determined through the Colorado Benefits Management System (CBMS) at the local county departments of human/social services and selected Medical Assistance (MA) sites – for a list of these providers go to Appendix II.

Applicants must meet financial eligibility criteria for one or more Medicaid program categories in order to qualify for benefits. Poverty or medical need alone is not suffi-cient to entitle the individual for public assistance. In general, in order to be eligible for Medicaid, an individual must:

• Be a Colorado resident

• Be a citizen or national of the U.S. or its territories

• Be a qualified alien which includes lawful permanent residents (LPRs) for more than 5 years, refugees and asylees for the first seven years and people who entered the U.S. prior to August 22, 1996 • Or must fall into one of the coverage groups

identified in the following pages

• Fall within the established earned and unearned income limits for the Medicaid program category applying for (see Medicaid Program Category descrip-tions below); and

Individuals interested in applying may go to the section on CBMS to determine where to go and what information is required to apply. Individuals and families that are determined eligible for Medicaid, gain eligibility to one or more of the Medicaid Program Categories described below. Anyone who is denied Medicaid eligibility for any reason has a right to appeal or file an appeal with the administrative law judge. There are time limits to appeal on the back of the notice received by the individual or family. The individual or family may contact their local county department of human/social services or can go directly to the administrative law judge if they wish to exercise their right to appeal.

Retroactive Eligibility

Medicaid eligibility may be retroactive up to 3 months prior to the date of application (Retro Medicaid). An applicant does not have to be eligible in the month of application to receive Retro Medicaid. A client must meet all eligibility requirements during the month that the Retro Medicaid is requested. Medical expenses must be reported to be eligible for Retro Medicaid. It is important to ask for retroactive Medicaid when filling out an initial application for Medicaid.

Services

Basic Medicaid Services

While each Medicaid program may provide different or additional services to meet the specific needs of eligible individuals, individuals who are deemed eligible may receive the following basic covered services under Medicaid:

• Physician services & health clinics • Inpatient & outpatient hospital • Laboratory and X-ray services • Prescription drugs

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MEDICAL BENEFITS AND

PUBLIC ASSISTANCE PROGRAMS

SECTION TWO:

Health & Other

Programs, Providers & Resources

• Home health care • Family planning • Medical equipment

• Community mental health services or institutional care • Early Periodic Screening, Diagnosis and Treatment

(EPSDT, care to identify, prevent or treat health problems of youth)

• Hospice care

• Long-term care in a nursing facility, alternative care facility, or at home, when necessary

• Dental Care

(for children and for adult emergency care only) • Eyeglasses

(for children and for adults after surgery only). Medicaid is also required to provide emergency and non-emergency transportation services for children and adults.

Providers

Basic health care services are delivered by Medicaid providers and managed care organizations and reimbursed by the program. In addition to managed care organizations and private physicians, other health care providers that accept Medicaid include: federally qualified community health centers, family practice residency programs, rural health clinics, some hospitals, and other health clinics. For more information on Medicaid programs or to apply, contact the local county departments of social/human services or selected Medical Assistance sites listed at www.cbms.state.co.us/links/Clientinformation/ Clientinformation.asp, go to Appendix II, or contact Medicaid customer service at 303.866.3513 (metro Denver) or 1.800.221.3943 (outside the metro Denver area).

Medicaid Program Categories

Family and Children’s Medicaid Eligibility

Categories

1931 Family Medicaid

The 1931 Family Medicaid program was established in 1997 when Colorado’s welfare reform bill passed.

This program is intended to ensure that families can be eligible for Medicaid whether or not they are on cash assistance through Colorado Works (see page 31). 1931 Family Medicaid also includes Transitional Medicaid and 4-Month Extended, see below.

The 1931 Medicaid program enables families, including the father, mother and older children to be eligible for Medicaid. There are no age criteria for adults under the 1931 program, however the household must have at least one dependent child who is either:

• Under 18 years of age; or

• Between the age of 18 and 19 who are full time students in a secondary school or equivalent and expected to graduate before age 19 (eligible through the month of graduation).

In addition, applicants must:

• Meet the Medicaid eligibility criteria (see page 20);

• Have household income less than or equal to the AFDC Need Standard (see page 17);

Individuals do not have to apply for cash assistance to get 1931 Medicaid, but can apply for 1931 by itself. In addition, two-parent families can receive Medicaid as well as one-parent families. Also, if a “boyfriend” is the biological or legal father of the dependent child and is living in the home, then his income/resources are counted. Individuals eligible for 1931 will be eligible for the basic Medicaid services (described above, page 20).

Transitional Medicaid

Transitional Medicaid applies to clients who were on 1931 for at least 3 of the last 6 months, but their earned income increased and put the household over the 1931 income limit. Transitional Medicaid provides a guarantee of 6 additional months of eligibility, up to a potential 12 month maximum, and continues the benefits and services provided under 1931. Applicants must work with their county department of social services or MA sites to provide Transitional Benefit Reports in the 4th, 7th, and 10th month of transitional benefits to remain eligible. Income can not exceed 185% of FPL (see page 16) for the 7th through 12th month of transitional benefits.

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Four-Month Extended Medicaid

Four-Month Extended Medicaid applies to clients who were on 1931 for at least 3 of the last 6 months, but the child/spousal support income put the household over the 1931 limit. Extended Medicaid provides a guarantee of 4 additional months of eligibility and continues the benefits and services provided under 1931. No additional reporting is required to remain eligible.

Baby Care-Kids Care

The Baby Care-Kids Care (BCKC) program is part of the Medicaid program and provides medical assistance for children and pregnant women. (Note: Qualified Child and Pregnant Women have the same income limits as 1931, see page 21.) BCKC is broken down into the following programs:

• Qualified and Expanded Child

• Qualified and Expanded Pregnant Women • Ribicoff

• Eligible Needy Newborn, and • Prenatal State Only.

Pregnant women qualify for BCKC based solely on income. When looking at income, the income of certain family members who live in the same household counts toward the income limit. For example, for pregnant women, the husband’s income is counted. For a child, the income of the natural or adoptive parent(s) is counted. The incomes of unrelated people living in the applicant’s household or of related family members not living in the household do not count. For specific income criteria for the different BCKC programs, see specific program information below. Services provided through BCKC include all of the basic covered services of Medicaid. In addition, pregnant women receive prenatal care, labor and delivery, family planning services and all other necessary medical care during pregnancy and for 60 days after. Children receive complete well and sick medical care and immunizations, in addition to the basic Medicaid services. In addition, any children enrolled in Medicaid up to age 21 are eligible for the Early Periodic

Screening, Diagnosis and Treatment (EPSDT) program. Through EPSDT, all children on Medicaid are eligible to receive regular medical, dental, vision, development and hearing check ups, in-depth diagnosis of problems and treatment of any identified problems. All services through Baby Care Kids Care are free to pregnant women and children.

Qualified and Expanded Child BCKC

The BCKC Qualified and Expanded Child program provides Medicaid benefits for children, ages 0-5. A child in a family with a household income at or below the AFDC Need Standard (see page 17) is eligible for the Qualified Child BCKC

program. A child in a family with a household income at or below 133% of FPL (see page 16) is eligible for the Expanded Child BCKC program. A child will continue to receive benefits for 12 months, if the child and household meet the above stated criteria.

Qualified and Expanded Pregnant Women BCKC

The BCKC Qualified and Expanded Pregnant Women program provides Medicaid benefits for women whose pregnancy has been verified by doctor’s statement or staff observation. A pregnant woman with her portion of the household income at or below AFDC Need Standard (see page 17) is eligible for the Qualified Pregnant Women BCKC Program. A pregnant woman with her portion of the household income at or below 133% of FPL (see page 16) is eligible for the Expanded Pregnant Women BCKC program. Eligibility for women ends 60 days after the child is born or the pregnancy is terminated (post partum).

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MEDICAL BENEFITS AND

PUBLIC ASSISTANCE PROGRAMS

SECTION TWO:

Health & Other

Programs, Providers & Resources

Ribicoff BCKC

The Ribicoff Medicaid program provides Medicaid bene-fits to children ages 6-18. To be eligible, the household income for the child must be at or below 100% FPL (see page 16). The child will continue to receive benefits for 12 months, if the child and household meet the above stated criteria.

Eligible Needy Newborns BCKC

The Eligible Needy Newborns BCKC program provides Medicaid benefits for children, ages 0-1, whose mother was on Medicaid at the time of birth. The child must remain in the mother’s home in order to receive benefits until the child’s first birthday. A new application is not required – the only requirement is that someone report the birth and have the baby added to the mother’s case. In order to extend benefits for the child turning 1, an application needs to be submitted for one of the other Medicaid programs.

State Only Prenatal BCKC

The State Only Prenatal Medicaid program is for pregnant women who do not meet the eligibility criteria for

Qualified or Expanded Pregnant Women programs because of their “alien” status. Women are eligible if:

• Their pregnancy has been verified by a doctor’s statement or staff observation

• When one is “known to the INS” and

• Their portion of household income is at or below 133% FPL (see page 16).

This program covers prenatal care and delievery.

Eligibility for women ends 60 days after the child is born or the pregnancy is terminated (post partum).

Undocumented Residents - Emergency Medical Services

Undocumented residents may be eligible for Family Medical Assistance benefits through the 1931 or BCKC Medicaid programs. Undocumented Aliens can receive benefits only if they:

• Meet all other program eligibility criteria (residency, age, income, and resources), with the exception of citizenship, and

• Have a “life or limb threatening” emergency medical condition, including active labor and delivery, that is verified by a doctor’s statement.

The applicant must apply for Family Medical Assistance at the time of each “life or limb threatening” medical condition. This program covers emergency delivery only – prenatal care is not covered.

Medicaid Psych < 21

Children under age 21, receiving active treatment as an inpatient in a psychiatric facility are eligible for Medicaid benefits. Children are eligible if their individual income is within the AFDC Need Standard limits (see page 17). Children are eligible to receive benefits for 12 months, if they continue to meet the above criteria, and need to reapply annually.

Medicaid Home & Community

Based Service Waiver Programs

In addition to other Medicaid program categories, there are several Medicaid Waiver Programs that provide Medicaid benefits to specific populations with special needs who meet specific eligibility criteria. These waivers can provide in-home services for individuals who qualify both financially and functionally. This program is designed to help individuals stay in the least restrictive environment possible. Waiver Programs are not mandated by the federal government, must be cost effective, and can limit enrollment. The Waiver Program Categories are listed below.

For more information about the Medicaid HCBS Waiver Programs, contact local county departments of social/human services (see back of this guide, Appendix II) or the enrollment number listed below for each program.

Children’s Home and Community Based Waiver (HCBS)

This waiver program provides Medicaid benefits in the home or community to disabled children who would otherwise be ineligible for Medicaid due to excess parental income and/or resources. Children, ages birth through 17, who are critically ill or disabled, not eligible for SSI due to parents’ income, and who are at risk of nursing facility or hospital placement are eligible. Functional eligibility is determined by Single Entry Point (SEP) Agencies, Community Centered Boards or other Case Management Agencies (see Appendix IIII). For more information, call 303.866.4770.

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Children’s Extensive Support Waiver (CES)

This waiver program provides children with developmental disabilities or delays, or who are most in need due to the severity of the disability, with Medicaid benefits and additional targeted services and supports. Children, birth through age 4, with a developmental disability or delay, with intensive behavioral or medical needs and who are at risk of institutionalization are eligible. Functional eligibility is determined by the Community Centered Boards (see Appendix I, back of guide). For more information, call 303.866.7467 or 303.866.7455.

Children’s Habilitation Residential Program Waiver

This waiver program provides residential services to children and youth in foster care who have a developmental disability and extraordinary needs. Children, from birth to 21 years of age, who are at risk for institutionalization, and who are placed through the county departments of social services, have a developmental disability and extraordinary service needs, and for whom services cannot be provided at the county negotiated rate are eligible. To apply, contact the county department of social/human services for chil-dren/youth in out-of-home placement (see Appendix II). For more information, call 303.866.3546.

Brain Injury Waiver (BI)

This waiver program provides two levels of care for persons with a brain injury. Level 1 waivers provide persons with a recent brain injury with Medicaid benefits to promote an early discharge from a hospital or rehabili-tation environment. These individuals must be in the process of discharging from a hospital, rehabilitation hospital, or rehabilitation facility. Level 2 waivers provide people with a brain injury who have maximized their rehabilitation potential and need specialized nursing and long-term care in the community. Individuals, ages 16 through 64, with a brain injury within an approved range of diagnoses codes are eligible. Functional eligibility is determined by the SEP agencies (see Appendix IV) and must meet the hospital or rehabilitation facility level of care. For more information, call 303.866.3728.

Mentally Ill Waiver (MI)

This waiver program provides persons with major mental illness with a community alternative to nursing facility care. Individuals, age 18 and older, with a diagnosis of a major mental illness are eligible. Functional eligibility is determined through the Single Entry Point (SEP) agen-cies (see Appendix IV). For more information, call 303.866.3728.

Persons Living with AIDS Waiver (PCWA)

This waiver program provides persons with HIV/AIDS with a community alternative to nursing facility or hospital care. Individuals of all ages with an HIV/AIDS diagnosis are eligi-ble. Functional eligibility is determined through the Single Entry Point (SEP) agencies (see Appendix IV). For more information, call 303.866.2148.

Elderly, Blind and Disabled Waiver (EBD)

This waiver program provides elderly, blind, and disabled persons with a community alternative to nursing facility care. Individuals with a functional impairment (aged 65+) and blind persons or physically disabled (ages 18-64) are eligible. Functional eligibility is determined at the Single Entry Point (SEP) agencies (see Appendix IV). For more information, call 303.866.3728.

Supported Living Services Waiver (SLS)

This waiver program provides persons with developmental disabilities with supported living in the home or commu-nity. Individuals, age 18 or older, who are developmental-ly disabled and can either live independentdevelopmental-ly with limited supports or who, if they need extensive supports, are already receiving that high level of support from other sources, such as family, are eligible. Functional eligibility is determined by the Community Centered Boards (see Appendix I). For more information, call 303.866.7459 or 303.866.7455.

Developmentally Disabled Waiver (DD)

This waiver program provides persons with developmental disabilities with services and supports out of the family home, which allow them to continue to live in the com-munity. Individuals, age 18 and older, who require exten-sive supports to live safely, including access to 24-hour supervision, who do not have other resources for meeting those needs, and who meet the intermediate care facility mentally retarded level of care, are eligible. Functional eligibility is determined by the Community Centered Boards (see Appendix I). For more information, call 303.866.7460 or 303.866.7455.

Consumer-Directed Care for the Elderly

This waiver program will serve disabled elderly persons, ages 55 and older, who are new or current Medicaid Elderly Blind Disabled clients and will allow clients to direct their own care and choose their own attendant sup-port. Functional eligibility is determined through the Single Entry Point (SEP) agencies (see Appendix IV). For more information, call 303.866.3358.

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MEDICAL BENEFITS AND

PUBLIC ASSISTANCE PROGRAMS

SECTION TWO:

Health & Other

Programs, Providers & Resources

Additional Waiver Programs

In addition, there are several Waiver Programs that will be implemented in the coming years, including:

Children’s Autism Waiver

By 2006, this waiver program will serve children, birth through 6 years old, who have been diagnosed with autism and who meet the nursing facility level of care. Functional eligibility will be determined by the

Community Centered Boards (see Appendix I). For more information, call 303.866.4770.

Children’s Hospice Waiver

This waiver program will serve children, birth to 19 years, who are critically ill and are at a hospice level of care and receiving services from a hospice agency. The agency responsible for determining medical eligibility has not been determined yet. For more information, call 303.866.4654.

Medicaid – Previously Incarcerated Individuals

Individuals who have been paroled/released from incar-ceration in public institutions, correctional facilities, or community corrections programs, may apply for Medicaid benefits or may have benefits reinstated effective the release date, if they were Medicaid recipients prior to incarceration. Individuals who are currently inmates of public institutions, correctional facilities, or community corrections programs are not eligible.

Medicaid/Medicare

Clients can have both Medicare and Medicaid. Medicare is a federally operated program for individuals who are aged 65+ or who have been receiving Social Security Disability Insurance for 24 months. Medicare is the pri-mary payer before Medicaid. Colorado Medicaid will pay the Medicare Part B premiums for all clients who have Medicare (either Part A or Part B or both) and any Medicaid program, including the Medicare Savings Programs. Colorado only pays the Part A premiums for individuals who do not get Part A for free and have either active Part A (payable) or conditional Part A. This is called Medicare Buy-In.

Disabled Widow(ers)

Disabled widow(ers) are age 50 - 64 who lose Social Security Income (SSI) and/or Colorado Supplement due to receipt of Social Security Administration benefits as a disabled widow(er). Income limits are the SSI limits (see page 17).

Refugees

Individuals who are deemed by the Immigration and Naturalization Administration to be refugees, asylees or victims of trafficking receive Medicaid benefits during the first 8 months upon entry to the United States through the Refugee Medical Assistance program administered through the Colorado Refugee Services Program. For more information on these other Medicaid programs, contact the local county departments of social/human services or selected MA site or go to Appendix II or contact Medicaid customer service at 303.866.3513 (metro Denver) or 1.800.221.3943 (outside the metro Denver area).

Presumptive Eligibility

For Pregnant Women

The presumptive eligibility (PE) program allows pregnant women who meet an initial eligibility screening to receive pre-natal care during the process of verifying eligibility. PE eligibility is only determined at designated eligibility sites, to see a list of eligibility sites go to

www.cchn.org/ckf/EA_site_list.pdf

To qualify for PE, a woman must self-declare income at or below 200% of the Federal Poverty Level. In addition, she must provide documentation of legal immigration sta-tus or citizenship. Once enrolled in the PE program, all pre-natal care services will be provided for women

throughout the verification process. If enrollment eligibili-ty is properly verified, a woman will continue to receive health care services throughout pregnancy. If eligibility is not verified, the cost of prenatal services already provided will be covered but additional services will not be cov-ered. For additional information on presumptive eligibility benefits and enrollment contact the Department of Health Care Policy and Financing 1.800.221.3493 (out-side of Denver area) 1.300.866.3513 (in(out-side Denver-Metro area).

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Child Health Plan Plus (CHP+)

CHP+ is health insurance coverage for low-income children under 18 years of age, who are not eligible for Medicaid, and whose families have incomes at or below 205% of federal poverty level (see page 16). Coverage includes a comprehensive package of benefits designed specifically for children and youth. The Colorado Department of Health Care Policy and Financing manages this program through a contract with ACS State Healthcare L.L.C.

Eligibility

Children are eligible for CHP+ if they are • Less than 18 years of age;

• Financially qualified, which is above Medicaid eligibility and below 205% of federal poverty level.

• Colorado residents

• Born in the U.S. or are permanent legal residents of the U.S. who entered five years prior to the appli-cation and other catagories; and qualified aliens • Not residents of correctional or mental

institutions.

Children are not eligible if they are: • Eligible for Medicaid

• Eligible for state employees’ dependent health coverage

• Covered by employer-provided health insurance during the last three months, if the employer paid 50% or more of the premium, or

• Undocumented immigrants.

Note:An exception to the three month rule is if children lose coverage due to a parent’s loss of or change in employment.

Income

Children from families who are not receiving Medicaid and whose household income is below 205% of the federal poverty level (see page 16) may be eligible for the CHP+ program. Note: Certain expenses may be deducted from a family’s gross income, so families can make more than this and still qualify for CHP+.

To Apply

Applicants may apply for CHP+ by mail or in person at a county or a medical assistant site. There are two medical assistant sites, Denver Health Hospital and ACS

(Contractor) of the Colorado Department of Health Care Policy and Financing.

Applications are available at schools, provider offices, hospitals, or by going to www.cbms.state.co.us/links/ Clientinformation/Clientinformation.asp, health related events, churches, or other community based organizations. One pay check stub from the current month or the previ-ous month and a signed application and a social security number or an alien registration number (A#) are necessary for a Medicaid or CHP+ application.

Eligibility is to be determined within 45 days from the date of the receipt of the completed application at a county, MA site or Satellite Eligibility Determination (SED) site or the Contractor. A child is enrolled in CHP+ if found to be eligible the date the completed application is received. A family has the right to appeal if they feel they were wrongly denied.

FAMILY SIZE MONTHLY INCOME

1 $1,744 2 $2,339 3 $2,933 4 $3,528 5 $4,122 6 $4,717

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MEDICAL BENEFITS AND

PUBLIC ASSISTANCE PROGRAMS

SECTION TWO:

Health & Other

Programs, Providers & Resources

Services

CHP+ covers

• Medical office visits to doctors and clinics for preventive, primary, acute and specialty care, including well child care and immunizations • Emergency care, urgent and after-hours care • Inpatient and outpatient hospital services • Behavioral and mental health care

• Home health care and skilled nursing facility services • Prescriptions

• Dental care with services limited to $500 per year • Limited coverage for: vision and audiological services;

alcohol and substance abuse services; physical, occupational, and speech therapy services; durable medical equipment; and transplant services. Depending on the geographic area in which an enrollee lives, services are provided either by a Health

Maintenance Organization or network of providers that are managed by the state. Children are covered for a full year unless they become eligible or enrolled in Medicaid, or the family becomes insured or moves out of Colorado.

Cost

CHP+ families may pay a small annual fee and a small co-payment per medical visit, determined by their family size and income. The fees may not exceed 5% of annual income.

• For those below 100% of the federal poverty level (FPL), the premium and copayments are waived. • Families below 151% of FPL have no enrollment fee,

but pay a small co-payment for provider visits and dental procedures, other than preventive care. • Families with incomes between 151% and 185%

of FPL pay an annual enrollment fee along with small co-payments for provider visits and dental procedures.

Depending on family size and income, some families have to pay an annual enrollment fee. The cost is:

• $25 to enroll one child for a year if the family’s income exceeds 151% and is below 185% FPL • $35 to enroll two or more children for a year if the family’s income exceeds 151% and is below 205% FPL.

Depending on family size and income, some families have to make co-payments at the time of services. Generally co-payments will be:

• $1-$5 per visit for medical care

• $3-$15 for urgent and emergency care, and • $5 per procedure for fillings and extractions. There are no fees charged to clients for preventive medical and dental care, including check-ups, shots, teeth cleanings and dental x-rays, which encourages the use of cost-effective preventive services.

For More Information

For more information about CHP+ in the Denver Metro area, call 1.800.359.1991 or go to www.cchp.org. For more information about applying to CHP+ through CBMS, go to www.cbms.state.co.us/links/

Clientinformation/ Clientinformation.asp.

Old Age Pension Program

The Old Age Pension (OAP) program was established in 1937 to provide basic retirement income, health care coverage, and cash benefits to individuals aged 60 years and older. There are 3 categories of assistance for the program - A, B, and C. In addition to the 3 Old Age Pension program categories, individuals may be eligible for the OAP Health & Medical Program (see below) or the OAP Dental Program (see page 60).

Eligibility

To qualify for OAP benefits, individuals must: • Be age 60 or older

• Be a resident of Colorado

• Have total gross income below approximately 80% of federal poverty level (see page 16), contact county department of social/human services for exact income requirements and for more information.

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Categories of Assistance, Eligibility, & Benefits

OAP-A

The largest of the three categories, serves individuals: • Age: 65 and over

• Income Limit: $604 per month

• Countable Resource Limit: $2,000 – Individual $3,000 – Couple

• Benefit(s): Includes income, cash and medical coverage

OAP-B

This program serves individuals: • Age: 60 to 64 years of age • Income Limit: $604 per month

• Countable Resource Limit: $2,000 – Individual $3,000 – Couple

• Benefit(s): Includes income, cash and medical coverage

OAP-C

This program serves individuals in state institutions (the Colorado Mental Health Institutes), who receive no Medicaid or OAP Health and Medical Program benefits (see below), including:

• Age: 60 and over

• Income Limit: $604 per month

• Countable Resource Limit: $2,000 – Individual $3,000 – Couple

• Benefit(s): Financial assistance only – No Medicaid or OAP Health and Medical Care Program (see below) • Other Requirements: Must be a resident in a

Colorado Mental Health Institute – Ft. Logan or Pueblo

OAP Health and Medical Care Program

The Old Age Pension (OAP) Health and Medical Care Program is a state-funded program that provides limited medical care for individuals participating in the Old Age Pension program (see above) that are not eligible for Medicaid. The Old Age Pension benefits require that health and medical services be provided to anyone who qualifies to receive an Old Age Pension cash payment and who is not a patient in an institution for tuberculosis

or mental health diagnosis. Clients are eligible for the OAP Health and Medical Care Program who meet the income, financial resources and residency criteria of the OAP program, who do not qualify for Medicaid, and who are either:

• Age 60-64 and not eligible for Social Security Disability or

• Age 65+.

The Old Age Pension program provides some coverage for inpatient hospital care, physician services, emergency medical transportation, home health services, laboratory and x-ray services, outpatient services, pharmacy, and emergency dental services. In addition, clients are eligible to apply for the Colorado Indigent Care Program (CICP, see page 34), for benefits not covered by the OAP Health and Medical Care program.

Adult Foster Care

The Adult Foster Care program provides care on a 24-hour basis to frail elderly, physically or emotionally disabled adults, 18 years of age and over, who do not require 24-hour medical care in licensed Assisted Living Residences. The Assisted Living Residencies must meet all applicable federal, state, local laws and regulations, and have been certified by the Colorado Department of Health Care Policy and Financing or its designee as a provider of Adult Foster Care Services. Services provided include but are not limited to:

• Availability of three balanced meals per day with provision for special diets when those diets have been prescribed as part of a medical plan • Assistance with transportation

• Protective oversight

• Assistance with basic personal tasks such as bathing, hair care, and dressing

• Supervision of self-administration of medications

• Housekeeping services such as changing of bed linen, cleaning of living areas, and rearrangement of furniture as needed to promote freer mobility • Laundering of residents’ clothing and bedding, and • Opportunities for structured recreational

References

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