Colorado Medicaid Office

Colorado Medicaid office (HCPF)

Health First Colorado pairs every member with a primary care provider and one of four Regional Accountable Entities — Rocky Mountain Health Plans, Northeast Health Partners, Colorado Community Health Alliance, or Colorado Access — that coordinate physical, behavioral, and long-term care under the Accountable Care Collaborative model. The Colorado Department of Health Care Policy and Financing (HCPF) sets policy, manages the RAE contracts, and runs statewide programs; the 64 counties' Departments of Human Services handle eligibility determinations and in-person help.

What the RAE model means for members

Members work with their primary care provider for most care and turn to their RAE when they need help coordinating across providers, managing complex conditions, or accessing behavioral health and substance use disorder services. Members who can get most of their care met by their primary care provider may never need to interact with the RAE directly; members with more complex needs lean on it heavily.

Where HCPF directs different member tasks

• Apply, renew, report a change, check status — the PEAK portal (Colorado.gov/PEAK) is the front door for every benefits action.
• In-person and phone help with applications — the local county Department of Human Services or a local application assistance site; HCPF's Denver office does not handle in-person member support.
• Member Contact Center for current members — toll-free at 1-800-221-3943, State Relay 711, with reduced hours on state holidays and the third Thursday of each month.
• 24/7 medical advice — the Nurse Advice Line at 1-800-283-3221 is free for all Health First Colorado members.
• Mobile self-service — the Health First Colorado mobile app links to PEAK and lets members find providers, view their card, and update household information.

Who qualifies for Health First Colorado?

Health First Colorado runs as one program with several distinct income gates depending on who is applying. HCPF publishes the active thresholds on the Programs for Adults page; the population-specific limits below are pulled from that source. A single application screens applicants for both Health First Colorado and Child Health Plan Plus (CHP+), so families do not need to file separately for each program.

Income thresholds by population

• Children ages 0–18 — household income at or below 142% of the federal poverty level.
• Pregnant women — household income at or below 195% FPL.
• Parents and caretaker relatives (applicant must have a dependent child) — household income at or below 68% FPL.
• Adults without dependent children — household income at or below 133% FPL.

Coverage tracks for narrower populations

• Breast and Cervical Cancer Program (BCCP) — uninsured women ages 40–64 diagnosed with breast or cervical cancer (or precancerous conditions), with income under 250% FPL, who are not already enrolled in Medicaid and not eligible for Medicare.
• Emergency Medical Services (EMS, "Emergency Medicaid") — covers emergency services and family planning for people who meet all Health First Colorado eligibility rules except immigration or citizenship status.
• Family Planning Limited (FAMPL) — family-planning and related services for households whose income is between 133% and 260% FPL.
• Health First Colorado Buy-In for Working Adults with Disabilities (WAwD) — for working adults age 16+ with a qualifying disability whose family income is below 450% FPL; members pay a monthly premium based on income.
• Elderly, Blind, and Disabled (EBD) waiver — age 65+ with a functional impairment, or age 18–64 who are blind or physically disabled, at risk of nursing facility placement, with income under 300% of the SSI allowance and countable resources under $2,000 single or $3,000 couple.

Cover All Coloradans

Cover All Coloradans is a state-level program that extends Health First Colorado-style coverage to children and pregnant people regardless of immigration status. HCPF runs a dedicated FAQ for that program; eligibility tools route applicants there when applicable.

Health First Colorado income limits

HCPF publishes Health First Colorado income limits as percentages of the federal poverty level — the dollar amounts shift every January when FPL updates. Below are the published FPL anchors. For the current dollar threshold at your household size, the PEAK application gives an immediate eligibility readout when used online.

Health First Colorado income limits

Co-pays

Children under 19, pregnant members, and American Indian or Alaska Native members do not pay co-pays. Members age 19 and older not in those categories owe small co-pays that vary by service. Members in a nursing facility typically do not have co-pays. The agency's benefits overview lists co-pay amounts per service.

How to apply for Health First Colorado

HCPF runs Colorado Medicaid applications through PEAK, the same online benefits portal that handles SNAP, cash assistance, and other state programs. A single PEAK application screens for both Health First Colorado and Child Health Plan Plus (CHP+) — families with children whose income lands between the two programs don't have to apply twice.

Three apply channels

• Online at PEAK (Colorado.gov/PEAK) — the fastest path. HCPF states that online applicants may find out if they qualify immediately, while paper applications can take up to 45 days for an eligibility determination.
• By paper — the Application for Public Assistance (used for medical, food, and cash assistance) is downloadable from the HCPF site and returned to the local county Department of Human Services.
• By phone or in person — county Departments of Human Services and local application assistance sites help applicants by phone or face-to-face. The state's site directory maps the help sites.

Federal decision deadlines

Federal Medicaid rules require states to decide non-disability applications within 45 days and disability-based applications within 90 days. Pregnancy and presumptive-eligibility decisions move much faster — often same-day at qualified hospitals and clinics.

After approval

New members receive a Health First Colorado card by mail at the address on file. The Health First Colorado mobile app and the PEAK portal both display a digital version of the card; members can also request a replacement card from PEAK without calling. Newborns added to an existing case are automatically enrolled in coverage until their first birthday.

PEAK technical help

If a PEAK account itself has problems — login issues, password resets, error messages — the PEAK Technical Support Center is the place to call. It is separate from the Member Contact Center, which handles benefit questions for already-enrolled members.

What Health First Colorado covers

Health First Colorado covers the federally required Medicaid benefits and Colorado's state-option additions. HCPF summarizes the core program as doctor visits, prescriptions, mental health and substance use disorder services, dental, and lab work and x-rays. On top of those, several waiver programs and population-specific tracks add care that the standard benefit package alone doesn't include.

Core medical benefits

• Doctor visits, specialist care, and emergency services
• Hospital inpatient and outpatient care
• Prescriptions
• Mental health and substance use disorder services (through the member's RAE)
• Dental (a benefit for members of all ages)
• Lab work and x-rays
• Pregnancy care, including a free Nurse Advice Line and Non-Emergent Medical Transportation
• Breast pumps for pregnant members from week 28 forward and for postpartum members

Children under 21: EPSDT

HCPF covers the Early and Periodic Screening, Diagnostic, and Treatment benefit for Health First Colorado members age 20 and younger. EPSDT is a federal Medicaid mandate that requires states to cover any medically necessary service for a child even when the service isn't otherwise on the state's covered list. Co-pays are zero for children under 19; co-pays for youth 19–20 vary by service.

Managed care plans

Health First Colorado runs two managed care plans on top of the RAE structure. Both are county-restricted.

• Elevate (Denver Health) Medicaid Choice — available to members in Adams, Arapahoe, Denver, and Jefferson counties who want a Denver Health primary care provider.
• Rocky Mountain Health Plans PRIME — available to members in Garfield, Gunnison, Mesa, Montrose, Pitkin, and Rio Blanco counties. Most children cannot enroll in this plan.

Long-term services and supports

• Elderly, Blind, and Disabled (EBD) waiver — an alternative to nursing facility care, with adult day services, community transition services, consumer-directed attendant support, home modifications, and supplies and equipment.
• Supported Living Services (SLS) waiver — for adults 18+ with developmental disabilities at risk of intermediate-care-facility placement, with assistive technology, day habilitation, personal care, respite, and supported employment services.
• Program of All-Inclusive Care for the Elderly (PACE) — comprehensive Medicare/Medicaid managed care for adults 55+ who meet nursing-facility level of care and live in Adams, Arapahoe, Broomfield, Denver, Jefferson, Pueblo, El Paso, Delta, or Montrose county.
• Transition Services — help moving Health First Colorado members from nursing homes and intermediate care facilities back into the community.

Specialty programs alongside the standard benefit

• Emergency Medicaid Services — emergency care and family planning for people who meet income eligibility but don't have qualifying immigration status.
• Family Planning Limited (FAMPL) — birth control (including 12-month supply), long-acting reversible contraception, sterilization, STI/STD screening and treatment, and related preventive services for income-eligible adults.
• Health Insurance Buy-In (HIBI) — premium assistance for members with access to commercial coverage that is cheaper to subsidize than direct Health First Colorado coverage.
• Old Age Pension (OAP) Health and Medical Care Program — limited medical care for Coloradans getting Old Age Pension who don't qualify for Health First Colorado.

Other state Medicaid pages