Colorado Medicaid Approved to Expand Medicaid Coverage through Continuous Eligibility

New policy will improve health coverage access and outcomes for children 0-3 and adults released from state prison

FOR IMMEDIATE RELEASE

November 15, 2024

Media Contact
Marc Williams
Public Information Officer
720-626-0801 (Cell)

Denver, CO - Today, the Department of Health Care Policy & Financing (HCPF) announced it has received approval from the Centers for Medicare & Medicaid Services (CMS) to extend CHP+ and Medicaid coverage eligibility for two groups of Coloradans, a change made possible by an amendment to Colorado's Expanding the Substance Use Disorder Continuum of Care 1115 demonstration waiver.

Through HCPF's coordinated efforts with policymakers, other state agencies, providers, and patient advocates, Colorado has prioritized continuous eligibility as a way to ensure that Medicaid members are getting timely access to the health care they need with as few barriers as possible.

The policy will support continuous coverage for children from birth to age three who are eligible for Health First Colorado (Colorado's Medicaid program) or Children's Health Insurance program (CHP+). This expands continuous coverage for young children to 36 months, rather than the current continuous coverage of 12 months.

CMS also approved Colorado's request to allow adults leaving a state prison to maintain continuous Medicaid coverage eligibility for 12 months regardless of any changes in income or other fluctuations. Both eligibility changes will be implemented on January 1, 2026.

Continuous eligibility is a policy that provides certain Medicaid and CHP+ enrolled children or adults continuous coverage, regardless of small or short-term fluctuations in household income or household size, with some exceptions. Coverage of children from birth up to age three assists children in healthy early development and strengthens overall mental health through regular connections with the health system. Additionally, ensuring 12-months of continuous coverage for previously incarcerated adults not only improves health outcomes and supports behavioral health, but may also improve public safety by reducing rates of recidivism.

"Enabling coverage for children ages 0-3 under Medicaid and CHP+ once they qualify can have a positive health impact on their health for the rest of their lives," said HCPF Executive Director Kim Bimestefer. "Maintaining coverage for people leaving prison for 12 months will improve their access to the mental health, substance use, and medical treatments and other Medicaid supports that increase the likelihood of their successful reentry into society. That benefits not only these individuals but our state and its residents as well."

The State's enrollment data in calendar years 2018 and 2019 shows that 20% of children ages zero to three experienced Medicaid or CHP+ coverage gaps. Through this amendment, HCPF expects to prevent coverage gaps for an average of 31,000 children over a 5-year demonstration period.

It is estimated that in 2023, there were more than 17,000 individuals incarcerated in 21 Colorado state prisons - many of whom are at a high risk of hospitalization and overdose during their re-entry into the community. Recent state data has shown an 11% improvement in engagement in behavioral health services within the first two weeks of release. By connecting people leaving incarceration with physical and behavioral health care and making sure they can continue to access care for 12-months following their release, the State expects to see a reduction in overdoses or people returning to prison.

Legislation from 2023 - Continuous Eligibility Medical Coverage (HB23-1300) - laid the groundwork to expand Colorado's continuous eligibility policies and also requires Colorado to design an implementation plan during 2025 to operationalize the approved amendment by January 1, 2026.

"We are proud to be able to support the health and wellbeing of our youngest children through this continuous eligibility expansion. We are also looking forward to supporting adults leaving incarceration by providing access to health care to help prevent recidivism" said Colorado Medicaid Director, Adela Flores-Brennan.

HCPF is committed to providing Coloradans access to affordable, high-quality care.

About the Colorado Department of Health Care Policy & Financing: The Department administers Health First Colorado (Colorado's Medicaid program), Child Health Plan Plus, and other programs for Coloradans who qualify. These health care programs now cover about one in four Coloradans. For more information about the Department, please visit hcpf.colorado.gov.