The Colorado Consumer Health Initiative

Transcription

1 Our Members 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 health care for all Coloradans. Colorado Consumer Health Initiative is a coalition of over 200 consumer advocacy organizations and individuals committed to increased access to health care. Current Programs and Activities We engage 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. In addition, we have 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 health care for Colorado s most at-risk populations. For additional information, contact the Colorado Consumer Health Initiative at or inform@cohealthinitiative.org. This book 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.

2 Connecting Care and Health in Colorado: A Guide to Services For the Uninsured ACKNOWLEDGEMENTS The Colorado Consumer Health Initiative (CCHI) wishes to acknowledge Pilar Ingargiola & Barbara Yondorf for their research and writing of the first version of this guide. We would also like to acknowledge the Colorado Health Institute, the Colorado Department of Health Care Policy and Financing, the Colorado Department of Public Health and Environment and our many other community partners for their extensive help with our most recent update. Lastly, we would like to thank Margaret Hedelund and Chloe Benson who put many hours into updating this guide. Approximately 813,000 of Colorado s residents have no health insurance. This represents 17% of the population and 1 in 6 Coloradans, above the national average. Being uninsured often results 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. Approximately 78% of the uninsured population is comprised of working-age adults. Many employees are not offered health insurance through their workplace or cannot afford their share of the premiums. Coloradans without health insurance are also more vulnerable to economic loss. The cost of care for the uninsured is frequently passed on to the state, to employers, or to individuals with insurance. The purpose of this guide is to help uninsured individuals and families, health care providers, and other social services workers understand what healthcare options are available for the uninsured in Colorado. This guide provides information about Programs that pay for health care or help with health insurance, 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 including assistance with housing, energy, etc. 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 in metro Denver, or toll free at , elsewhere in Colorado. 4 COLORADO CONSUMER HEALTH INITIATIVE I CONNECTING CARE AND HEALTH IN COLORADO

3 Connecting Care and Health in Colorado: A Guide to Services For the Uninsured HOW TO USE THIS GUIDE This is a guide for consumers, consumer advocates, healthcare 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 three major sections: Section One includes eligibility and other program tables, and program summaries. Section One may be used for: An understanding of the changing healthcare environment and its effects on the safety 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 Two includes information on healthcare programs, providers, and other resources. Section Two may be used in identifying 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 Three includes a listing of safety net agencies and providers. Section Three may be used 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 guide entitled, The Colorado Guide to Free and Low Cost Health Care for Pregnant Women and Children published by The Piton Foundation. This version has been expanded to include information on safety net programs, resources and services for ALL consumers including adults, seniors, pregnant women, children and youth, disabled and special needs, and other populations. 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 with updates and corrections. A copy of the directory can be found on the CCHI website: Some of the providers in this directory may cap the amount of safety net services 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 patients. UPDATES? FAX I 5

4 Connecting Care and Health in Colorado: A Guide to Services For the Uninsured TABLE OF CONTENTS SECTION ONE: Update, Summaries & Tables Changes in Colorado s Healthcare Safety Net PAGE 9 Colorectal Cancer Screening Program Medical Benefits for Legal Immigrants Colorado Healthcare Affordability Act Summary of Programs, Populations Served & Page Numbers PAGE 12 Income Eligibility Charts and Standards PAGE 15 Eligibility At a Glance Table PAGE 16 Federal Poverty Guidelines PAGE 17 Income Guidelines PAGE 18 SECTION TWO: Health & Other Programs, Providers & Other Resources ` Medical Benefits and Public Assistance Programs PAGE 20 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 Assistance Supplemental Security Income 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

5 Connecting Care and Health in Colorado: A Guide to Services For the Uninsured Public Health Programs PAGE 42 Public Health Nurses Health Care Program for Children with Special Needs Ryan White AIDS & Related Programs Nurse Home Visitor Program Healthcare Providers PAGE 47 Health Clinics Hospitals Private Providers Long-Term Care PAGE 53 Long-Term Care Agencies and Providers Long-Term Care Programs and Services Long-Term Care Resources Mental Health PAGE 58 Payers of Mental Health Services Providers of Mental Health Services Mental Health 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 Services Housing Translation and Interpretation Environmental Justice Transportation Additional Resources and Programs SECTION THREE: Agency & Provider Listing Appendix I. Listing of Links to Important Resources PAGE 74 Appendix II. Listing of County Departments of Social Services PAGE 75 Appendix III. Safety Net Provider Listing by County PAGE 92 Appendix IV. Single Enry Point Site Listing PAGE 171 UPDATES? FAX I 7

6 SECTION ONE: Update, Connecting Care and Health in Colorado: A Guide to Services For the Uninsured HEADLINE Summaries & Tables SECTION ONE: Update, Summaries & Tables Section One includes an update on the healthcare safety net, eligibility and other program tables, and program summaries. Section One inclides: Changes in Colorado s Healthcare Safety Net Summary Table of Programs and Populations Served Eligibility At a Glance Table Income Eligibility Charts and Standards Summary of Programs by Population Program Summaries. 8 COLORADO CONSUMER HEALTH INITIATIVE I CONNECTING CARE AND HEALTH IN COLORADO

7 SECTION ONE: Update, Summaries & Tables CHANGES IN COLORADO S HEALTHCARE SAFETY NET The economic downturn has resulted in increases in unemployment and underemployment as well as indirect increases in the numbers of uninsured and underinsured individuals and families in Colorado. The impacts on the healthcare 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 populations 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 costs are shifted to meet the demand. 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 significantly. 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. 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 complications with the implementation of CBMS. The new system requires more information so the application and eligibility interview is longer than in the past. As a result, the department will be implementing a new user entry program called PEAK projected for introduction in April of PEAK is a user friendly program that will allow consumers to key in basic data and determine what benefits they are eligible for. Public Health Per Capita Funding State and local-public health budgets have continued to decline while federal funds have become increasingly categorical. 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 overburdened safety net. As of 2008, Colorado ranks 16th in the United States in terms of per capita state funding on Public Health. Colorado spent $241,227,800 in FY on public health or about or about $49.62 per citizen. Budget cuts in may reduce that figure. UPDATES? FAX I 9

8 CHANGES IN COLORADO S HEALTH CARE SAFETY NET SINCE 2004 SECTION ONE: Update, Summaries & Tables 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 used to fund: public health insurance expansion for Colorado families through the Child Health Plan Plus and Medicaid; comprehensive primary care through Community Health Centers and other clinics serving a high portion of uninsured; tobacco education, prevention and cessation programs; and prevention, early detection and treatment of cancer, cardiovascular and pulmonary diseases. As of August 2009, an executive order reallocated $15 million of Amendment 35 tobacco tax revenue to be diverted to pay for Medicaid. This is on top of $20 million the Colorado Legislature diverted from the Amendment 35 revenues earlier in The total $35 million is roughly 70% of the fund for these services. Colorectal Cancer Screening Program (House Bill ) Colorectal cancer is the second highest cause of cancer death among men and women. It is the only cancer type that can be prevented and cured through screening. The Colorado Colorectal Screening Program, passed in 2008, provides funding to carry out colorectal screenings for legal residents of Colorado. The program was awarded monies through a competitive grants program through the Colorado Department of Public Health and Environment s Cancer, Cardiovascular Disease and Chronic Pulmonary Disease Competitive Grants Program, which utilizes a portion of the state s tobacco tax revenue. Eligibility Criteria Age 50 or older (at average risk) or under 50 at increased risk for colorectal cancer (those having a personal or family history of cancer or polyps) Uninsured, or have insurance that does not cover ANY cost for endoscopic colorectal screening Household income below 250% of the Federal Poverty Level (FPL) Lawfully present in Colorado Patient in a partnering clinic Eligible for a colorectal screening according to American Cancer Society clinical guidelines To learn more about CCSP and to find out how to get screened for colorectal cancer in the program, visit To locate clinics participating in the program in your area, please call Medical Benefits for Legal Immigrants (House Bill ) Subject to sufficient appropriations and the receipt of federal financial participation, House Bill 1353, passed in 2009, authorizes the Colorado Department of Health Care Policy and Financing to provide benefits under Medicaid and the Children s Basic Health Plan (CBHP) to pregnant women and children who are legal immigrants without a waiting period, so long as other eligibility criteria are met. Previously, legal immigrants were not eligible for Medicaid or CBHP for 5 years after the date of entry into the United States. The University of Colorado Cancer Center (UCCC) at the Anschutz Medical Campus coordinates the program, which is based in over 65 community health clinics across Colorado. These community clinics will offer free endoscopic screenings to those who qualify. 10 COLORADO CONSUMER HEALTH INITIATIVE I CONNECTING CARE AND HEALTH IN COLORADO

9 SECTION ONE: Update, Summaries & Tables CHANGES IN COLORADO S HEALTH CARE SAFETY NET SINCE 2004 Colorado Healthcare Affordability Act (House Bill ) In 2009, the State Legislature passed HB , the Colorado Healthcare Affordability Act. This legislation will increase Medicaid eligibility for Colorado citizens beginning in After the federal Centers for Medicare and Medicaid Services (CMS) approve the hospital provider fee waiver (currently targeted for April 2010), Colorado will expand Medicaid eligibility as follows: 1) Increase eligibility for parents of Medicaid eligible children from 60% of FPL to 100% of FPL in the Spring of % of FPL is equivalent to an annual income of $10,830 for an individual or $22,050 for a family of four. 2) Provide eligibility for adults without dependents up to 100% of FPL in early ) Provide Medicaid Buy-In for disabled adults and children up to 450% of FPL by the summer of % of FPL is equivalent to an annual income of $48,735 for an individual or $99,225 for a family of four. 4) Provide 12 month continuous eligibility for Medicaid children by the spring of UPDATES? FAX I 11

10 SUMMARY OF PROGRAMS AND POPULATIONS SERVED SECTION ONE: Update, Summaries & Tables Summary of Programs and Populations Served PROGRAM SUMMARIES Medicaid PAGE 21 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. 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 clientinformation/pdfs/countydssandmadirectory.pdf Child Health Plan Plus PAGE 26 Child Health Plan Plus (CHP+) is health insurance coverage for low-income children under 19 years of age, who are not eligible for Medicaid, and whose families have incomes at or below 205% of federal poverty level (see page 17). Coverage includes a comprehensive package of benefits designed specifically for children and youth. You can call CHP+ Customer Service at For more information about applying for CHP+ go to Old Age Pension Program PAGE 28 The Old Age Pension program was established in 1937 to provide basic retirement income, healthcare coverage, and cash benefits to individuals aged 60 years and older. There are three categories of assistance for the program A, B, and C. In addition to the three OAP 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 or Appendix II. Adult Foster Care PAGE 29 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 (see Appendix II). Food Assistance Program PAGE 29 The Colorado State Food Assistance Program assists low income individuals and families who need assistance purchasing food. Individuals and families should apply for food stamp benefits at their local county department of social services. The Food Assistance Program is offered in at least one location in all Colorado counties. The county worker will interview applicants and determine the household eligibility for benefits. They will provide the applicant with a Quest card that can be used to purchase groceries 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 Supplemental Security Income Program PAGE 30 The SSI 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 Aid to the Blind/Aid to the Needy Disabled 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. 12 COLORADO CONSUMER HEALTH INITIATIVE I CONNECTING CARE AND HEALTH IN COLORADO

11 SECTION ONE: Update, Summaries & Tables SUMMARY OF PROGRAMS AND POPULATIONS SERVED Home Care Allowance PAGE 31 The Home Care Allowance (HCA) is a capped state program that provides direct client payments monthly 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. For more information on the Home Care Allowance, contact the local county department of social/human services, Appendix II or go to 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 sufficient 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, contact the local county department of social/human services, Appendix II, or go to 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. 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 and click on the Medicaid link. From there, click on the Colorado Indigent Care Program (CICP) link. Medicaid Breast & Cervical Cancer Program PAGE 35 The Breast and Cervical Cancer Program provides full Medicaid benefits to uninsured women up to the age of 64 who meet the eligibility requirements. Eligibility for this program is not determined through the CBMS system. To apply and determine eligibility, women must go to a Colorado Women s Wellness Connection (WWC) site in their local community to locate, call , or go to: state.co.us/pp/cwcci/index.html Ryan White AIDS Program PAGES 36 & 44 The Ryan White HIV/AIDS Program is a federal program that provides HIV-related health services. The program works with cities, states, and local community-based organization to provide services to more than half a million people each year. For more information or for contact information on the Ryan White AIDS program, go to page 36. Kaiser Connections PAGE 38 Kaiser Permanente s community service program, Connections, provides low-cost healthcare coverage for families who otherwise could not afford health care. For more information on Kaiser Permanente s Connections program, call or go to Early Intervention Colorado PAGE 39 Early Intervention Colorado 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 EI Colorado, call or go to: 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 UPDATES? FAX I 13

12 SUMMARY OF PROGRAMS AND POPULATIONS SERVED SECTION ONE: Update, Summaries & Tables their children. For more information, or to speak to someone about finding a provider call the Nurse Support Line at 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 or go to: regular, in-home, visiting nurse services to low-income, first-time mothers, with their consent, during their pregnancies and through their children s second birthday. For more information, call or go to 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 children up to 5 years of age. For more information on the WIC program and to find a local WIC program, contact or , or go to Health Care Program for Children With Special Needs PAGE 43 The Health Care Program for Children with Special Needs (HCP) is a resource for families, healthcare providers, and communities. The program goal is to improve the health, development, and well being of Colorado s children with special healthcare needs and their families by developing a system of healthcare services and supports for all families. These programs can have limits on the number of children that can be enrolled. For more information on the program, go to or call Nurse-Family Partnership PAGE 45 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 14 COLORADO CONSUMER HEALTH INITIATIVE I CONNECTING CARE AND HEALTH IN COLORADO

13 SECTION ONE: Update, Summaries & Tables INCOME ELIGIBILITY CHARTS & STANDARDS Income Eligibility Charts & Standards Summary of Programs by Population Below is a list of programs available by population category: PROGRAMS PREGNANT WOMEN NON- DISABLED CHILDREN & YOUTH LOW INCOME CHILDLESS ADULTS SENIORS DISABLED PARENTS PAGE NUMBER 1931 Family Medicaid X X X 22 Medicaid Baby Care Kids Care X X 22 Medicaid Home & Community Based Services X 24 Additional Medicaid X X X X 25 Child Health Plan Plus X X 26 Old Age Pension X X 28 Adult Foster Care X X X X 29 Supplemental Security Income X X 30 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 For women with cancer only 35 Ryan White AIDS X 36, 44 Kaiser Connections X X X 38 Early Childhood Connections X X 39 Older Americans Acts Prorams X 40 Health Care Program for Children with Specials Needs X 43 Nurse Home Visitor Program Pregnant women and children up to age 2 45 Women, Infants and Children Program X X 64 UPDATES? FAX I 15

14 INCOME ELIGIBILITY CHARTS & STANDARDS SECTION ONE: Update, Summaries & Tables Eligibility At A Glance Table PROGRAM INCOME PAGE FOR MORE INFORMATION 1931 Family Medicaid 37% Federal Poverty Level (FPL) or less 22 Call local county departments of social/human services (Appendix II) or Transitional Medicaid 185 % FPL 22 same Four-Month Extended Medicaid Baby Care Kids Care (BCKC) Qualified Child & Pregnant Women AFDC Need Standard (disregarding child/spousal support income) AFDC Need Standard (disregarding child/spousal support income) 22 same 23 same Baby Care Kids Care (BCKC) Expanded Child & Pregnant Women - pregnant women and children 6 and younger Ribicoff BCKC - children over the age of 7 through the age of 18 Expanded Prenatal & Needy Newborn BCKC - pregnancy through the age of 1 Home & Community Based Service (HCBS) Waivers 133% FPL 23 same 100 % FPL 23 same 133% FPL 23 same 3 times the SSI limit 23 same Other Medicaid Programs Varies 25 same Child Health Plan Plus - pregnant women and children through the age of % FPL Old Age Pension Program SSI Income 28 Call local county departments of social/human services (Appendix II) or Adult Foster Care Varies 29 same Supplemental Security Income Varies Aid to the Blind/Aid to the Needy Disabled Varies 30 Call local county departments of social/human services (Appendix II) or Home Care Allowance Varies 31 same 16 COLORADO CONSUMER HEALTH INITIATIVE I CONNECTING CARE AND HEALTH IN COLORADO

15 SECTION ONE: Update, Summaries & Tables INCOME ELIGIBILITY CHARTS & STANDARDS 2009 Annual Poverty Guidelines (Effective January 23, 2009) For more information visit 48 Contiguous States & DC PERSONS IN FAMILY 60% FPL 73% FPL 100% FPL 133% FPL 205% FPL 219% FPL 250% FPL 1 $6,498 $8,642 $10,830 $14,404 $19,157 $25,479 $33,887 2 $8,742 $10,636 $14,570 $19,378 $25,773 $34,278 $45,590 3 $10,986 $13,366 $18,310 $24,352 $32,389 $43,077 $57,292 4 $13,230 $16,097 $22,050 $29,327 $39,004 $51,876 $68,995 5 $15,474 $18,827 $25,790 $34,301 $45,620 $60,675 $80,697 6 $17,718 $21,557 $29,530 $39,275 $52,236 $69,473 $92,400 7 $19,962 $24,287 $33,270 $44,249 $58,851 $78,272 $104,102 8 $22,206 $27,017 $37,010 $49,223 $65,467 $87,071 $115,805 Each add l. Add: $2,244 $2,730 $3,740 $4,974 $6,616 $8,799 $11,703 Income Eligibility for State Health Programs Eligibility for publicly financed health care services in Colorado Family Income as % of FPL >250% No subsidy for care or coverage FPL 250% 200% 205% 250% 219% Medicaid (Acute care & community mental health care) Family income as % of 150% 100% 50% 0% 133% Children % Children % Pregnant women 60% Adults 73% Elders and disabled Child Health Plan Plus (CHP+) Colorado Indigent Care Program (CICP) Medicaid Long-Term Care (Community & nursing facility) Source Chart: Colorado Health Institute *Additional program eligibility expected as a result of the Colorado Healthcare Affordability Act of See Page 11 for details. UPDATES? FAX I 17

16 INCOME ELIGIBILITY CHARTS & STANDARDS SECTION ONE: Update, Summaries & Tables AFDC Need Monthly Standard Income Guidelines (Effective April 1, 2009) For 1931 Family Medicaid & Qualified Pregnant Women & Children 1931 Need Standard (based on old AFC Need Standard from 7/16/96) # CHILDREN 0 ADULTS 1 ADULTS 2 ADULTS 0 $253 $357 1 $117 $331 $439 2 $245 $421 $533 3 $368 $510 $628 4 $490 $605 $716 5 $587 $697 $787 6 $678 $770 $861 7 $756 $844 $928 8 $830 $920 $1,009 Each Additional $67 $67 $67 Supplemental Monthly Security Income Guidelines (Effective January 2009) INDIVIDUAL IN OWN HOME $ INDIVIDUAL IN HOME OF ANOTHER $ COUPLE IN OWN HOME $1, COUPLE IN HOME OF ANOTHER $ ISM MAXIMUM CHARGE $ % LIMIT $2, COLORADO CONSUMER HEALTH INITIATIVE I CONNECTING CARE AND HEALTH IN COLORADO

17 SECTION TWO: Update, SECTION Health & Other A Guide SECTION TWO: Health & Other HEADLINE HEADLINE Connecting Care TWO: and Health in Colorado: to Services For the Uninsured Programs, Providers & Resources Summaries & Tables Programs, Providers & Resources SECTION TWO: Health & Other Programs, Providers & Resources Section Two includes information on healthcare programs, providers, and other resources. Section Two may be used to identify more in-depth information on: Medicaid Presumptive Eligibility Child Health Plan Plus Old Age Pension Program Adult Foster Care Food Assistance SSI Colorado Indigent Care Program UPDATES? FAX 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, and transportation I 19

18 SECTION TWO: Health HEADLINE & Other Programs, SECTION Providers TWO: Health & Resources & Other Programs, Providers & Resources MEDICAL BENEFITS AND PUBLIC ASSISTANCE PROGRAMS Colorado s children, adults, families, people with disabilities, and the 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 sites (see Appendix II for contact information). 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: 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 completed 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 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. How to Apply Individuals applying for Medicaid, public assistance, and other medical programs through CBMS may need to provide proof or documentation before being determined eligible for programs and services. These may include: proof of age, proof of income, proof of citizenship or alien status, proof of residency, proof of resources, or 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 applying for benefits for one of the public assistance or Medicaid programs, individuals and families may go to to download an application for medical benefits or for an application for other public assistance programs. People can also get some idea of whether they are eligible for benefits by going online and using PEAK (Program Eligibility and Application Kit) at: state.co.us/selfservice/. Colorado expects to expand PEAK so that people can apply for medical and other benefits online. 20 COLORADO CONSUMER HEALTH INITIATIVE I CONNECTING CARE AND HEALTH IN COLORADO

19 SECTION TWO: Health & Other Programs, Providers & Resources MEDICAL BENEFITS AND PUBLIC ASSISTANCE PROGRAMS Medicaid Medicaid is a federal and state financed program that provides health and long-term care coverage for lowincome children and their parents, the elderly and people with disabilities. The Colorado Department of Health Care Policy and Financing 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 sites (Appendix II). Applicants must meet financial eligibility criteria for one or more Medicaid program categories in order to qualify for benefits. In order to be eligible for Medicaid, an individual must: Be a Colorado resident Be a citizen or qualified immigrant. A qualified immigrant includes, but is not limited to, persons who have been legal permanent residents for more than 5 years of the U.S. or its territories, or are refugees or asylees. Fall within the established earned and unearned income limits for the Medicaid program category applied for (see Medicaid Program Category descriptions). Individuals and families might be eligible under more than one category of Medicaid. It is important to understand that just because someone is not eligible for one category, does not mean they might not be eligible for another. Anyone who is denied Medicaid eligibility or has their benefits terminated for any reason has a right to appeal. 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. An applicant does not have to be eligible in the month of application to receive Retro Medicaid, however 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 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 and treat health problems of children under age 21 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 nonemergency transportation services for children and adults. Providers Basic healthcare 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 UPDATES? FAX I 21

20 MEDICAL BENEFITS AND PUBLIC ASSISTANCE PROGRAMS SECTION TWO: Health & Other Programs, Providers & Resources 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 & applicants or contact Medicaid customer service at (metro Denver) or (outside the metro Denver area). Medicaid Program Categories Family and Children s Medicaid Eligibility Categories 1931 Family Medicaid 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) Family Medicaid also includes Transitional Medicaid and four-month Extended, see below. The 1931 Medicaid program enables families, including the father, mother, and children to be eligible for Medicaid. 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 Medicaid eligibility criteria (see page 20); Have household income less than or equal to the AFDC Need Standard (see page 18); Families must be eligible for, but do not have to apply for cash assistance to get 1931 Medicaid. Two-parent families can receive Medicaid as well as one-parent families. If a boyfriend/girlfriend is the biological or legal parent of the dependent child and is living in the home, then their income/resources are counted in determining household eligibility for Medicaid. Family definitions and whose income is counted for purposes of Medicaid eligibility can be complicated so check with your county or Medical Assistance site. Individuals eligible for 1931 Medicaid will be eligible for the basic Medicaid services. Transitional Medicaid Transitional Medicaid applies to clients who were on 1931 Medicaid 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 Applicants must work with their county department of social services or an MA site to provide Transitional Benefit Reports in the 4th, 7th, and 10th month of transitional benefits to remain eligible. Income cannot exceed 185% of FPL (see page 16) for the 7th through 12th month of transitional benefits. 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 four additional months of eligibility and continues the benefits and services provided under 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. BCKC is broken down into the following programs: Qualified and Expanded Child; Qualified and Expanded Pregnant Women; Ribicoff; Eligible Needy Newborn; and Legal Immigrant Prenatal. Pregnant women qualify for BCKC based solely on income and pregnancy status. The fetus is counted as a household member for purposes of determining income eligibility. 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 22 COLORADO CONSUMER HEALTH INITIATIVE I CONNECTING CARE AND HEALTH IN COLORADO

21 SECTION TWO: Health & Other Programs, Providers & Resources MEDICAL BENEFITS AND PUBLIC ASSISTANCE PROGRAMS 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 postpartum. 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 EPSDT services. 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 (see page 39). 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 18) 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 17) is eligible for the Expanded Child BCKC program. 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 18) 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 17) 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 (postpartum). Ribicoff BCKC The Ribicoff Medicaid program provides Medicaid benefits to children ages To be eligible, the household income for the child must be at or below 100% FPL (see page 17). The child will continue to receive benefits for 12 months if the child and household continue to 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. 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. Legal Immigrant Prenatal BCKC The Legal Immigrant 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 They are legal residents of the United States and Their portion of household income is at or below 133% FPL (see page 17). Services provided through the Legal Immigrant Prenatal Medicaid program 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 postpartum. Undocumented Residents - Emergency Medical Services Undocumented residents may be eligible for Family Medical Assistance benefits through the 1931 or BCKC Medicaid programs. Undocumented residents 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 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 UPDATES? FAX I 23