HealthColorado.org - Your Medicaid Choice
HealthColorado.org - Your Medicaid Choice
What is a FAQ??
An FAQ is a list of questions and answers. You can find many answers to common questions here.
EPSDT is a special Medicaid program for children, teenagers and young adults up to age 20. EPSDT provides regular checkups, shots, doctor visits and any other treatment and services that the doctor says is medically necessary for the child, teen, or young adult.
All children, teens and adults who get Medicaid can get EPSDT services. They do not have to do anything to join EPSDT.
EPSDT stands for Early, Periodic, Screening, Diagnosis and Treatment.
EPSDT covers all of these services, and any others that the doctor says are medically necessary:
A Behavioral Health Organization (BHO) can provide your mental health care. You do not need a referral from your doctor to go to your BHO.
You do not need to enroll in a health plan to get mental health care. You can get mental health care from the Behavioral Health Organization (BHO) in your area. If you need mental health services, call the BHO in your area:
Denver
Colorado Access Behavioral Care
1-800-804-5008
Adams, Arapahoe, Douglas
Behavioral Healthcare, Inc.
303-889-4805 or 877-803-4494
Boulder, Broomfield, Clear Creek, Gilpin, Jefferson
Foothills Behavioral Health
303-432-5950 or 866-245-1950
Cheyenne, Elbert, Kit Carson, Larimer, Lincoln, Logan, Morgan, Phillips, Sedgwick, Washington, Weld, Yuma
Northeast Behavioral Health
970-347-2366 or 888-296-5827
Alamosa, Archuleta, Baca, Bent, Chaffee, Cheyenne, Conejos, Costilla, Crowley, Custer, Delta, Dolores, Eagle, Fremont, Garfield, Grand, Gunnison, Hinsdale, Huerfano, Jackson, Kiowa, Lake, La Plata, Las Animas, Mesa, Mineral, Moffat, Montezuma, Montrose, Otero, Ouray, Phillips, Pitkin, Prowers, Pueblo, Rio Blanco, Rio Grande, Routt, Saguache, San Juan, San Miguel, Summit
Colorado Health Partnerships
303-751-9030 or 800-984-9133
Doctors think you should bring children in for regular checkups and shots at these ages:
A special health care need is a health problem, developmental delay, or lifetime disability. Children with special health care needs often need extra services, supplies and equipment, and Medicaid will pay for them.
Open Enrollment is the time of year that you can change plans for any reason. Open enrollment is the two months befor your month of birth. Each member of your family on Medicaid may have a different open enrollment period each year.
A PAR (a Prior Authorization Request) is a form that gives permission to get extra services and supplies if you have a special health care need. The Primary Care Physician must sign the PAR services or equipment are received.
A service is medically necessary if it will correct or improve physical or mental health problems.
A referral is permission from a Primary Care Physician to visit another provider.
A Primary Care Physician is a doctor or clinic that you choose to be your regular doctor or clinic. Your Primary Care Physician will get to know you and your health care needs.
A health plan is a place where you go regularly for medical care, and where you have a Primary Care Physician.
A managed care organization (MCO) is a group of doctors, clinics, hospitals, pharmacies and other providers who work together to take care of their members health needs
An emergency is a medical crisis that you think is very serious. For example, a lot of bleeding, trouble breathing, or an injury that could be life-threatening.
A co-pay is a small amount of money that you pay for the cost of your medical care. Medicaid pays most of the cost of your care, but you may have to pay a small amount. Children 18 and under do not pay co-pays.
An Outreach Coordinator is a worker in your area who can help you learn about EPSDT services for children.
If you live in the Denver Metro area, you can call 303-866-6006 or 303-866-6167. If you live outside of Denver, you can call 1-800-221-3943. The call is free.
An Ombudsman is a state worker whose job it is to help solve health care problems. You can call the Ombudsman if you have a problem with the quality of health care or if you want to make a complaint and file a grievance or appeal.
A provider is a health care worker who gives people services, such as a doctor, nurse, pharmacist, or dentist.
A HealthColorado counselor is a worker who answers the HealthColorado phone and helps people on Medicaid find a health plan and doctor.
You can do these things:
If your problem is with your doctor, you can change doctors if you wish. Call your health plan to change, or, if you are in the PCPP, call HealthColorado.
If you live in the Denver Metro area, call 303-839-2120. If you live outside of Denver, call 1-888-367-6557. The call is free. If you use a TTY, call 1-888-876-8864
If you are in a managed care health plan or the Primary Care Physician Program, call the Ombudsman. In the Denver Metro area call 303-830-3560 or outside of Denver call 1-877-435-7123.
Yes. Everyone has different health care needs. You can choose a different Medicaid health plan and primary care doctor for each eligible member of your family.
You do not need to enroll in a health plan to get mental health care. You can get mental health care from the Behavioral Health Organization (BHO) in your area. If you need mental health services, call the BHO in your area.
Basic Medicaid covers medically necessary services such as:
Some benefits are not normally covered or need special approval:
If you lose Medicaid and then get it back within 60 day, Medicaid will keep you enrolled in the health plan you had before you lost Medicaid.
If you have other insurance, give your county technician your insurance information as soon as you know. Always show your Medicaid card and your other insurance case each time to see a doctor. You should never pay more than the Medicaid co-pay if you show both your Medicaid card and your other insurance card.
If you are temporarily out of the state but still a resident of Colorado, you may receive some Medicaid benefits under some conditions:
The doctor/hospital that treats you must enroll in the Colorado Medicaid Program. Please have that doctor work with The Department's Fiscal Agent (ACS) so that reimbursement is guaranteed.