Coloradans with health coverage through Medicaid are facing a looming requirement for the first time in three years: Over the coming 12 months, they will need to prove they are still eligible for the program.
This wasn’t the case during the height of the COVID pandemic, when the federal government told states not to disenroll anyone from Medicaid. This was done to make sure as many people as possible had health coverage with which to face down the coronavirus. But now that the officially designated federal public health emergency is coming to an end, Medicaid eligibility redeterminations will start back up.
We at The Sun recently hosted a panel discussion for people facing an eligibility renewal. What do you need to know to stay on Medicaid? How can you maintain some kind of health care coverage if you are no longer eligible? What help is available if you worry about being able to pay for private insurance?
Here are answers to some of the major questions from that event. You can watch the whole thing — it’s a little over an hour — on The Colorado Sun’s YouTube page. (Closed-captioning is available, and it can be configured to automatically translate into Spanish or other languages using the YouTube settings menu.)
What’s happening with Medicaid eligibility?
There is no change to what makes someone eligible for Medicaid — in fact, the income thresholds to qualify went up this year, meaning more people may be eligible based on what they earn. What is different is that people on Medicaid will need to fill out an eligibility renewal packet to confirm that they still qualify.
The state added about 500,000 people to its Medicaid rolls during the pandemic, bringing the total number of people on Medicaid in the state to more than 1.7 million people.
Kim Bimestefer, the executive director of the state Department of Health Care Policy and Financing, which administers Medicaid in Colorado, said her department estimates that more than 80% of people currently receiving Medicaid coverage will remain eligible.
But the roughly 20% of people who won’t be eligible to renew — approximately 325,000 people, Bimstefer said — will need to find new coverage options.
“What’s different is people could lose their coverage for the first time in three years if they don’t act on the renewal process,” Bimestefer said.
Eligibility redeterminations are also starting back up for people covered by the Child Health Plan Plus, or CHP+, which covers kids and pregnant people whose families make slightly over the income threshold for Medicaid.
When does this happen?
The renewals will not happen all at once. A person’s specific renewal date falls on the anniversary of when they became eligible for Medicaid.
The state has already sent out renewal packets to about 65,000 people whose renewal dates are in early May. But those with later renewal dates won’t receive theirs until later in the year — or even into 2024, if their anniversary date falls in the first months of the year.
What is the most important thing I can do right now?
“The most important thing you can do right now is make sure that Health First Colorado, that we have your updated address,” Bimestefer said.
This is important because renewal paperwork will come via mail — though the department will also send updates via email or text, if that contact information is provided, as well.
To update your address, log into your account on Colorado PEAK, which is the state’s online Medicaid consumer portal.
How does the renewal process work?
People with coverage through Medicaid should look for their renewal packet in the mail 60 days before their Medicaid anniversary month.
“It’s labeled in big red letters: ‘URGENT — PLEASE REPLY,’” Bimestefer said.
Fill out the paperwork and send it back. Renewals can also be completed online using your Colorado PEAK account.
If for some reason you don’t do this before your coverage expires, Bimestefer said the state and county governments are aiming to turn around re-applications in 15 days.
Some people will be automatically renewed, based on state checks with various databases. Instead of receiving a renewal packet, they will be informed of their automatic renewal prior to their anniversary date.
Sample renewal packets in English and in Spanish can be found on this website.
How do I know if I am still eligible for Medicaid?
There can be a lot of technical details that go into determining Medicaid and CHP+ eligibility, so it is best to ask specific questions to the department directly.
But, for many people, Medicaid and CHP+ eligibility is income-based. For 2023, single-person households with income of up to $19,392 per year are eligible for Medicaid, while the income max for a family of four is $39,900. For CHP+, those figures are $38,637 and $79,500.
Where can I find health insurance if I’m no longer eligible for Medicaid?
First, check to see what kind of coverage is available to you.
Do you have a job where your employer offers health insurance to workers? Reach out to the company HR department to figure out if that coverage is an option for you.
Are you 25 years old or younger? You are eligible to be on your parents’ health insurance plan.
Are you eligible for Medicare?
If those are not options for you and you need to buy health insurance on your own, you can use the state’s Connect for Health Colorado platform. Connect for Health is an online exchange — sort of like Amazon for health insurance. You can set up an account, enter some information about yourself and see coverage options in your area.
What if I can’t afford health insurance?
State officials encourage people who think they may not be able to afford insurance to shop for plans on Connect for Health anyway. There is a lot of financial help available if you need to buy insurance on your own.
Kevin Patterson, CEO of Connect for Health, said three-quarters of the people who shop on his platform qualify for federal tax credits to help cover the upfront cost of insurance premiums. The tax credits are advance tax credits, meaning they immediately reduce the price of coverage. After those tax credits are applied, the average premium price on Connect for Health is $135 per month for an individual — though that will vary depending on your age and where you live.
For some people, plans are available for as little as $20 a month. There is also financial support to help pay the back-end costs of using your insurance, such as deductibles, copays and coinsurance. The lower your income is, the more financial help there is available to you.
“It’s going to be really important for people to go on to Connect for Health Colorado and shop,” Michael Conway, the state’s insurance commissioner, said.
There are a number of people available to help navigate the health insurance market, starting with brokers.
Health insurance brokers work at no additional cost to consumers — they get paid by commissions from insurance companies and those commissions are built into the price of the premiums everyone pays.
Meagan Fearing, a health insurance broker and the president of the Colorado State Association of Health Underwriters, said brokers can help consumers figure out which insurance plans cover certain doctors or medications. They can also help consumers find financial help to pay for their coverage — including on Connect for Health.
“I can’t tell you the number of times I’ve had someone who is genuinely shocked that they qualify for anything because they think, ‘Oh, I’m middle income,’” Fearing said. “Just check and see if you qualify for something.”
You can find a broker by using the National Association of Benefits and Insurance Professionals’ lookup tool.
Connect for Health also has a network of “assisters” who can help with finding coverage on the exchange. To find one, use the lookup tool on its website.
This is really overwhelming. Is there someone who can help me?
How do I make sure my doctor or medicine is covered by my new insurance?
Connect for Health’s Quick Cost and Plan Finder tool allows you to search for plans that include certain doctors and medications. (Click the tiny green button in the far upper right of the page to translate it into Spanish.)
But if you really want to be sure that your doctor or medication is covered, seek out a broker, since they are skilled at reading the fine print of health insurance plans.
“They will help you analyze the market, understand what a carrier’s customer service looks like, what you can expect from that carrier, what their network looks like, what their pharmacy benefit looks like as far as formulary — are your drugs going to be covered — is your doctor in network, all of those key things that people need to know before they ultimately select a plan,” Fearing said.
How long do I have to find new insurance if I lose Medicaid coverage?
Ordinarily, there are only certain times during the year when people can buy or change insurance coverage. This is called the open enrollment window, and in Colorado it typically runs from November to January.
That is not a concern for people who will be shopping for insurance after losing Medicaid coverage.
The state has created a 16-month special enrollment window that runs from April 1 through July 2024. People who lose Medicaid coverage as a result of the end of the federal public health emergency will be eligible to buy a new insurance plan throughout that period.
Where can I find more information?
The state has set up a website with information for people on Medicaid at KeepCOCovered.com.
You can also learn more by watching the recording of our panel discussion with state leaders on this topic. Again, you can find the video on The Sun’s YouTube page.
Hang in there and don’t give up. This is important.
The next year will likely see the greatest upheaval in the health coverage world since the start of the Affordable Care Act a decade ago.
And, as even the state’s foremost experts on the topic acknowledge, health insurance is super complicated and not easy for people to deal with. That can produce an understandable urge to just bail on the whole thing and try to get by without insurance.
But it is vital for the health of the community — and for your family’s personal and financial well-being — to have coverage.
“It’s going to be overwhelming, folks; it’s going to feel overwhelming at first,” said Conway, the insurance commissioner. “But there are tools in everything we talked about that are out there to help. And there are people who want to help.”