What is Colorado Medicaid?

Medicaid is a joint federal-state program, managed by the state and, subject to rules established by the Federal Social Security Administration. Unlike Medicare, Medicaid is a needs-based program a form of welfare. To receive Medicaid in Colorado, an application must be made to and approved by the county office of the Colorado Department of Health Care Policy and Financing (HCPF). There are many Medicaid insurance programs available in Colorado, from basic medical coverage to long-term nursing home programs. These programs have income and asset restrictions and, with limited exceptions, payback is usually required under the Colorado Medicaid Assistance Estate Recovery Program.

Who is Eligible to Receive Medicaid Benefits?

There are two areas or eligibility that must be met –Medical and Financial.  In other words, to qualify for Medicaid you have to be sick enough and poor enough. 

Medical The applicant must show that they are sick enough – that they require the help of another person to perform the basic activities of daily living. The Colorado HCPF defines the need as:

  • Requiring the aid of another person to perform personal functions required in everyday living, such as bathing, feeding, dressing, attending to the wants of nature, adjusting prosthetic devices or protecting himself/herself from the hazards of his/her daily environment, or

  • Being blind or nearly blind, or

  • Being bedridden, in that his/her disability or disabilities requires that he/she remain in bed apart from any prescribed course of convalescence or treatment, or

  • Being a patient in a nursing home due to mental or physical incapacity.calculator and pen on notebook with numbers

Financial The applicant must also be poor enough - qualifying under an asset test and income test. After the applicant meets the medical and financial requirements (sick enough and poor enough), then HCPF will look to see if the applicant made any gifts within the 5 years prior to meeting the medical and financial requirements and a penalty period will be assessed.  Basically this entails taking the amount of the gift and dividing it by the average cost of nursing home care in Colorado (the divestment penalty divisor) to determine the number of months of nursing home costs the gift would have covered.  Once the penalty period is assessed, it is up to the applicant to determine how they are going to manage during the assessed period. Once the penalty period is passed, Medicaid will begin contributions to pay for services.