| Group |
Income Eligibility |
| Children |
200% FPL |
| Pregnant Women |
200% FPL |
| Parents |
60% FPL |
| SSI Disabled (non-elderly) |
74% FPL |
Medicaid, SCHIP, and Federal Authority2
HIFA Waiver - In 2002, Colorado received approval from CMS for a HIFA demonstration to cover adult prenatal coverage under the SCHIP program, CHP+. The waiver, amended in 2005 to increase eligibility, provides coverage to uninsured pregnant women with incomes between 134 percent and 200 percent FPL who are not otherwise eligible for Medicaid and SCHIP.
High-Risk Pool
Colorado 's high-risk pool, CoverColorado, became operational in 1991. The pool has a premium cap of 150 percent of market rate for similar coverage and is financed by the state's unclaimed property trust fund, premiums paid by recipients, and a premium tax credit. For recipients who earn less than $50,000 per year, premium subsidies may be available. Premium discounts represent an approximately 20 percent reduction from the standard PPO rate. As of June 2006, just over 5,000 persons were enrolled in the program.
Limited-Benefit Plan
In 2003, the Colorado legislature passed HB 1164, which requires carriers in the small group market to offer one of three basic health benefit plans: Basic Health Benefit Plan without specified mandates; Basic High Deductible Health Benefit Plan; or Basic High Deductible Plan without specified mandates.
Dependent Coverage
Effective January 1, 2006, unmarried children are considered dependents and remain eligible for health insurance until their 25th birthday if they: a) maintain the same legal residence as the parent; or b) are financially dependent on the parent. Dependent coverage is paid for by policyholder premium.
Children previously maintained dependent status only as full-time students up to age 24.
Information presented in the profile was summarized in December 2006 from a review of state Web sites and reports, and through contacts with state officials. In most cases the profiles were reviewed by state officials; however, it is possible that states have implemented strategies that are not reflected in this profile. |
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| 1 This overview provides a general description of state coverage levels under their Medicaid and SCHIP programs, including coverage through waivers, as of October 2006. Health Management Associates researched eligibility information from state web sites, data from state reports, and verified through contacts with state officials during the fall of 2006. This does not reflect the specific eligibility categories or requirements. This is not intended to be a substitute for eligibility information provided by each state. Individuals interested in applying for these programs should contact the state directly for specific eligibility requirements. |
2 The profile only includes Medicaid and SCHIP waivers intended to make comprehensive expansions to the uninsured. At this time, the profiles do not include Family Planning, Pharmacy Plus waivers, or long-term care waivers. |
3 Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2005 and 2006 Current Population Survey. |
| 4 Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends. 2004 Medical Expenditure Panel Survey-Insurance Component. |
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