Colorado Medicaid Law

Medicaid is a federally and state-funded health insurance program that states operate to provide assistance to qualifying low-income individuals, including the elderly, disabled, pregnant women and children. Colorado's Department of Health Care Policy and Financing oversees the rules and regulations for the state's Medicaid program.

Supplemental Security Income (SSI)

• If you are age 64 or younger and receive Supplemental Security Income (SSI), you are automatically eligible for coverage under Colorado's Medicaid program. SSI is available to elderly individuals who do not have a sufficient work history that involved paying Social Security taxes to qualify for retirement benefits and disabled individuals who do not have a sufficient work history to qualify for disability benefits. If you are currently receiving SSI and are not enrolled in Medicaid, contact your county Medicaid department for enrollment instructions.

HIPAA

• Colorado's Medicaid program adheres to the federal Health Insurance Portability and Accountability Act (HIPAA), which sets specific guidelines regarding protected health information (PHI). PHI may only be disclosed when written consent is provided by the patient. Individuals enrolled in Colorado's Medicaid program have the right to file a complaint to the Department of Health Care Policy and Financing if they believe that their rights have been violated.

Centers for Medicare & Medicaid Services

• The Centers for Medicare and Medicaid Services (CMS) is an agency under the U.S. Department of Health and Human Services responsible for oversight of Medicare and Medicaid rules and regulations. The Colorado Medicaid program is required to follow the guidelines set forth in CMS's State Medicaid Manual regarding eligibility determination, services covered, payment collection, quality control practices, utilization control and management information systems.

Residency

• In order to receive benefits under the Colorado Medicaid program, you must be able to prove your identity by submitting a state-, federally or military-issued photo identification card, birth certificate and Social Security card. You must be a resident of the state of Colorado and a lawful resident of the United States in order to be eligible for Medicaid benefits.

Income / Resources

• Colorado Medicaid regulations require that an individual meet specific income and resource limits to qualify for Medicaid benefits. The resource limit varies depending on the type of Medicaid, whether you are married and other factors, such as whether you are residing in the same room at a nursing home as your spouse or if your spouse is even residing at a nursing home at all. For long-term care Medicaid, the income limit as of 2010 is $2,022 per month and the resource limit is $2,000 for individuals, $3,000 for a couple living in separate rooms in a nursing facility, $4,000 for couples living in the same facility and $109,560 for couples if only one member of the couple is residing in a long-term care facility. Contact [phone] to determine the exact resource and income limit based on your family size, reason for applying for Medicaid, age and other individual factors.