Bookmark and Share

Medicaid, SCHIP, & Federal Authority

  • Health Insurance Flexibility and Accountability (HIFA) Waiver – In 2002, Colorado received approval from the Centers for Medicare and Medicaid Services (CMS) for a HIFA demonstration to provide adult prenatal coverage under the State Children’s Health Insurance Program (SCHIP), CHP+. The waiver, amended in 2005 to increase eligibility, provides coverage to uninsured pregnant women with incomes between 134 percent and 200 percent of the federal poverty level (FPL) who are not otherwise eligible for Medicaid and SCHIP. Additionally, this waiver provides a premium assistance option for children with family incomes at or below 200 percent of the FPL with access to employer-sponsored insurance. Beneficiaries may opt out of the premium assistance program at any time and resume coverage through SCHIP.

    During the 2007 Legislative Session, Colorado passed Senate Bill 07-097, which increased CHP+ eligibility for pregnant women and children (ages 0 through 18) from 200 percent of the FPL to 205 percent, using funds from the State’s tobacco litigation settlement. This bill also approved presumptive eligibility for pregnant women throughout pregnancy and for 60 days following the pregnancy. In addition, a child born to a woman eligible for the plan is now automatically enrolled in the plan. Legislation in 2007 was also passed to extend Medicaid eligibility until age 21 for foster care children who, prior to turning age 18 or becoming emancipated, are eligible for Medicaid under Title IV-E of the Social Security Act.
    In April, 2008 Governor Ritter signed legislation to expand access to SCHIP to pregnant women and children up to 225 percent of FPL. The SCHIP expansion was part of several reform proposals in Governor Ritter’s “Building Blocks to Health Care Reform” package, all of which has been approved by the 2008 state General Assembly.

High-Risk Pools

  • 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 Plans

  • 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. (H.B. 1101)


State Specific Strategies

  • In 2007, legislation was passed which required that “claim experience” and “health status” be deleted from the list of demographic “case characteristics” which health insurance carriers are allowed to use in setting premium rates for small employer health care plans. Also enacted in 2007 was a law that required group insurance policies to include coverage for mental disorders and defines “mental disorder” as posttraumatic stress disorder, drug and alcohol disorders, eating disorders, anxiety disorders and depressive disorders to the extent those disorders are not already covered as a biologically-based mental illness.