Health First Colorado 101 Eligibility Benefits and Grievances

Health First Colorado 101 Eligibility, Benefits, and Grievances

AGENDA • Welcome and Introductions • Health First Colorado Eligibility and Application Processes • Benefits and Services • Grievance and Appeals Process • Thank You and Q&A • Resources 2 rmhp. org

Health First Colorado Eligibility and Application Processes

Who Qualifies? • Income eligibility for Health First Colorado is based on Modified Adjusted Gross Income (MAGI). • Individuals may qualify if they fall into one of the following categories and meet the income guidelines: Children (Age 0 -18) 142% Poverty Level Adults (19 -65) 133% Poverty Level 4 Pregnant Women (195%) Poverty Level Parents & Caretaker Relatives 68% Poverty Level rmhp. org

How to Apply? Online Colorado. gov/PEAK- this is the fastest way to apply In-Person At your local county office or an Application Assistance Site By Phone 1 -800 -221 -3943 / State Relay 711 By Mail 5 Mail it to your local County Department of Human Services rmhp. org

What info is needed to apply? • Name, address and contact information of each applicant • Social Security number • Birth Date • Employer information • Income information • Information and policy numbers for health insurance plans currently covering members of the household; and • Citizenship and identity documentation 6 rmhp. org

How much does it cost? • Individuals may have to pay a small co-pay to receive some services, unless that person falls into one of the categories below. q If he/she is age 18 and younger, q Pregnant q Are an American Indian or Alaska Native, you do not pay co-pays. q If you are a qualifying former foster care youth, you only pay co-pays for prescription drugs. q If you reside in a nursing facility you typically do not have to pay co-pays. • To find out more about Health First Colorado Benefits and Co-Pays, visit: https: //www. healthfirstcolorado. com/benefi ts-services/ 7

Health First Colorado Benefits

Benefits If an individual qualifies for Health First Colorado, some of the benefits they can receive include: • • Behavioral health Dental services Emergency care Family planning services • Laboratory services • Maternity care • Newborn care • Outpatient care • Hospitalization • Prescription drugs • Preventive and wellness services • Primary care • Rehabilitative services See a full list of benefits and co-pays in the Health First Colorado Benefits & Services Overview and learn more about your coverage and how to use it in the latest Health First Colorado Member Handbook. 9 rmhp. org

Grievances and Appeals

Grievances • Members have a right to file a complaint or grievance at any time, if they think they were treated unfairly or unhappy with a service. • They cannot lose their coverage for filing a grievance. • Members can get help filing a grievance by contacting Rocky Mountain Health Plans at 888 -282 -8801. • Or by contacting the Ombudsman for Health First Colorado Managed Care: • 303 -830 -3560 • 877 -435 -7123 • Or email help 123@ maximus. com 11 rmhp. org

Grievances • Once a grievance is filed, RMHP will send the member a confirmation letter to let them know their grievance was received. • The grievance will be reviewed and may contact the member for more information. • Within 15 business days, a determination will be made 12 rmhp. org

Appeals • If a member does not agree with the answer they’ve received from RMHP, they are able to ask for a second review of their grievance by contacting: Colorado Department of Health Care Policy and Financing Medicaid Managed Care Contract Manager 1570 Grant Street, Denver, CO 80203 Phone: 303 -866 -4623 Email: hcpf. mcos@state. co. us • The Department will work with members who have requested second review and send a determination letter upon completion. This decision is final. 13 rmhp. org

Thank You. Any Questions? 14 rmhp. org

Additional Resources To find more information about Health First Colorado visit: • Health First Colorado (Colorado’s Medicaid Program) • Member Handbook • RMHP’s Website 15 rmhp. org