1. Child Health Plan Plus (CHP+)
Colorado Community Partners…
Keeping Colorado
Kids Healthy

2. Department of Health Care Policy and Financing
The Department of Health Care Policy and
Financing is the state department that
administers Child Health Plan Plus (CHP+)
and other medical programs for low income
families, persons who are blind or persons
with disabilities and the elderly.

3. Who is MAXIMUS?
The Department contracted with MAXIMUS, Inc. in January 2006 to increase CHP marketing, outreach, and enrollment
Regional Outreach Coordinators work for MAXIMUS

4. What does a Regional Outreach Coordinator (ROC) do?
The ROCs are employed by MAXIMUS to increase pubic awareness of CHP+ through:
Education
Program Resources and Referral Support
Training on CHP+ and application assistance to professionals and families
Participation in community events

5. For Marketing and Outreach Purposes Only

6. What is CHP+ & Medicaid?
CHP+ – Low-cost health insurance for Colorado children and pregnant women who exceed the income guidelines for Medicaid eligibility
Medicaid – Low-cost health insurance for Colorado children, pregnant women, parents with dependent children, the elderly, and people with disabilities

7. Who is eligible for CHP+ ?
Children who are 18 years old and under
Not eligible for Medicaid
Within income guidelines
Not covered by other health insurance
Colorado residents
US citizens or legal permanent residents for at least 5 years
Unable to access health insurance as an employee or child of an employee through the State of Colorado

8. Who is eligible for Medicaid?
Children who are 18 years old and under
Parents caring for dependent children who are enrolled in Medicaid or CHP+
Pregnant women
Within income guidelines
Colorado residents
US citizens or legal permanent residents for at least 5 years
Some exceptions to 5 year ban
Okay to have another form of insurance

9. What does CHP+ cover? Medical Services
Well-child check-ups and physicals
Immunizations (shots)
Doctor visits
Hospital services
Mental health services
Eye care and eye glasses
Hearing aids
Prescriptions (medicine)
Prenatal care
Dental services ($600 each calendar year for children)

10. What does Medicaid cover?
Medical Services
Well-child check-ups and physicals
Immunizations (shots)
Doctor visits
Hospital services
Mental health services
Eye care and eye glasses
Hearing aids
Prescriptions (medicine)
Prenatal care
Dental services (children age 21 and younger, adults extractions only)

11. Who is eligible for the CHP+ Prenatal Care Program?
Pregnant women who are:
19 years old and over
Not eligible for Medicaid
Within income guidelines
Not covered by other health insurance
Colorado resident
US citizen or legal permanent resident for at least 5 years
Unable to access health insurance as an employee or child of an employee through the State of Colorado

12. What does the CHP+ Prenatal Care Program cover?
Prenatal care visits
Other doctor visits
Hospital services including delivery
Medications/Prescriptions
Mental health services
Postpartum care (limited)
Vision services
Dental services are not covered

13. How long does CHP+ Children coverage last?
-12 months from the received date of application
Members receive a renewal packet in the mail up to 60 days prior to coverage ending
Packet is to be returned to CHP+ with current proof of income and any required documents immediately

14. How long does Medicaid coverage last?
12 months from the received date of an application
Members receive a renewal packet in the mail up to 60 days prior to coverage ending
Packet is to be returned to Department of Human/Social Services with current proof of income and any required documents immediately

15. How long does CHP+ Prenatal Care coverage last?
From the enrollment date at least 60 days after the pregnancy ends
Baby born to a CHP+ enrolled mother is automatically guaranteed 12 months of enrollment effective as of baby’s date of birth
CHP+ must be notified of the baby’s birth in order to enroll child

16. Income Guidelines for CHP+ & Medicaid

17. What expenses should be listed on the application?
Child care and elder care expenses
Medical/prescription expenses
Health insurance premiums
Outgoing and incoming child support and alimony
Expenses must be from the same month as the income being reported
Some or all of these expenses will be deducted from the family’s income to determine eligibility

18. What is acceptable proof of income?
Paycheck stubs
At least one paycheck stub with pay date in previous or current month OR
Signed written document from employer
Exact gross income from previous month OR
Exact hourly wage, hours worked, how often paid, and date of last paycheck

19. What about self-employed applicants?
Profit and loss statement for previous or current month must be included OR
Complete self-employment section - the ledger - on the application

20. What is Presumptive Eligibility (PE)?
Temporary health care insurance for children and pregnant women while their eligibility is being determined
PE Coverage is no less than 45 days
PE Site list available:
CHPplus.org/materials/PESiteList.pdf

21. What is Presumptive Eligibility (PE)?
Allows immediate access to health care
Medicaid PE for children: includes all Medicaid-covered services
Medicaid PE for pregnant women: includes only outpatient services
CHP+ PE: includes all CHP+ and inpatient services - except dental benefits

22. Cost for CHP+ family Some families pay nothing
Annual premium -$25 for 1 child, $35 for 2 or more kids
$0 - $5 co-pay for each office visit
$0 - $15 co-pay for emergency room and hospital visits
No co-pay for check-ups
No enrollment fee or co-pay for prenatal care; non-pregnancy related services may have a co-pay

23. Cost for Medicaid family
No annual premium
No co-pays for children
No co-pays for pregnant women

24. Joint Application Determines eligibility for Medicaid and CHP+
Applications are checked for Medicaid eligibility first, then CHP+
Available in English and Spanish
Available at CHPplus.org or Colorado.gov/hcpf or Department of Human/Social Services Offices or by calling toll free:

25. Points of Clarification
Question 1:
Use legal names
Include mailing address if different from physical address
Must include at least 1 phone number
Question 3:
List all members of the household even if the person is not a family member
Make a copy of this page if more than 8 people live in the household

26. Points of Clarification
Question 4:
This information is for any child in the family
Question 5:
If anyone in the household is pregnant, be sure to complete this entire section

27. Points of Clarification
Complete one page for each child applying; if needed, make a copy of this page for each additional child
Add child’s full name including middle initial
Include only natural or adoptive parents living in the home (don’t include step-parents in this section)
Alaskan Native or Native American applicants: check box in order to receive fee exemptions

28. Points of Clarification
Question 2:
If applicable, write alien registration number on the line and make a copy of both sides of resident card to include with the application
Question 4:
Medicaid will allow up to 3 months of backdated coverage; CHP+ does not back date and enrollment begins the day an application is received and date-stamped by a CHP+ partner organization

29. Points of Clarification
Question 5:
Applicants who have access to Colorado State Government health benefits do not qualify for CHP+ but may qualify for Medicaid
Question 6:
Pre-existing conditions do not impact eligibility
If yes, child may qualify for other programs

30. Points of Clarification
ONLY Pregnant women and adults 19 years and older in the household applying for health insurance will complete this form
Permanent legal residents must include a copy of both sides of the resident card with the application

31. Points of Clarification
Questions 1 and 2:
Only refer to those applying for benefits
If anyone applying is/ was covered by other health insurance, complete ALL fields in the appropriate section
Include a copy of both sides of the health insurance card for question 1 if available

32. Points of Clarification
List all working members of the household and their income details
Question 1:
Self-employed workers must complete this section OR submit a profit and loss statement showing income and expenses for either the current or previous month
Question 2:
List all other income for all household members here

33. Points of Clarification
List all allowable expenses/income deductions for each member of the household
Blue box:
Applicant must include HMO choice or the State Managed Care Network depending on the county of residence (refer to application insert)

34. Selecting an HMO for CHP+
An HMO is a group of doctors, nurses, hospitals, and other providers who care for members
An HMO manages the health insurance benefits that CHP+ offers
Applicants must select an HMO or the State Managed Care Network, depending on the county of residence
For a complete list of HMOs available in your county, see:
CHP+ deskguide for professionals
Health Plan Comparison Chart Insert (in application)
CHPplus.org

35. What is the pre-HMO enrollment period?
All CHP+ members have a pre-HMO enrollment period
Provides medical coverage from received date of application up to HMO/Dental effective date.
Provides medical care immediately so members don’t have to wait
The pre-HMO coverage is through the State Managed Care Network
Members will receive a temporary identification card during this time
Dental services are not covered during this time

36. Points of Clarification
All adults 19 or older applying for health coverage must sign here
Parents or guardians applying for health coverage for their children must sign name, print name, and write the date here

37. Verification may be required by applicants
Because applications are reviewed for both Medicaid and CHP+, applicants may be asked to provide original or certified copies of documents proving the identity and citizenship of all who are applying
Clients must provide the original copies to the Certified Application Assistance Site or the county to be verified

38. Verification may be required by applicants
An insert explaining the documents required is included in each application
List of documents and organizations where original documents can be verified: Colorado.gov/cs/Satellite?c=Page&cid= &pagename=HCPF%2FHCPFLayout

39. Verifying Documents for Medicaid
For US Citizens or legal permanent residents
Applicants must present an original or certified copy, never a photocopy
Exemptions include: PE clients, Needy Newborns, SSI and SSDI eligible clients, current Medicare recipients, and Foster Care children

40. Certified Application Assistance Sites
Agencies that assist families in completing the “Colorado Public Health Insurance for Families Application”
Certified to verify citizenship and identification documentation

41. Expectations of a Certified Application Assistance Site
A certified agency must:
Agree to Department rules, regulations and agency letters. To view these documents, visit: Colorado.gov/cs/Satellite/HCPF/HCPF/
Train all staff on the process for completing an application and how to verify citizenship and identity documents.

42. Expectations Continued . . .
A certified agency must also:
Complete an “Certification Site Application” also know as Certified Application Assistance Site Application, visit: Colorado.gov/cs/Satellite/HCPF/HCPF/
Submit completed applications and all documentation to their local county within five business days.

43. Citizenship and Identity Documentation
A passport (current or expired) can be used to establish both citizenship and identity

44. Citizenship Documentation
Examples of acceptable citizenship documents:
U.S. birth certificate
Certificate of birth abroad
U.S. Nation ID card
Native American Tribal document
Final adoption decree
Official military record of service showing a U.S. place of birth
Religious/School records

45. Identity Documentation
Examples of acceptable identity documents:
Driver’s license or state ID card with photo
ID card issued by a federal, state, or local government agency
U.S. military card or draft record or U.S. Coast Guard Merchant Mariner Card
School ID card with photo
Verified school, nursery or daycare records (for children under age 16)
Clinic, doctor or hospital records (for children under age 16)

46. Written Affidavits
Can only be used when other documentation is not available
Can only be used to prove either citizenship or identity, not both
Affidavits do not need to be notarized

47. Submitting Certified Documents - Option 1
A photocopy of the original or certified document, with the following information either stamped or written on each copied document:
Agency name
Name and signature of staff who viewed documents
Agency’s full address
Agency’s phone number
Date documents are verified
Write words “verified original” above stamp or agency information on each document

48. Submitting Certified Documents – Option 2
A photocopy of the original or certified documents attached to the “Citizenship and Identity Documentation Received” form

49. What happens if falsified documents are submitted?
Sites are verifying that documents submitted are original or a certified copy
If doubts or reservations about a submitted document, do not certify the document; refer the client to local county office
Sites should not knowingly accept documents such as a fax or photo copied birth certificate; all documents must have a visible stamp or the required certification information on it

50. Submitting Applications
Applicant must sign and date the
last page of the application
Send applications to the county Department of Human/Social Services in which the applicant resides, or:
CHP+
PO Box 929
Denver, CO 80201

51. How does an applicant follow up?
All communication is sent directly to the applicant, not the Certified Application Assistance Site
Eligibility should be determined within 45 days
If an applicant has not been notified, contact the agency to which the application was submitted

52. Appeal Process Clients can appeal an eligibility decision
They will be notified by mail of their appeal rights and instructions on how to proceed if their application is denied
They have 30 days from the date on the denial letter to appeal the decision
Appeals must be submitted in writing

53. Resources CHPplus.org Colorado.gov/hcpf
CHP+ Customer Service:
Medicaid Customer Service
Denver Metro:
Toll free: