1. Enrolling Families and Children in Medicaid and Child Health Plan Plus

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. What we will cover Medical Assistance (MA) Sites
Presumptive Eligibility (PE) Sites
Certified Application Assistance sites (CAAS)
Responsibilities
Expectations
Application and certification
I will give you information about becoming a CAAS, MA or PE site by covering the responsibilities, expectations, and application and certification requirements.

4. Responsibilities for all sites
Must meet all Federal and State criteria
Adhere to all Department of Health Care Policy and Financing (Department) rules, regulations, and agency letters. To view these documents, visit: Colorado.gov/cs/Satellite/HCPF/HCPF/
Assist families with the completion of the Public Health Insurance for Families Application and other Medical programs

5. Responsibilities for all sites
Participate in required trainings
Display current site location and contact information on the Department Web site
Inform the Department of any changes made to the primary site contact in a timely manner

6. Responsibilities for all sites
Abide by all applicable HIPAA Privacy and Security requirements regarding health information
As defined in 42 U.S.C. 1320d – 1320d-8, and implementing regulations at 45 C.F.R. Parts 160, 162 and 164

7. Responsibilities for all sites
Offer voter registration at the time of initial application
Pursuant to the National Voter Registration Act of 1993, 42 U.S.C.S 1973gg-5(a)(2)(H)
Track the number of voter registrations offered

8. National Voter Registration Act
Congress enacted the National Voter Registration Act (NVRA) in 1993
Requires voter registration opportunities to be offered at each agency that:
Provides public assistance (including food stamps, Medicare and Medicaid, WIC, and Colorado Works/unemployment assistance)
Provides state-funded programs primarily for persons with disabilities
Recruits for the armed forces
(also known as the "NVRA" and the "Motor Voter Act"),
U.S.C. 1973gg 5(a), (b),
Other federal, state, local government, or nongovernment offices may choose to provide voter registration services

9. Complying with NVRA Voter registration must be offered:
Upon initial request for services
At service renewal
Upon address change
Applicants must be:
Provided a voter registration form including a declination section
Offered assistance in completing the forms
Each agency is required to transmit forms to the appropriate county clerk

10. Agency-Based Voter Application

11. Implementing NVRA
The Department will inform all PE and CAAS sites with requirements and implementation dates.
Each site will be responsible for implementing a NVRA process to be in compliance with NVRA.

12. Voting Registration Supplies
Blank agency voter registration forms, agency voter registration reporting forms and special envelopes may be ordered directly from the Secretary of State’s office or through your local county clerk.

13. Additional NVRA Information
Elections Questions and Answers:
Voter Information:
County Elections Offices:
NVRA Address:

14. Medical Assistance Sites (MA)

15. Medical Assistance (MA) Site
Designated site that:
Accepts and processes applications for Medical Assistance Programs
Uses the Colorado Benefits Management System (CBMS) to determine eligibility for Child Health Plan Plus (CHP+) and Medicaid programs
Transfers the cases to the appropriate County Department of Human/Social Services for ongoing case maintenance
The Department is authorized to establish MA sites by Statue (CRS et seq).

16. MA Site expectations Self-funded (non-monetary contract)
Have capacity and capability to process all Medical Assistance applications submitted to include: i.e., staff, workspace, equipment
Provide and maintain adequate hardware and software to access the CBMS application through the Department’s secured Web Portal
Previous Certified Application Assistance Site (CAAS) and Presumptive Eligibility (PE) experience preferred

17. MA Site expectations
Process and authorize the eligibility determination within the processing timelines; 45 days for family and children’s applications and non-disability applications, and 90 days for disability applications
Resolve any applicant/client issues in a timely manner
Respond to requests from the Department in a timely manner

18. MA Site expectations
Accept and process all walk-in and mail-in applications in a timely manner
Explain the benefits of the programs that are administered by the Department
Conduct internal quality improvement reviews on a monthly basis
*The above is not a comprehensive list, but a representation of primary responsibilities. Details of the overall responsibilities will be included in the contract between the Department and the approved MA site.

19. MA Site expectations
Respond to any audit or Medicaid Eligibility Quality Control (MEQC) requests for case files and client information
Maintain copies of the active case files and non-active case files for three years after the discontinuation or denial of eligibility

20. How to apply to be an MA site
Submit a Letter of Interest (LOI) to the Department
The LOI should address the following:
Why is your organization interested in becoming an MA Site?
What population will benefit from your organization becoming an MA Site?
What are the benefits to your organization in becoming an MA Site?
What are the anticipated staffing levels and location(s) if your organization becomes an MA Site?
How is your organization going to fund your ability to function as an MA site?

21. Address
Health Care Policy and Financing (HCPF), at 1570 Grant Street, Denver, CO , Attention: Monica Owens, MA Site Contract Manager, or via to

22. Presumptive Eligibility (PE) Sites

23. Presumptive Eligibility (PE) Site
Temporary health care coverage for children 18 and under 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

24. What does a PE site offer?
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+ covered services - except dental benefits

25. PE Site qualifications
Sites must meet specific federal and state criteria:
• Federal Criteria
A “qualified provider” may grant Presumptive Eligibility to pregnant women if all of the following criteria is met:
Be eligible to receive payments through the State;
Provide outpatient hospital services, rural health services, or clinic services; and
Be determined by the state agency to be capable of making PE determinations.

26. PE Site qualifications
A “qualified entity” may grant presumptive eligibility to children if any one of the following criteria is met:
Be eligible to receive payments through the State;
Provide health care items or services; and
Be determined by the State agency to be capable of making PE determinations.

27. PE Site expectations • State Criteria
Have appropriate internet access that is capable of supporting the Colorado Benefit Management System (CBMS);
Be a Medicaid and/or CHP+ provider OR be affiliated with a Medicaid/CHP+ provider;
Routinely be able to provide pregnancy testing or assure referral to prenatal care and/or children’s routine medical care;

28. PE Site responsibilities
Make necessary referrals to practitioners for continued care for normal and high-risk patients;
Have client contact personnel available to determine eligibility;
Accept the Colorado Public Health Insurance for Families Application and forward to the appropriate county;
Maintain at least a 90% accuracy rate of eligibility determinations;

29. PE Site responsibilities
Participate in initial and ongoing PE trainings;
Agree to fulfill all the responsibilities of a qualified provider as stipulated by the Department; and
Be capable of assisting non-English speaking clients.
CAAS trained and approved

30. How to apply to be a PE site
Download the application from the Department website, colorado.gov/hcpf
Contact Corinne Lamberson

31. Certified Application Assistance Sites (CAAS)

32. 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

33. CAAS responsibilities
A certified agency must:
Train all staff on the process for completing an application and how to verify citizenship and identity documents.

34. CAAS responsibilities
A certified agency must also:
Complete an “Certification Site Application” aka Certified Application Assistance Site Application, visit: Colorado.gov/cs/Satellite/HCPF/HCPF/
Submit completed applications and all documentation to local county within five business days.

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

36. 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

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

38. 2010-2011 Income Guidelines for CHP+ and Medicaid
Slide updated 07/13/2010 by Jeff Konrade-Helm
Slide updated: 07/13/2010

39. Financial Responsibility
Self Self
Spouse Spouse
Parent Child
Sibling Sibling
Child Parent
Others Child

40. 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

41. 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

42. 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

43. 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:

44. 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

45. 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

46. 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

47. 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 date-stamped and received by a CHP+ partner organization

48. 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

49. 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

50. 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

51. 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

52. 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)

53. Medicaid Disregards The disregards run automatically in CBMS
Earned Income Disregard
$90/month/person whose earned income is used to determine program eligibility
Child/Spousal Support Disregard
$50/month/household
Dependent Care Disregard
$200/person < age 2; or
$175/person ≥ age 2

54. 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

55. 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

56. 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

57. Verification requirements
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

58. Verification requirements
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

59. Verifying Documents for Medicaid and CHP+
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

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

61. 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

62. 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)

63. 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

64. 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

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

66. 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

67. 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

68. 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

69. 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

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