To save you time, we've answered some of the most common questions about Colorado Community Health Alliance (CCHA) and Health First Colorado (Colorado’s Medicaid program). If you are unable to find the answer to your question here, visit the Health First Colorado frequently asked questions page or contact CCHA Member Support Services
Health First Colorado covers doctor visits, hospital stays, emergency room and urgent care, prescription drugs, dental services, behavioral and mental health services, X-rays and blood work, well-child visits, maternity care, newborn care and many others. Learn how to apply on the Health First Colorado website.
As a Health First Colorado member, you are part of a team that helps make sure you get connected with what you need to get and stay healthy. This team includes you, your family members or caregivers, your primary care provider (sometimes called a PCP), and CCHA care coordinators. If you have questions about your health care or covered benefits, contact CCHA Member Support Services. We can help you:
- Find a provider who is the right fit for you
- Get appointments for all your health needs
- Connect with non-medical resources
Sign up for programs to help with your health
To find helpful information about language assistance services, including the written, oral interpretation and auxiliary aids/services that are free of charge, contact CCHA Member Support Services.
You can learn about your rights and responsibilities as our member in the Member Handbook.
As a member of Health First Colorado and CCHA, you have the right to:
- Get the information in the Member Handbook and about your coverage, plans, benefits and services
- Be treated with respect and consideration for your privacy and dignity
- Get information in a way you can easily understand
- Get information from your provider about treatment choices for your health condition
- Be involved in all decisions about your health care and say “no” to any treatment offered
- Not be secluded or restrained as a punishment or to make things easier for your provider
- Ask for and get a copy of your medical records and ask that they be changed or corrected
- Get health care services and freely exercise your choice of provider.
- Use your rights without fear of being treated poorly
- Any other rights guaranteed by law
- Be free from discrimination based on race, color, ethnic or national origin, ancestry, age, sex, gender, sexual orientation, gender identity and expression, religion, creed, political beliefs, disability or health status
- Ask your health plan for help if your provider does not offer a service you need because of moral or religious reasons (CCHA does not deny access to service due to moral or religions reasons.)
If you have questions about your member rights, do not feel like you are able to use your member rights, or believe you are being treated poorly because you used your rights, contact CCHA Member Support Services for more information on how to file a complaint.
Our goal is to help you get the most from your health care and live a healthy life. We want you to be able to get care at any time. When your primary care provider (sometimes called a PCP) is closed, you have options.
- Leave a message with your PCP’s office. The on-call provider will call you to talk about your concern and set up an appointment.
- Call the Health First Colorado Nurse Advice Line at 1-800-283-3221 (TTY 711) for free advice 24/7 or visit an urgent care center near you.
- Call 9-1-1 or go to the nearest emergency room if you have an urgent health need that could be life threatening or cause serious harm to your body.
- Call the confidential Colorado Crisis Support Line 24/7 at 1-844-493-8255 (TTY 711) or text TALK to 38255 if you are struggling with mental health, substance use or emotional issues.
If you get care from a provider who is not your PCP, follow up with your PCP as soon as you can.
We are committed to helping you access quality physical and behavioral health care services in a timely manner. View our Access to Care Standards to learn more about what you can expect.
Contact CCHA Member Support Services if you need oral interpretation services or information in large print or other formats.
Behavioral health services include both mental health and substance use treatment. We’re here to help connect you to services and resources you need for your health and well-being.
Your Health First Colorado benefits include:
- Licensed Mental Health Professional (LMHP); an LMHP is a provider who works with members who have behavioral health concerns.
- Alcohol and drug: screening, counseling, treatment*
- Behavioral health assessment, evaluation and testing*
- Emergency and crisis services
- Inpatient psychiatric hospital services for a mental health diagnosis*
- Medication-assisted treatment*
- Outpatient day treatment, nonresidential*
- Medication management*
- Psychotherapy: family, group or individual*
See your member handbook to learn more about your benefits
You don’t need a referral from your primary care provider (PCP) to see a behavioral health provider.
*Some treatments and services may need approval before you get them. For information about services that need preapproval, please see your member handbook.
If you are temporarily out of the state but still a resident of Colorado, you may receive some Health First Colorado benefits under certain situations:
- It is a medical emergency
- Your health would be endangered if you were required to return to Colorado for the medical care/treatment
The health care provider that treats you must enroll in the Health First Colorado program. Health care providers can visit the For Our Providers page for more information.
If you have more questions about seeing a health care provider out of state, call the Health First Colorado Customer Contact Center.
Health First Colorado members who have no other means of transportation can ask for a ride to and from their appointments. Types of transportation may include:
- Mileage reimbursement
- Public transportation
- Private vehicle or taxi
- Wheelchair or stretcher van
- Other options may also be available
Transportation can only be provided for appointments with Health First Colorado providers. Transportation cannot be used for picking up prescriptions, medical equipment or completing interviews and paperwork.
For help coordinating transportation, contact CCHA Member Support Services.
As a Health First Colorado member, you can receive dental services such as cleanings, fillings, root canals, crowns, partial dentures and others. In addition, children under age 20 can receive preventive services including exams, cleanings, X-rays, sealants, space maintainers, fluoride treatments and more.
For adults, the annual benefit covers each member up to $1,000 per state fiscal year, which runs from July 1 through June 30.
Call DentaQuest at 1-855-225-1729 (TTY 711). For more help finding a dentist, contact CCHA Member Support Services.
The adult dental benefit is available to eligible adult Health First Colorado members (age 21 and over) and covers:
- Basic preventive dental exams
- Diagnostic and restorative dental services (such as X-rays and fillings)
- Extractions (tooth pulling)
- Root canals
- Partial dentures*
- Complete dentures*
- Periodontal scaling
- Root planing
- Other procedures requiring prior authorization
* Partial and complete dentures are not subject to the $1,000 cap per year.
For more information about adult and children’s dental benefits, visit the Health First Colorado dental benefits page.
Health First Colorado provides pharmacy benefits. For more information about pharmacy benefits and the Health First Colorado formulary, go to the Health First Colorado Pharmacy Benefits page.
To request a copy, contact CCHA Member Support Services.
Call us. We’re here to help. If you have a problem with your Health First Colorado services or providers, we would like you to tell us about it. Contact CCHA Member Support Services and we’ll try to solve the problem on the phone.
Filing a Complaint (Also Known as a Grievance)
If we can’t take care of the problem when you call us, you can file a complaint. Once you file a complaint, it will be reviewed and you will get a letter with a decision. If you do not agree with the answer you get, you may be able to ask for a second review. Learn more about filing a complaint.
Filing an Appeal
There may be times when a service that was approved will be denied, end or be reduced. In other cases, all or part of the care your provider asked for may not be paid. You will get a letter called a Notice of Action for any decision that affects your coverage or services. It will tell you the decision, why it was made and how to appeal if you disagree.
For help filing a complaint or appeal, call:
Ombudsman for Health First Colorado Managed Care
1-877-435-7123 (toll free)
Your Health First Colorado Member Handbook will tell you more about your rights to file a complaint or an appeal. If you have questions about anything you read here or in the Member Handbook, contact CCHA Member Support Services.
Advance directives are written instructions to those caring for you that tell them what to do in case you can’t make decisions for yourself. They list the type of care you do or do not want if you become so ill or injured that you cannot speak for yourself. Advance directives include, but are not limited to, medical durable powers of attorney, durable powers of attorney, or living wills. CCHA provides information on advance directives, so you can plan and make decisions accordingly. Learn more about advance directives.
The Colorado Medical Treatment Decision Act (C.R.S.15-18-101) recognizes the right of an adult or his or her authorized surrogate decision-maker to accept or reject medical treatment and artificial nutrition or hydration. Each adult has the right to establish, in advance of the need for medical treatment, directives and instructions for the administration of medical treatment in the event the adult later lacks the decisional capacity to provide informed consent to, withdraw from, or refuse medical treatment.
The Colorado Medical Assistance Act – (C.R.S. 25.5-4-413) states each hospital, nursing care facility, home health agency, hospice program, and health maintenance organization participating in the state medical assistance program or providing medical assistance pursuant to parts 3 to 12 of article 6 of this title shall provide written information to all adult patients of such providers concerning patients' rights under state law to make medical treatment decisions, including the right to accept or refuse any medical or surgical treatment and the right to formulate advance directives regarding said decisions. As used in this section, "advance directives" includes any written or oral instructions recognized under state law concerning the making of medical treatment decisions on behalf of or the provision of medical care for the person who provided the instructions in the event such person becomes incapacitated.
You may request information on advance directive via mail at any time by contacting CCHA Member Support Services.
You may file a complaint concerning non-compliance with advance directives, by using this grievance form.
The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children and youth ages 20 and under, including adults who are pregnant, who are enrolled in Health First Colorado. These services are provided without cost to eligible individuals except for any enrollment fee, premium or similar charge that may be imposed on medically needy recipients. EPSDT is key to ensuring that children and youth receive appropriate preventive, dental, mental health, developmental and specialty services.
With EPSDT, a service may be covered even if it is not a Health First Colorado benefit or has service limits. Your provider must ask Health First Colorado for the medically necessary service. Health First Colorado will read the medical necessity request and approve or deny it. You must still see licensed participating providers and get needed pre-approvals.
Early: Assessing and identifying problems early
Periodic: Checking children's health at periodic, age-appropriate intervals
Screening: Providing physical, mental, developmental, dental, hearing, vision and other screening tests to detect potential problems
Diagnostic: Performing diagnostic tests to follow up when a risk is identified
Treatment: Control, correct or ameliorate health problems found
Necessary transportation and scheduling assistance described in 42 CFR §441.62 is available to the EPSDT eligible individual upon request.
EPSDT is made up of screening, diagnostic and treatment services that are medically necessary in nature.
All Health First Colorado coverable, medically necessary services must be provided even if the service is not available under the state plan to other Health First Colorado members. Medical necessity is determined on a case-by-case basis. No arbitrary limitations on services are allowed (e.g., one pair of eyeglasses or 10 physical therapy visits per year).
- Comprehensive health and developmental history
- Comprehensive unclothed physical exam
- Appropriate immunizations (according to the Advisory Committee on Immunization Practices)
- Laboratory tests (including lead toxicity testing)
- Health education (anticipatory guidance including child development, healthy lifestyles, and accident and disease prevention)
At a minimum, vision services include diagnosis and treatment for defects in vision, including eyeglasses.
At a minimum, dental services include relief of pain and infections, restoration of teeth, and maintenance of dental health, including examinations, cleanings and fluoride treatments.
At a minimum, hearing services include diagnosis and treatment for defects in hearing, including hearing aids.
Other Necessary Health Care Services
Additional health care services that are coverable under the Federal Medicaid program and found to be medically necessary to treat, correct or ameliorate illnesses and conditions discovered regardless of whether the service is covered in a state’s Medicaid plan. It is the responsibility of states to determine medical necessity on a case-by-case basis. (For more information, see the question below about how to access EPSDT services.)
When a screening indicates the need for further evaluation, diagnostic services must be provided.
Necessary health care services must be made available for treatment of all physical and mental illnesses or conditions discovered by any screening and diagnostic procedures.
Colorado also provides case management and outreach through Healthy Communities and other programs:
- Information to all Health First Colorado-eligible individuals age 20 and under, including adults who are pregnant, that EPSDT services are available and of the need for age-appropriate screenings, well child visits and immunizations
- Provide or arrange for the provision of screening services for all children
- Arrange (through referral) for corrective treatment as determined by child health screenings
- Missed appointment follow-up
- Refer for transportation assistance
Colorado makes the final determination of medical necessity and it is determined on a case-by-case basis. Provider recommendations will be taken into consideration, but are not the sole determining factor in coverage. Colorado determines which treatment it will cover among equally effective, available alternative treatments.
Providers can access medically necessary services by submitting a prior authorization request (PAR) to coloradopar.com. All requirements for completing a request apply to those requesting any exception to state plan benefit limits. EPSDT cannot override licensing or other payment restrictions for providers.
The Health First Colorado Nurse Advice Line provides Health First Colorado members free 24/7 access to medical information and advice in both English and Spanish by calling 1-800-283-3221 (TTY 711).
- Available free of charge, 24 hours a day, 7 days a week, 365 days a year.
- Nurses will answer your medical questions, provide care advice and help you determine if you should be see a doctor right away.
- Get help with medical conditions, such as diabetes or asthma.
- Get advice on the type of doctor that may be right for your medical condition.
Colorado Community Health Alliance (CCHA) serves the following primary functions for assigned Health First Colorado members:
- Help find a provider
- Coordinate care and services
- Provide utilization management and payment for capitated behavioral health services
- And more!
For more information about how CCHA can help you, contact CCHA Member Support Services.
For information, see the Health First Colorado website.
Colorado Community Health Alliance (CCHA) is the regional organization for Health First Colorado members whose primary care provider is located in one of these counties: Boulder, Broomfield, Clear Creek, El Paso, Gilpin, Jefferson, Park or Teller. For help finding a provider, contact CCHA Member Support Services. You can also search for a provider in our online provider directory.
CCHA does not restrict or limit any Health First Colorado services because of moral or religious objections. If your provider will not provide a covered service to you due to a moral or religious obligation, contact CCHA Member Support Services.