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What to do if you lose your Medicaid eligibility?

Have you or your loved one lost Health First Colorado Medicaid eligibility? Here are the primary reasons why this may have happened and what do to if you become ineligible.

Medicaid eligibility is determined by the following ways

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Functional Needs Assessment

(this applies to HCBS waivers)

  • Every 12 months the case manager is required to perform a functional needs assessment of the individual receiving care. This assessment is called the ULTC 100.2 and must be completed every 12 months to ensure that client needs haven’t changed.
  • An updated PMIP (Professional Medical Information Page) form from your physician must also be obtained each year which documents a professional opinion for the need for ongoing supports.

For more detailed information about Long-Term Services and Supports Case Management Tools please visit this link.

Please reach out to your Case Manager if you have any questions or concerns about your functional eligibility for your current Home and Community-Based Services (HCBS) waiver.

What you should do if you become functionally ineligible?

Contact your Case Management Agency

Find Your Single Entry Point Find Your Community Center Board
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Financial

(redetermination)

Medicaid eligibility is redetermined every 12 months (as required by law) from the initial start date. A letter is sent to your address of record 60 days before the renewal date.

It is paramount that you fill out the information requested and return the letter to your designated county office even if you or your loved one’s functional or financial status has not changed.

When you receive this redetermination packet, you should review the current information about your household and report any changes or corrections of this information.

Please pay attention to see if any additional information has been specifically requested and provide the required proof.

You can report your changes and updated information by either:

  • Going to Colorado.gov/PEAK
  • Logging into your account, and following the Redetermination/Recertification link
    OR
  • Complete the “Redetermination Form” and mail, fax, or bring the Renewal Form back to your local county human services office

We recommend sending the completed paperwork by certified mail or hand delivering it to the local county office to guarantee it is received.

An increase of countable income or a loss of SSI or TANF can impact your Medicaid eligibility. Some examples of increases in countable income could be:

  • Inheritance
  • Financial Settlement
  • Wage increase
  • Bonuses

What you should do if you become financially ineligible?

Contact or visit your local county

Find Your Local County Office