Provider Search Tool Frequently Asked Questions
What is the provider search tool?
The Department of Health Care Policy and Financing website offers a Find a Doctor provider search tool for Health First Colorado and Child Health Plan Plus members to search for and contact health care providers including physicians, clinics, and dentists. Members who use this tool to search for providers should keep in mind that they also need to contact the individual provider to confirm the provider is accepting new patients.
Why is there a need for a provider search tool?
The Department maintains all Health First Colorado provider information and works to make this information accessible so that members can find providers to deliver covered services.
What information does the provider search tool contain?
The provider search tool search results provide a list of providers sorted by providers’ names:
- Provider legal name / Doing Business As name
How frequently is provider information updated?
The data is updated daily.
How do members use the search tool?
Members can search for providers by location, provider type, specialty, and/or name.
What If I Dont Have A Newborn Child Declaration Form
If you dont have a Newborn Child Declaration form, or if your baby is older than 52 weeks, you can use a Medicare enrolment application form. You will need your childs birth certificate and some supporting documents. You can mail or email the form to Medicare. Read more on the Services Australia website.
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How Do I Get Insurance For My Newborn
Due to personal incidents I recently missed the enrollment period to add my newborn daughter to my work health insurance plan and have to wait until November to enroll her. I appealed and they still refused to let me add her. Obviously I cant have my newborn without insurance for nearly a year. Is there a plan that I can sign her up for that will cover her up until November 2015. I just need coverage for her. My wife and I are currently covered by my health plan. I am a member of the military and will actually be deploying again in November/December of 2015.
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If You Have Medicaid Or The Childrens Health Insurance Program Coverage:
- If youâre found eligible during your pregnancy, youâll be covered for 60 days after you give birth.
- After 60 days, you may no longer qualify. Your state Medicaid or CHIP agency will notify you if your coverage is ending. You can enroll in a Marketplace plan during this time to avoid a break in coverage.
Start Smart For Your Baby
Our Start Smart for Your Baby® program provides customized support and care for pregnant women and new moms. This program focuses on your health during your pregnancy and your babys first year.
- Start Smart for Your Baby® offers these benefits at no cost to you:
- Information about pregnancy and newborn care
- Community help with housing, food, clothing and cribs
- Breastfeeding support and resources
- Experienced and licensed medical staff to work with you and your doctor if any issues occur during your pregnancy
- Text and email health tips for you and your newborn
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How Long Does Medicaid Or Chip Coverage For Pregnancy Last
Medicaid or CHIP coverage based on pregnancy lasts through the postpartum period, ending on the last day of the month in which the 60-day postpartum period ends, regardless of income changes during that time. Once the postpartum period ends, the state must evaluate the womans eligibility for any other Medicaid coverage categories.
7. Is abortion covered by Medicaid or CHIP?
The Hyde Amendment, an annual requirement added by Congress to a federal appropriations bill, prohibits using federal funds abortion coverage except when a pregnancy results from rape or incest, or when continuing the pregnancy endangers the womans life. However, states may use their own funds to cover abortions, and 17 states currently do.
Can Uninsured Immigrant Women Receive Medicaid Or Chip Services
Maybe. Immigrants with qualified non-citizen status are eligible to enroll in Medicaid if they otherwise meet state Medicaid eligibility requirements, but are subject to a five-year waiting period from the time they receive their qualifying immigration status before becoming eligible. Some categories of qualified non-citizens are exempt from the five-year ban because they are considered lawfully residing immigrants. For lawfully residing immigrants, the five-year waiting period was waived in 2010, giving states the option to provide lawfully residing immigrant women with pregnancy-related Medicaid regardless of the length of time they have been in the U.S. Twenty-three states provide pregnancy-related Medicaid to lawfully residing immigrants without waiting periods. For undocumented and DACA-eligible immigrants, states may provide undocumented immigrant women with federally funded prenatal services through CHIP. Some states may also provide prenatal care entirely using state funds.
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When Does The 48
If you deliver in the hospital, the 48-hour period starts at the time of delivery. So, for example, if a woman goes into labor and is admitted to the hospital at 10 p.m. on June 11, but gives birth by vaginal delivery at 6 a.m. on June 12, the 48-hour period begins at 6 a.m. on June 12.
However, if you deliver outside the hospital and you are later admitted to the hospital in connection with childbirth , the period begins at the time of the admission. So, for example, if a woman gives birth at home by vaginal delivery, but begins bleeding excessively in connection with childbirth and is admitted to the hospital, the 48-hour period starts at the time of admission.
Is It Permissible For My Health Plan Insurance Company Or Hmo To Require Me To Get Permission For A 48
No. Plans, insurance companies and HMOs cannot deny your coverage for the 48-hour hospital stay based on a failure to show medical necessity. However, plans, insurance companies, and HMOs can deny coverage for any portion of the stay that is longer than 48 hours based on their determination of whether it is medically necessary.
In addition, a plan may require you to give notice of pregnancy before admission to the hospital in order to obtain more favorable cost sharing. However, a plan may not reduce your benefits because your pregnancy began before the first day of coverage and you failed to give notice of the pregnancy before becoming covered under the plan. This type of plan provision operates as a preexisting condition exclusion and these exclusions cannot be applied to pregnancy.
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What If You Dont Have Health Insurance
If you dont have health insurance, now is the time to get it. Youll need coverage for the babys delivery and for frequent newborn checkups.
Medicaid and the Childrens Health Insurance Program
Medicaid and the Childrens Health Insurance Program 6 are insurance programs for low-income people, including pregnant women and children. Medicaid eligibility and program rules vary by state. Check with your state to see if you qualify for free or low-cost coverage. Some people on Medicaid pay a small portion of costs, while others pay nothing at all.
CHIP covers children whose families earn too much to qualify for Medicaid and, in some states, lower-income pregnant women.
Consolidated Omnibus Budget Reconciliation Act
If you or your spouse or partner recently lost their job at a company with at least 20 employees, youre likely eligible for coverage through the Consolidated Omnibus Budget Reconciliation Act .7
With COBRA, you can buy your former employers health insurance at full price for 18 months8 after youve left the job. COBRA tends to be very expensive because the employer no longer pays any part of your premiums. But if youre about to have a baby and you dont have other options, COBRA may help in the short term. Check with your former employer for details about costs and the process for getting covered.
Qualified Medical Child Support Orders
State Programs
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Can A Pregnant Woman Receive Medicaid Or Chip Services Prior To An Eligibility Decision
Maybe. States may elect, but are not required, to provide some categories of Medicaid enrollees, including pregnant women, with presumptive eligibility. This allows pregnant women to receive immediate, same-day Medicaid services, typically at the clinic or hospital where they submit an application for Medicaid presumptive eligibility. Currently, 30 states provide presumptive eligibility to pregnant women.
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Lawfully Residing Targeted Low
States have the option to provide CHIP and Medicaid coverage to children and pregnant women who are lawfully residing in the United States and are otherwise eligible for coverage, including those within their first five years of having certain legal status. If states do not adopt this option, federal law requires a 5-year waiting period before many legal immigrants are permitted to enroll in Medicaid and CHIP. Learn more about providing health coverage to lawfully residing children and pregnant women at 2107 of the Social Security Act, and in SHO# 10-006 . A list of states providing Medicaid and CHIP coverage to lawfully residing children and/or pregnant women.
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How Does A Woman Enroll In A Chip Perinatal Health Plan
Once a woman is found to be eligible for CHIP perinatal services, her unborn child must be enrolled in a health plan. The woman has 15 calendar days to select a health plan. The 15-day window opens the day she receives a letter from HHSC saying she qualifies for CHIP perinatal services on behalf of her unborn child. If she does not choose a health plan within the 15-day timeframe, HHS will choose one for her.
Once she has enrolled, the woman will receive an ID card from her health plan that specifies CHIP Perinatal Program.
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Do Medicaid And Chip Provide Pregnant Women With Comprehensive Health Coverage
Yes, in most but not all states. Full-scope Medicaid in every state provides comprehensive coverage, including prenatal care, labor and delivery, and any other medically necessary services.
Pregnancy-related Medicaid covers services necessary for the health of a pregnant woman and fetus, or that have become necessary as a result of the woman having been pregnant. Federal guidance from the Department of Health and Human Services clarified that the scope of covered services must be comprehensive because the womans health is intertwined with the fetus health, so it is difficult to determine which services are pregnancy-related. Federal statute requires coverage of prenatal care, delivery, postpartum care, and family planning, as well as services for conditions that may threaten carrying the fetus to full term or the fetus safe delivery. The state ultimately decides what broad set of services are covered. Forty-seven states provide pregnancy-related Medicaid that meets minimum essential coverage and thus is considered comprehensive. Pregnancy-related Medicaid in Arkansas, Idaho, and South Dakota does not meet MEC and is not comprehensive.
CHIP coverage for pregnant woman is also typically comprehensive. However, in states where services are being provided to the pregnant woman by covering the fetus, the services may not be comprehensive with respect to the health needs of the pregnant woman.
If You Dont Have Health Coverage
- Health coverage makes it easier to get the medical check-ups and screening tests to help keep both you and your baby healthy during pregnancy.
- If you qualify for a Special Enrollment Period
A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if youâve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.
due to a life event like moving or losing other coverage, you may be able to enroll in a Marketplace health plan right now. Being pregnant doesnât make you eligible, but the birth of a child does.
- Create an account now to apply for Marketplace coverage through the Open Enrollment Period or a Special Enrollment Period. If you select the option to get help paying for coverage on your application, youâll be asked if youâre pregnant. Reporting your pregnancy may help you and your family members get the most affordable coverage.
- If you donât qualify for a Special Enrollment Period right now, youâll be eligible to apply within 60 days of your childâs birth. You can also enroll in coverage for the next plan year during the next Open Enrollment Period this fall.
- If eligible for Medicaid or CHIP, your coverage can begin at any time.
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Your Protections Under The Newborns And Mothers Health Protection Act
If a group health plan, health insurance company, or health maintenance organization provides maternity benefits, it may not restrict benefits for a hospital stay in connection with childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section.
You cannot be required to obtain preauthorization from your plan in order for your 48-hour or 96-hour stay to be covered.
The law allows you and your baby to be released earlier than these time periods only if the attending provider decides, after consulting with you, that you or your baby can be discharged earlier.
In any case, the attending provider cannot receive incentives or disincentives to discharge you or your child earlier than 48 hours .
If your state has a law that provides similar hospital stay protections and your plan offers coverage through an insurance policy or HMO, then you may be protected under state law rather than under the Newborns and Mothers Health Protection Act.
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Pregnant Women Frequently Asked Questions
If I have a health question or concern, who should I call?
Health First Colorado offers a free 24-hour, 7 days a week Nurse Advice Line at 1-800-283-3221. Help is available in both English and Spanish.
What is the Nurse Home Visitor Program?
The Nurse Home Visitor Program is a special program for qualifying women who are pregnant with their first child. The program is also for these first children up to their second birthday. NHVP offers case management and health education services to moms and their first babies in order to help them get the medical and social services that they need.
How much are my co-pays?
You have no co-pays for Health First Colorado-covered services and prescriptions while you are pregnant and for two months after your pregnancy ends.
Can I get help to quit smoking?
- Contact the Colorado QuitLine at 1-800-QUIT-NOW for free coaching and support.
- Talk with your health care provider about the benefits and risks of taking smoking cessation medications while you are pregnant. Health First Colorado covers two 90-day courses of smoking cessation medication with counseling to help you quit.
Are prenatal vitamins covered?
Prenatal vitamins are a free benefit for all pregnant women. Talk with your health care provider about the benefits of taking a prenatal vitamin every day. A prescription is required.
Can I get transportation to my appointments?
Can I get help for depression?
How do I enroll my newborn in Health First Colorado?
Are breast pumps covered?
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What Services Are Covered
Medicaid covers breast pumps and breast feeding support during your pregnancy and after your baby is born.
You will get health care services through health plans. The health plans all have special programs for high-risk pregnancies. To learn more, go to Health Plan Information. Or call your health plan.
Health First Colorado Regional Organizations Frequently Asked Questions
What is changing about Health First Colorado?
Health First Colorado is working to improve the delivery of services. Starting July 1, 2018, Health First Colorado began contracting with one organization in each region of the state to manage both your physical and behavioral health care.
What is a Health First Colorado regional organization?
Your regional organization manages both your physical and behavioral health care. They support a network of providers to make sure you can access health care for your body, vision, mental health, and substance use in a coordinated way. Every Health First Colorado member belongs to a regional organization. Your regional organization is on your enrollment letter.
What is a regional organization and why are they involved in my health care?
Health First Colorado contracts with regional organizations to manage both your physical and behavioral health care. They support a network of providers to make sure you can access health care for your body, vision, mental health, and substance use in a coordinated way. Every Health First Colorado member belongs to a regional organization. Your regional organization is on your enrollment letter.
I’ve been a Health First Colorado member for years and I have never been contacted by a regional organization. I’ve never even heard of them. Why is that?
What will the regional organization do exactly? How will they be involved?
What is a managed care plan? How is it different from Health First Colorado?
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Medicaid Coverage And State
Private health insurance covers the cost of substance-use disorder treatment and services to varying degrees. Each insurer has its own policy, and insured individuals will need to refer to the policy of their respective insurance companies to determine the extent of services that are covered. Many women needing treatment, including pregnant women, may have once had private insurance but have lost that insurance. This section presents information for women who are uninsured, women who may qualify for Medicaid insurance, and women who are currently insured with Medicaid.
Medicaid Services for Women and Children
- Medicaid for Infants and Children
Medicaid for Infants and Children provides medical coverage for children younger than 19 years old. The income limits are determined by the family size and the age of the child or children applying for benefits. There is no limit on resources.
- Medicaid for Families with Dependent Children
Medicaid for Families with Dependent Children provides medical coverage for parent or other caretaker/relative with a child 18 years or younger in the household and for children under age 21. A pregnant woman may also qualify.
The family cannot have more than $3,000 in assets such as savings in the bank.
If the family income is above the cut-off and the child and/or family has high medical bills, the family might still qualify for Medicaid .
- Medicaid for Pregnant Women