[CO] YSK: There’s a fatal flaw in the Colorado Medicaid system, make sure everyone’s covered!

Story time: apparently my daughter lost Medicaid coverage a long time ago, and due to two very weird things about the Colorado Medicaid system (Health First Colorado), I had no idea for about 6 months. First off, she was only eligible for medicaid as a <1yo – a fact that in all the craziness around her birth, I managed to forget. Her birthday is in February. So, we re-did our marketplace renewals in January, and made sure the medicaid renewals were correct – however, I was having a little trouble getting the results to sync across both systems (ultimately there was no issue there, but that is relevant). Come February around her birthday, we got a letter from medicaid – which I read carefully – which states that Ada “qualifies for limited family planning benefits”. No mention of any coverage ending, etc. I immediately assumed that this was related to the problems I was having with the online services vis-a-vis my applications – but out of an abundance of caution, I logged into PEAK (the online system for medicaid), and confirmed: my daughter had medical coverage, and that would not be reevaluated until 02/2025.

Weird thing #1: unlike literally anything else that touches health insurance, there’s no “effective until” date for medicaid. This can be reevaluated at literally any time for any valid reason by the state, and they can drop your coverage as of the first of the next month for any valid reason. PEAK is very unclear about this, and really makes it looks like they’re telling you the soonest it could be reevaluated, but the date they show is actually when your paperwork is due, and NOTHING ELSE. So, when I checked in February, after her birthday, and after I had received the new eligibility letter, the only thing shown on PEAK was the already active plan (since the new plan was not yet active, it didn’t show AT ALL), and short of any change the state sees in the meantime, my re-application for that plan was only due in 2025. Kinda understandable why I thought her coverage was okay, no?

Anyway, there are no further letters at this point from medicaid – and they have properly covered her 1yr check-up in February (after her birthday). I have absolutely no reason to think she is not covered, until months later I start to get bills denied for her. But if she lost coverage, I should have gotten a notification around March 1 to that effect, no?

Weird thing #2: “Limited Family Planning benefits”. Literally everyone I’ve talked to about this problem at the county or state level has had some negative thing to say about this program. In theory, it’s great – make sure that people can get coverage for their birth control, even in funny eligibility situations. However, there are two problems with this benefit as it relates to my situation – first, since she continued to be covered under medicaid, even though it was only LFP benefits, she never technically “lost” her coverage, hence no notification that she lost her coverage – second, LFP has “higher priority” in the system than CHP+, so it never evaluated her for CHP+ coverage until I finally had them remove the LFP. If I had gotten either notification in March, it would have triggered me to dig deeper, and I would have had this fixed by April 1 at the worst… but again, there was actually no reason for me to even consider the possibility that she wasn’t covered. I’ll never know what they think an 18-month-old needs birth control for, and multiple providers expressed that they thought it was a mistake in medicaid, because no way she’d ever qualify for that so young, right?

Her CHP+ eligibility is a whole different story, long story short I had to go through the marketplace to get her covered. The saving grace to this problem is that the removal of the LFP benefits (NOT the change from full benefits to LFP) triggers a loss of coverage qualifying event – this didn’t actually matter for her (since she’s a Native American), but if that weren’t true, I’d still be okay now. We’re still in the unfortunate situation that the marketplace plan won’t start until 10/1, but with a reschedule of one appointment for her, and some hope that she doesn’t get injured or sick in the next two weeks, it’s taken care of.

In summary: while I fully recognize that this is 100% my fault, I ended up in a really lousy position thanks to my understandable misunderstanding of some quirks of the Colorado medicaid system. I did need to rant a bit, but I’m hoping that maybe this info will save someone some headache down the line. Biggest takeaway: read and understand EVERY SINGLE LETTER you get, and don’t assume it’s a mistake. If you don’t 100% know why you got a letter, CALL THEM and have them explain it to you. I spent this February recovering from back surgery, so I let myself get a little lax about that rule (assuming I had figured it out myself), but that’s still no excuse – following up at that point would have been totally possible, and would have let me ensure continuous coverage for her.