Project Health Colorado is here to help answer your questions. And when the responses are really complex, we call on health care experts from across Colorado—doctors, consumer advocates, insurers and others—to answer the questions that you have asked. These experts represent and understand often complicated health care issues and provide you with straight answers. To select answers by the topics that most interests you, click on the circles below.
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What other options for health care coverage are available if one has a preexisting condition?
Under the federal Affordable Care Act (ACA), insurance companies can no longer refuse coverage to children based on pre-existing health conditions. This part of the law, called “guaranteed issue,” began in 2010 for children, but will not begin for adults until January 2014. Until then, adults can still be denied individual health insurance coverage. Until this time, CoverColorado is the only option for those who can’t get insurance because of a pre-existing condition.
The ACA tries to make insurance for those with pre-existing conditions more affordable by changing the way insurance plans decide how much a person’s premium will be. Right now, many insurers set premiums based someone’s use of health care services, their health status, gender and many other factors. Beginning on January 1, 2014, health plans will be allowed to adjust their premiums based only on these few factors:
- Individual versus family enrollment. Health plans will be allowed charge different rates if the plan covers only an individual or a family.
- Geographic area. Insurance plans will be allowed to charge higher premiums in geographic areas where the costs of medical care are relatively high in comparison to other areas.
- Age. Insurance plans will be allowed to vary premiums based on age, but there is a limit. Older adults will not be charged more than three times the rate of younger individuals.
- Tobacco use. Insurance plan will be allowed to charge higher rates for people who use tobacco but there is a limit. Premiums for tobacco users cannot be more than 1.5 times higher than premiums for non-tobacco users.
What organizations in Colorado are planning on setting up accountable care organizations (ACO)? If none, then why not? Is there any legislative action that will make this happen faster?
Many experts believe that Accountable Care Organizations – or ACOs – are a promising model to achieve payment and delivery system improvements. While ACOs do not put an end to traditional fee-for-service payments, they do include financial incentives for doctors to reduce medical costs and improve patient care. Like patient-centered medical homes and bundled payments, ACOs offer a new health care model in which providers take joint responsibility for keeping patients healthy while simultaneously controlling costs. The driving concepts behind ACOs is that by working together and opening the lines of communications, health care providers can reduce duplication of services, eliminate unnecessary procedures and decrease unnecessary visits to the ER - all resulting in improved care at a lower cost.
ACOs have also emerged as a component of Congress' recently approved H.R. 3590 – the Patient Protection and Affordable Care Act. Section 3022 of the federal health care reform bill establishes ACOs as a means to provide incentives for performance-based care.
Colorado is exploring the possibilities offered by this model. Sandeep Wadhwa, MD, Colorado Medical Director, Colorado Department of Health Care Policy and Financing (HCPF) says that Colorado's version of ACOs, Regional Care Coordination Organizations (RCCOs), are intended to provide a medical home for Colorado Medicaid patients, coordinate care across health programs and providers, and establish regional accountability for patients' health outcomes and affordability of care. HCPF plans to implement the RCCO pilot statewide by year-end.
How does my child’s oral health impact their overall wellness? Is anything being done at the state level to try to improve access to oral health services for kids?
Children’s oral health is one of the top priorities for Colorado – and the nation. Colorado’s Governor Hickenlooper has designated children’s oral health as one of the State’s 10 winnable battles over the next five years. And many key stakeholders – such as foundations and providers – are working to help improve access to oral health care.
Oral disease can impact a child’s performance in school, speech development, nutrition, self-esteem and sleep. Yet, oral disease can be prevented by increasing access to oral health and educating families about its importance.
Colorado children living in poverty face significant oral health challenges despite increased awareness about the importance of oral health, more preventive measures such as fluorides and sealants, and efforts to improve access to oral health care. Nearly 60 percent of low-income kindergartners in Colorado have suffered from tooth decay. For more than one in four of those low-income children, tooth decay goes untreated. Most of those kindergartners have dental coverage through publicly funded programs—Medicaid and Child Health Plan Plus (CHP+). But fewer than half use the coverage. Only one in four visited the dentist by age 1 as is recommended.
That being said, Colorado has made commendable strides in addressing children’s oral health needs. Local foundations have increased investments in prevention, access to care and workforce development and public-private collaborations have expanded resources to address needs. Despite limited infrastructure, the Colorado Department of Public Health and Environment has collected and analyzed oral disease data and assessed workforce capacity.
Still, much more can be done to help ensure that Colorado’s children have the best oral health possible and the State and other stakeholders continue to think about ways to improve children’s oral health in Colorado.
How do I find a doctor in rural Colorado who is accepting new patients?
There are a few different places where those in Colorado can go when trying to find a new provider.
The Colorado Consumer Health Initiative has extensive resources for both the insured and uninsured, most poignantly, a provider map where users can search by zip code, distance, and type of care needed. The Colorado Department of Health Care Policy and Financing (HCPF) also has resources for finding providers for those who qualify for Medicaid in rural Colorado. Colorado Rural Health Center has a map on its website that outlines rural health clinics (amongst many other helpful rural health resources).
Unfortunately, finding a doctor who is accepting new patients is not simple. We recommend reaching out to any of these aforementioned organizations directly in order to find the health care provider that will fit your needs.
What is Colorado doing to help persons with disabilities access needed care while waiting for disability benefits approval (SSI)?
For those seeking heath care In order to provide aid to persons with disabilities, Colorado has an Aid to the Needy Disabled (AND) program that provides a small cash assistance benefit to individuals ages 18 – 59 who have at least a six-month disability that prevents them from engaging in significant gainful activity. These benefits do not provide a medical benefit, but are available while an individual's application for Social Security Disability/SSI benefits is pending. To apply for AND, call or go to your local County Department of Social/Human Services.
The Colorado Department of Health Care Policy and Financing (HCPF) recently began accepting Medicaid applications for low-income adults without dependent children (AwDC). This program is limited to individuals below 10 percent of the Federal Poverty Level (approximate $90 per month for a single adult). Unfortunately, this program is limited to 10,000 clients and HCPF currently has a waitlist for eligible individuals. Despite these restrictions, this program may provide very low-income adults with disabilities much-needed medical assistance while disability benefits are being determined.
For those who are not awaiting disability benefits approval, the Medicaid Buy-In Program for Working Adults, age 16-65, with Disabilities (Adult Buy-In) provides adults with disabilities, who earn too much income or have too many resources to qualify for regular state plan Medicaid, the opportunity to purchase Medicaid. To be clear, this program is not available to individuals while their disability determination is pending.
Information provided by the Colorado Center on Law and Policy.
There have been some changes with companies offering child-only coverage that might affect whether my kids can keep their insurance or not. My employer’s coverage is expensive and I’m not sure I qualify for any public programs. What’s available?
One of the benefits of the Affordable Care Act included a provision that insurance companies must not deny children with pre-existing conditions. Some insurers did not want to abide by this reform and, in turn, opted to eliminate their child-only health policies before that provision began in September 2010. To correct this unanticipated occurrence and to maintain access to health coverage for children, child health advocates and insurance leaders developed state legislation in 2011 that passed into law providing two one-month enrollment periods in January and July of each year in which insurers have to offer child-only policies along with policies for any applicants.
Child-only insurance plans provide a critical health coverage option for Colorado families. Some employers do not offer dependent coverage or it's simply too costly. In other cases parents might be uninsured but want to make sure their children are able to get the coverage and care they need to stay healthy.
In addition to individual market plans that may be available in those two annual enrollment periods, other resources for children's health coverage where you can check on your eligibility include Child Health Plan Plus, Medicaid for low-income families and the Medicaid Buy-In Program.
Is there anything being done at the state or federal level to prevent huge increases in individual health insurance premiums? These increases are pricing individuals out of the health insurance market.
There are many strategies underway at both the state and federal levels of government to reduce costs. Colorado is fortunate to be a leader in working to improve health care, with many organizations leading the way on these efforts.
At the federal level, the Affordable Care Act (health reform law) contains many key components aimed at bringing down costs to individuals, including a new requirement for insurance companies to publicly justify their actions if they propose raising rates by more than 10%. As well, Coloradans will benefit from rebates or reduced premiums from insurance companies for dollars they spend on administrative costs.
Fundamentally, though, the most important way to control the rising cost of health insurance is to rein in the cost of health care. A major reason that the US spends more on health care than any other country – but has worse outcomes than many – is that our system is set up to pay for the volume of services we get, not their value. For more information about activities intended to protect consumers from sharp increases in premiums, click here.
Please illustrate the differences between Medicaid and Medicare and how they impact the state differently?
Medicare is a federal insurance program that primarily serves people over 65, as well as people under 65 with disabilities and dialysis patients. Medical bills are paid from trust funds which Medicare recipients have paid into. Medicare patients pay partial costs through deductibles for hospital and other costs, and small monthly premiums for non-hospital coverage. Medicare is essentially the same in each state and is run by the Centers for Medicare and Medicaid Services (CMS), which is a federal agency. In Colorado, there are an estimated 631,000 Medicare beneficiaries, according to CMS data.
Medicaid is a state-federal insurance program that serves low-income people of every age. Eligibility for Medicaid varies from state to state. Patients typically do not pay out-of-pocket for covered medical expenses. The federal government provides about 50% of the Medicaid funding, and the rest comes from state government, which account for about one-quarter of the state General Fund. Medicaid is run by state and local agencies within federal guidelines. In Colorado, Medicaid serves families, children, pregnant women, persons who are blind or persons with disabilities, and elderly residents.
As of March 2012, there are currently 632,511 Medicaid clients in Colorado, according to the Department of Health Care Policy and Financing.
For more information about the differences between Medicare and Medicaid, you can visit the U.S. Department of Health and Human Services.
For more information about Colorado's Medicaid program or other public assistance programs, you can visit the Department of Health Care Policy and Financing.
I want to purchase health care for my son who is 24 and between jobs. I have no idea where to even start looking. Please help.
Because of the Affordable Care Act, young people can now stay on their parents' health insurance through age 26 and children can no longer be denied coverage because of a pre-existing condition. If you are uninsured or can't afford to add your son to your insurance, then your son can look into individual insurance. Colorado is currently developing its own health insurance exchange, which will help individuals and small employers purchase insurance through a simple system that compares the cost and coverage of various health insurance options.
I am disabled and cannot work, my wife can’t find a job and is not in the best health. Even if she could work, I don’t think we could afford to have her insurance cover me. What kind of insurance could we get?
Individuals that meet the outlined eligibility requirements for people with disabilities can receive health insurance for themselves and spouses through Social Security. There are two types of Social Security: Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). Social Security Disability Insurance makes payments to the disabled and blind through the federal government’s Social Security trust fund. Additional assistance can come from the SSI Program to those who have limited income and resources. You can find out if you meet the criteria for a person with a disability and how to apply for Social Security benefits through the Social Security Association Disability Programs. Additionally, anyone who is eligible for SSDI is automatically enrolled in Medicare for health insurance coverage after a 24-month waiting period (during the waiting period, you may be eligible for health insurance through a former insurance). And people who are disabled and low-income are considered “dual eligible,” meaning that they also qualify for Medicaid programs. It can be a complicated system to navigate, so you can also review this comprehensive guide or contact the State Health Insurance Assistance Program.
