Colorado Medicaid – Explained

Medicaid benefits can be confusing – here is a brief explanation of your Medicaid coverage.

Center for Resilience Strategies is credentialed with Colorado’s Medicaid program – now known as Health First Colorado.

Medicaid is a state-funded health insurance program – think of Medicaid as a “type” of insurance. Colorado Medicaid is actually split up into what are called Regional Accountable Entities (RAEs) – think of them as separate insurance companies responsible for administering and managing your health benefits. These companies cover different sections of Colorado.

RAE Map.png

There are 5 Medicaid RAEs, or companies. Each company administers the benefits for its indicated counties (refer to the above image). The main 2 companies for the Denver Metro Area are Colorado Access (CO Access) and Colorado Community Health Alliance (CCHA).

How is my Medicaid “company” (RAE) determined?

When you apply for Medicaid, it asks some basic demographic questions such as address. Then it asks you about your Primary Care Physician (PCP). If you have a PCP you regularly see who accepts Medicaid and you enter their information, your Medicaid company is based on the county of your PCP. This could mean you live in Boulder county, but if your doctor is in Denver county, your Medicaid will be with CO Access.

If you do not set a PCP at the time of application, your company is determined by your home address, and you are randomly assigned a PCP in your closest Medicaid region.

What companies (RAEs) does CRS accept?

The Center for Resilience Strategies accepts Colorado Community Health Alliance (CCHA), Colorado Access (CO Access) & Rocky Mountain Health Plans (RMHP).

However, different therapists can accept different companies. All of our therapists accept CCHA, RMHP. Only our fully licensed therapists accept CO Access. We try to pair you with the best therapist for your needs that accepts your Medicaid RAE.

Is there a difference between Medicaid and Medicare?

Yes, these are two completely different insurances. Medicare is coverage for older adults aged 65+, or individuals of any age who have a disability. Typically, when you are searching for therapists who accept Medicare, you will want to find a Licensed Clinical Social Worker, or LCSW.

Our practice is not able to accept Medicare at this time, but we do accept Medicaid.

How much do my sessions cost through Medicaid?

Your counseling and therapy sessions typically cost $0. In rare cases, your plan may include a small fee for your sessions, depending on your coverage. As a new client, we will look into your benefits and provide you with this information upfront.

We are unable to accept out-of-pocket payments from Medicaid members for all “covered services,” including outpatient therapy. Accepting payments puts your eligibility for Medicaid coverage at risk of being canceled.

How many sessions does Medicaid cover?

Under active Medicaid, you are entitled to unlimited outpatient counseling sessions. Higher levels of care and other services may require a prior authorization.

What if I want to work with a provider who doesn’t accept my coverage?

Unfortunately, this gets tricky, as we are unable to accept out-of-pocket payments from Medicaid clients. Again, accepting payments from you would put you at risk of losing your Medicaid benefits. Some exceptions exist if services are not covered by Medicaid. However, Medicaid generally requires you work with providers who are “in-network” or have a contract with Medicaid.

Are there any limits to my Medicaid benefits?

If you have Medicaid, you typically cannot have multiple sessions in a day. If you are being seen for individual and family, please schedule them on different days.

All other limits depend on your plan, so we recommend looking into your Medicaid plan if you have more questions.

If you have questions about your Medicaid and how it affects your services at CRS, please reach out to our billing specialist.

720-647-6700 ext. 2

Medicaid Resources

Apply for Colorado Medicaid – check eligibility and apply.

Colorado Access Website – find providers and benefit information

Colorado Community Health Alliance (CCHA) Website – find providers and benefit information

Rocky Mountain Health Plans (RMHP) Website – contact info and member support