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Health insurance is a method of paying or receiving reimbursement for health care costs from covered services. Health insurance companies spread the costs and risk of covered health care services across all members of a plan in exchange for premiums and other cost-sharing mechanisms, such as deductibles and copayments. These rates are actuarially determined and set at a level that covers the estimated health care costs incurred by all members of the group. This issue brief provides an overview of the health insurance market in Colorado and federal and state health insurance regulations.

Prior authorization—sometimes referred to as preauthorization or precertification—is a process by which an insurer reviews a request for health care services or drugs before consenting to cover the costs of the proposed treatment. Upon receiving a request, an insurer can approve or deny the request, or request additional information from the patient or their health care provider. Health insurers may require prior authorization for a variety of reasons, including cost control and verification of medical necessity.

Colorado currently administers ten Home- and Community-Based Services Medicaid (HCBS) Waivers. This issue brief discusses the four waivers available to children.

Colorado currently administers ten Home and Community-Based Services Medicaid (HCBS) Waivers. This issue brief discusses the six waivers available to adults.

Medicaid is a joint federal and state program that provides health benefits and services to Coloradans who meet eligibility requirements. Each state administers its own Medicaid program, and the federal Centers for Medicare and Medicaid Services (CMS) set standards for the program to receive federal financial participation. The Department of Health Care Policy and Financing (HCPF) oversees Colorado’s Medicaid. This issue brief summarizes the process to add benefits under Medicaid.

This issue brief provides an overview of minors’ rights to deny others access to medical records under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Colorado state law.  It also discusses state law pertaining to the ability of minors to consent to medical care.

The health care system frequently distinguishes between physical and behavioral health.  Physical health refers to the condition of the body. Behavioral health refers to the condition of cognitive processing systems.  Behavioral health services include, among others: individual and group therapy; psychiatric care; assertive community treatment; substance use disorder services; and prevention and early intervention activities.

This issue brief provides an overview of federal and state family, medical, and sick leave laws.

Vaccinations offer protection from common infectious diseases.  The federal Centers for Disease Control and Prevention (CDC) recommends specific vaccines for all infants, children, and adults during their lifetime to provide immunity from preventable illness.  A recent analysis estimated that for children born in a single year in the United States, vaccination prevented nearly 20 million cases of disease and over 40,000 deaths.

This issue brief addresses Colorado’s emergency mental health hold procedure, which allows for an individual to be involuntarily held for a 72‑hour period of treatment and evaluation if he or she appears to have a mental illness and, due to the mental illness, appears to be an imminent danger to self or others, or appears to be gravely disabled.  The brief also discusses treatment options following a mental health hold and the newly created Community Transition Specialist Program.   

Colorado currently administers 11 Home-and Community-Based Services Medicaid (HCBS) Waivers. This issue brief discusses the six waivers available to adults. An issue brief entitled Medicaid Waiver Programs Part I – Home- and  Community-Based Services Medicaid Waivers for Children discusses the five waivers available to children.

Respite care provides temporary relief to a caregiver from the physical and emotional impacts of caring for a person with special needs who is unable or needs assistance to care for himself or herself. It can be provided for a few hours, overnight, or on an extended basis by a friend, family member, volunteer, paid service provider, or in a community-based care setting. This issue brief provides a brief overview of state-funded respite care services and information about the Respite Care Task Force, which met during the 2015 interim.

Federal and state laws allow Medicaid applicants and clients who have their benefits denied, terminated, or reduced to appeal the decision. This issue brief provides an overview of the Medicaid appeals process in Colorado.

This issue brief provides information about Community-Centered Boards (CCBs) and recent legislation enacted to promote CCB transparency.

Colorado currently administers 11 Home- and Community-Based Services Medicaid (HCBS) Waivers. This issue brief discusses the five waivers available to children. An issue brief entitled Medicaid Waiver Programs Part II – Home- and Community-Based Services Medicaid Waivers for Adults discusses the six waivers available to adults.