OTHER THINGS YOU SHOULD KNOW TO HELP YOU USE YOUR MEDICAID MENTAL HEALTH BENEFITS

Office of Member and Family Affairs

CHP has an Office of Member and Family Affairs (OMFA) to help you with any problems or questions about your mental health services. The Office of Member and Family Affairs:

• Helps members with grievances (complaints) and appeals;
• Advocates for members and their families;
• Helps members and families understand the mental health services available and how to get those services; 
• Provides information about other resources in the community, such as self-help groups and advocacy organizations;
• Helps members and their families understand their rights and responsibilities when getting mental health care; works to protect members’ rights;
• Helps members and their families to have a voice in the mental health system by getting involved in committees and advisory boards;
• Provides education about mental health and other recovery issues.

Call your mental health center or CHP if you would like to talk to someone from the Office of Member and Family Affairs at 1-800-804-5040. They can also tell you about member advisory boards in your area.

Quality Improvement Program
CHP has a Quality Improvement (QI) Program. This program helps us measure and improve the quality of our services. It gives us information about things like: 

• How our services help people get better
• How we are doing to help people meet their recovery goals
• How quickly we respond to complaints and appeals
• How satisfied members are with the complaint process
• How long people have to wait for appointments
• How long people stay in the hospital
• How we are doing at keeping people from going back to the hospital too soon after discharge

To learn more about our Quality Improvement program or to get a free copy of our Quality Plan, call us at 1-800-804-5040.

Member Surveys
We want to know your opinion about the services you get. To get your opinion, we do surveys over the phone or by mail. Our surveys ask you questions about your mental health treatment. They will also ask what you think we can do better. All information we get from the survey is confidential. We do not give out any names. If you have questions about the survey, please call CHP and ask to speak to someone in the Quality Department.

Client Advisory Committees
CHP and the mental health centers have advisory committees that give us feedback about how we are doing. If you would like to learn more about any member advisory committees in your area, call the Office of Member and Family Affairs, at 1-800-804-5040, to find out how you can get involved.

OTHER MEDICAID BENEFITS
Your Non-Mental Health Benefits under Medicaid 

We have listed some of the Medicaid benefits you may be eligible for in the following section. This handbook does not list all of your Medicaid benefits. For more information about your Medicaid health care benefits please call:

Medicaid Customer Service
1-303-866-3513 (Denver Metro Area)
1-800-221-3943. (outside of Denver)
Or go to the state Medicaid website,

http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1197364086675

How can I get Care for Physical Health Problems?
If you need medical care, see your primary care or other doctor. If you do not have a Primary Care Provider (PCP) call HealthColorado. HealthColorado is a state program that helps people on Medicaid enrolls in (join) health plans to get Medicaid services.   

HealthColorado
Metro Denver 1-303 839-2120
All Other areas 1-888-367-6557
TTY: 1-888-876-8864

http://www.healthcolorado.net/

CHP can also help you find a doctor. Call us at 1-800-804-5008. 

You may have to pay co-pay for medical care. Co-pay is your share of the cost of your health care. Call Medicaid Customer Service at 1-303-866-3513 or 1 -800-221-3943 to learn more about co-pays. Or go to the state website at:

http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1197364127331

Coordinating your Care
Your mental and physical health affects one another. It is important that you tell your mental health and your medical providers about the care you are getting from all providers. It is especially important that all your providers know about any medications you are taking. If you have questions, or need help coordinating your care, call us at 1-800-804-5008.

Early Periodic Screening, Diagnosis & Treatment (EPSDT)
Early Periodic Screening, Diagnosis and Treatment (EPSDT) are a special health care program for children and youth ages 20 and under who have Medicaid. Children and youth can get health checkups, nutrition checkups, dental checkups, baby shots and other tests under EPSDT. There is no fee for EPSDT check-ups. Regular check-ups are important. They will help keep your child healthy and find any health problems early. If the EPSDT screening finds that your child has health problems, EPSDT will also provide for the medical treatment.

If your child is Medicaid eligible, and you would like to get an EPSDT check-up, call your Primary Care Physician (PCP). Your PCP will do the health check or refer you to a health clinic. To learn more about Colorado’s EPSDT program, visit their web site at:

http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1218622604254

Under certain conditions EPSDT will also cover mental health services for youth between 18 and 21 who have a disability. These youth must be eligible for Medicaid, but their paperwork has not transferred from the child system to the adult system.

Home and Community-Based Services (HCBS) Waivers
The State of Colorado has many waiver programs. Waiver programs are special programs to help people with special health care needs to remain in their home and community. To qualify for a waiver, people must meet specific financial, medical and program criteria.   

People who receive services through a waiver are eligible for all basic services that Medicaid covers except services in a nursing facility and long-term hospital care. Some waivers may be applied for through a state agency. Others must be applied for through a Single Point of Entry (SEP) agency. Appendix C of this handbook lists the Single Point of Entry organizations for your county.

Each waiver has an enrollment limit and may have a waiting list. People may apply for more than one waiver, but may only receive services through one waiver at a time. Anyone whose application for a Waiver program is denied has a right to appeal to the state.

There are several different types of waiver programs. In most cases you can get general information about a waiver by calling:

Department of Health Care Policy and Financing (HCPF).
303-866-4770,
1-800-221-3943, or
TTY 1-800-659-2656

http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1223894303509

Waivers for Children

Children's HCBS Waiver: Provides Medicaid services in the home or community for disabled children through 17 years old. This is for children who are not eligible for regular Medicaid because their parents have income and/or resources above the required limit. Children must be at-risk of being placed in a nursing facility or hospital. Methods for applying for this waiver vary from area to area. To find out how to apply, call your county Single Entry Point, listed in Appendix C.

Children with Autism Waiver: Provides Medicaid services in the home or community for children through age 5 with a medical diagnosis of Autism. A child must have intensive behavioral needs making him/her at risk of being placed in an institution. To apply for this waiver, contact the Community Centered Board in your area (Appendix D).

Children's Extensive Support Waiver: Provides Medicaid services in the home or community for children through 17 years old with developmental disabilities or delays. The child must be at risk of being placed in an institution. Children age 0-4 must have a developmental delay; children 5-17 must have a developmental disability. Children must meet some additional criteria as well. For more information, call the Division of Developmental Disabilities, Colorado Department of Human Services (DHS) at 303-866-7467. To apply for the waiver, call the Community Centered Board in your area (Appendix D)

Children's Habilitation Residential Program Waiver: Provides residential services for children and youth in foster care who have a developmental disability and extraordinary needs. Children must be at risk for being placed in an institution. This program helps children and youth from birth to 21 years old to acquire, retain, and/or improve self-help, socialization and adaptive skills necessary to live in the community. To be eligible, children and youth must be placed through a County Department of Human Services. Also, they must have a developmental disability and extraordinary service needs for which services cannot be provided at the county negotiated rate. For more information, call the Division of Developmental Disabilities, Colorado Department of Human Services at 303-866-4393. To apply call the Department of Human Services in your county.

Pediatric Hospice Waiver (HOPEFUL Program): Provides access to Medicaid services for children with a life-limiting illness. The program is for children from birth to age nineteen with a medical diagnosis of a life-limiting illness who would otherwise be placed in a hospital or institution. Additional eligibility criteria apply. To apply, call the Single Entry Point agency for your county (see Appendix C).

Waivers for Adults

Waiver for Persons with Brain Injury: Provides a home or community-based alternative to hospital or specialized nursing facility for persons 16-64 years of age with brain injury. Qualified brain injuries are defined in the Colorado Code of Regulations. To apply for this waiver, call the Single Entry Point in your community (see Appendix C).

Waiver for Persons Living with AIDS: Provides a home or community-based alternative to hospital or nursing facility care for people of all ages living with HIV/AIDS. To apply for this waiver, call the Community Centered Board in your area (see Appendix C).

Waiver for Persons with Mental Illness: Provides a home or community-based alternative to nursing facility care for people 18 years of age and older with major mental illness. To apply, call the Single Entry Point in your community (see Appendix C).

Waiver for Persons who are Elderly, Blind, and Disabled: Provides a home or community-based alternative to nursing facility care for elderly, blind, and disabled persons 18 years of age and older. To apply, call the Single Entry Point in your community (see Appendix C).

Waiver for Supported Living Services: Provides supported living in the home or community to persons age 18 and older with developmental disabilities. For more information, call the Division of Developmental Disabilities, Colorado Department of Human Services, at 303-866-7462. To apply for this waiver, call the Community Centered Board in your area (see Appendix C).

Waiver for Persons Developmentally Disabled: Provides services and supports out of the family home which allow people age 18 and older with developmental disability to continue to live in the community. For more information, call the Division of Developmental Disabilities, Colorado Department of Human Services, at 303-866-7462. To apply, call the Community Centered Board in your area (see Appendix D).