How to Use your Medicaid Plan
RMHP Medicaid Prime Member Handbook English | Español
Rocky Mountain Health Plans (RMHP) has served Colorado Medicaid clients since 1974. If you are an RMHP Medicaid member:
RMHP Medicaid Prime Service Area - Area de Servicio de RMHP Colorado Medicaid.
- RMHP will help you get all your Medicaid benefits.
- You can call RMHP Customer Service if you have questions or need help.
- RMHP can help connect you to doctors and coordinate with other providers.
- RMHP can also help you find social and community services in your area.
Most adults who qualify for Medicaid in the following counties can join RMHP Medicaid Prime:
- Rio Blanco
RMHP Medicaid Accountable Care Collaborative Service Area
Most people who qualify for Medicaid in the following counties can join the Medicaid Accountable Care Collaborative with RMHP as their Regional Care Collaborative Organization:
Archuleta, Delta, Dolores, Eagle, Garfield, Grand, Gunnison, Hinsdale, Jackson, La Plata, Larimer, Mesa, Moffat, Montezuma, Montrose, Ouray, Pitkin, Rio Blanco, Routt, San Juan, San Miguel, Summit Counties.
Rocky Mountain Health Plan Medicaid Regional Care Collaborative Organization Counties
RMHP ID Cards
All new Rocky Mountain Health Plan Members are mailed an RMHP ID card. Show this ID card any time you go to the doctor, hospital or get prescription drugs. This will tell people where to send the bill. If you need another card, ask RMHP Customer Service at email@example.com or 970-244-7860 or 888-282-8801
How can RMHP Help?
Do you need help with your health care? Do you have questions?
We are here to help and easy to reach.
Have you not seen a doctor in more than a year?
Do you need help finding a doctor?
Do you need help getting health or medical care?
Are you confused about your health care?
Do you have an ongoing health condition?
Do you need help with activities of daily living?
Are you a loved one, caregiver, or family member of someone with health care needs?
Do you smoke, drink, or use drugs and want help?
Do you want to talk to a counselor?
Do you want to know about other services in your community that can help you?
Do you need help with life planning activities like an advanced care plan or advanced directive?
Do you need health care information in another language or format?
Do you need large print?
Necesitas informacion en espanol? Para asistencia en espanol llame al 888-282-8801.
How to Pick a Doctor or PCP
Rocky Mountain Health Plans has a Medicaid Provider Directory that lists doctors in you county. Look for a doctor that you want to see when you are healthy and when you are sick. This doctor may be a physician with a focus on primary care, general practice, internal medicine, pediatrics, geriatrics or obstetrics and gynecology. If you do not know the doctors on the list, pick a doctor with an office close to your home.
If you pick a doctor you have not seen before, call the doctor's office. Ask the office if they will take you as a new patient. If they will take you as a patient, tell them you are picking the doctor as your RMHP Medicaid PCP. If you have not seen a doctor in the past year, make an appointment. Keep your scheduled appointment, or let the doctor's office know you need to reschedule. The doctor may ask you to sign a form that shows that you want them to be your medical home.
Call RMHP Customer Services if you need help finding a PCP or if you need a Provider Directory. Each person in your family can have a different PCP. Call RMHP Customer Service at 970-244-7860 or 888-282-8801.
Changing Your PCP
If you want to change your PCP, follow the steps above for picking a PCP. You can change your PCP at any time. It is important for you to have a PCP. If you are changing doctors because you moved, call RMHP and let us know so we have your new address. Call RMHP if you need help changing your PCP.
A participating provider is a health care provider who has a contract with RMHP to serve our members. Services from providers who do not work with RMHP are not covered, unless:
- you need urgent or emergency care. If you have a medical emergency; then call 911 or go to the nearest emergency room.
- the health care you need is covered by Medicaid but cannot get the care from a doctor that works with RMHP. You must have permission before going to a doctor that does not work with RMHP.
Note: You may receive family planning services from a provider that does not work with RMHP.
Mental Health Services
Most mental health services are covered by the Behavioral Health Organization (BHO). RMHP does not pay for these services. Colorado Medicaid has more information on BHO services and to find the BHO in your community (link to https://www.colorado.gov/pacific/hcpf/behavior-health-organization)
Click here to learn more about RMHP Medicaid covered services and benefits
Click here to learn more about your member rights and responsibilities
You have many rights with Medicaid. You have the right to complain about RMHP or about any decision that they have made related to your health care. You have the right to complain about the health care you receive, or about your provider.
You have the right to appeal an action by RMHP. This means you can ask for a review of something RMHP has done or a decision they have made, such as a decision to deny services or payment for services you have received.
You have the right to file a grievance. This means you can complain about any other matter, such as a problem with your doctor or with RMHP customer service.
In addition to filing an appeal or grievance with RMHP, you may file for a State Fair Hearing, with the State of Colorado if you think that something that was denied should be approved. The State Fair Hearing process is described in Section C below.
Learn more about how you can appeal.
Use this form to file a complaint or an appeal.
How to request a State Fair Hearing
Future Health Care Decisions
You may want to make some decisions ahead of time about future health care. These decisions are called advance directives. They tell your doctor and other health care providers what you want to have done in case you are not able to talk to them.
Click here to learn more about Advance Directives.
Some Medicaid members may have to pay copayments when they get health care services. These copayments are low. You will not have to pay any copayments if you are:
- 18 years old or younger
- American Indian or Alaska Native
- Living in a nursing facility
Learn more about Medicaid benefits and copayments.
Para información de Medicaid y CHP+ llame al 970-244-7860 o 888-282-8801.