Health care can be confusing. We know there’s quite a bit of information, so we’ve created this frequently asked questions page to answer more questions you might have about Health First Colorado (Colorado's Medicaid Program) and how RMHP can help you get the care you need, when you need it.
About Health First Colorado
You have options. You can use Connect for Health Colorado to compare and buy a new health plan or check to find out if you qualify for Health First Colorado (Colorado's Medicaid Program). Another helpful website is cohealthinfo.com, which provides information if you have health insurance, if you need health insurance, or if you are just looking for additional resources. RMHP can answer your questions and can help you find health insurance.Connect for Health Colorado
You will receive a letter from Health First Colorado (Colorado's Medicaid Program) when you become eligible. This letter will tell you how you can find your Member handbook, as well as include an online survey link to help identify any healthcare needs you have. A mobile Member card is available through the PEAKHealth mobile app, or you can print a card from co.gov/peak. Health First Colorado will not send you a Member card. You do not need a Member card to get care. When you visit a doctor or pharmacy, you will need to provide your date of birth and either your social security number or your Health First Colorado ID number.
If you are a Health First Colorado Member and also enrolled with RMHP Prime, you will receive a Member ID card from RMHP for your RMHP Prime plan.
If you lose your Health First Colorado eligibility, you are no longer enrolled in your regional organization.
If you get your Health First Colorado benefits back within 60 days of losing them, you will be automatically re-enrolled into the regional organization with the same primary care provider you had the last time you enrolled. After a 60-day break in coverage, you will be re-enrolled in the regional organization, but you may receive a new notification letter. If you have questions about your enrollment in Health First Colorado, contact Health First Colorado Enrollment at 888-367-6557.
If you are enrolled in Health First Colorado, you can update your information online using the PEAK website or through your mobile phone using the PEAKHealth mobile app.
Changes you should report include:
- Number of people in your home (for example if you got married or had a baby)
- New home address
- New phone number
- New email address
- Income changes
- Job changes
You should report the change within 10 days of the change.
To learn more, you can watch a video on how to keep your information up-to-date.Visit Colorado PEAK
Learn about PEAKHealth
Watch the video
About the Regional Organization and RMHP Prime
Every Health First Colorado Member (Colorado's Medicaid Program) belongs to a regional organization. A Member’s regional organization is based on the county where the Member’s primary care provider is. RMHP is the regional organization for Health First Colorado Members who live in Western Colorado and Larimer County. As part of the RMHP regional organization, some of your benefits are covered by RMHP, including your behavioral health benefits. RMHP and local community care teams can help connect you to providers near where you live, work with your primary care provider to help you get the medical care you need, and help your providers work with each other and with you to make sure your healthcare needs are met. RMHP does not make any of your medical decisions; you and your medical providers do.
RMHP has a health plan that provides healthcare services to most adult Health First Colorado (Colorado's Medicaid Program) Members who reside in the counties of Garfield, Gunnison, Mesa, Montrose, Pitkin and Rio Blanco. This plan is known as RMHP Prime. Member enrollment is determined by Health First Colorado based upon an individual’s county of residence and Health First Colorado eligibility category. For RMHP Prime, covered benefits include Health First Colorado-covered benefits.
If you are a Health First Colorado (Colorado's Medicaid Program) Member living in one of the following counties, then you are a part of the RMHP regional 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, or Summit counties.
RMHP has a health plan that provides health care services to most adult Health First Colorado Members who live in the counties of Garfield, Gunnison, Mesa, Montrose, Pitkin and Rio Blanco. This plan is known as RMHP Prime. Member enrollment is determined by Health First Colorado based upon an individual’s county of residence and Health First Colorado eligibility category.
RMHP will mail you a Member ID card when you enroll with RMHP Prime. Your RMHP Prime Member ID card has important information, including phone numbers and plan details. Be sure to show your Member ID card when you visit the doctor or pick up a prescription. If you need a new card, contact RMHP Customer Service.
If you are planning to move or have moved, contact RMHP to help you find a primary care medical provider closer to your new home. You can also stay with your current primary care medical provider if you want. If you are moving to a new region or county that is served by a regional organization other than RMHP, contact Health First Colorado Enrollment at 888-367-6557 to change your regional organization.
About Your Healthcare
Your primary care provider (PCP) is your main healthcare provider. Your PCP is your
medical home, where you will get most of your health care. By knowing you, your PCP can better help you manage your health or help you when you are sick. When you need care from a specialty doctor, your PCP will help you find the right provider to treat you. Your PCP can also refer you to other services and supports in your community as necessary.
We encourage all RMHP Members to visit a primary care provider at least once a year, even if you feel well. It is important to see your doctor when you are well so he or she knows you and can help you when you are sick. Your primary care doctor will provide the healthcare you need or will refer you to another provider or to services that can help you. Make an appointment with your primary care doctor now if you have not had a visit in the past year.
Urgent care is different from emergency care. Urgent care is for a sickness or injury that needs medical care quickly but it is not an emergency. Emergency rooms treat severe and life-threatening conditions. Hospital emergency rooms have specially trained doctors, paramedics, nurses and other support staff that can recognize, diagnose and make recommendations on a wide variety of medical issues.
Examples for when a trip to the emergency room is appropriate include the following:
- Your primary care medical provider tells you to go to the emergency room
- Severe bleeding
- Chest pain
- Difficulty breathing
- You think your condition may endanger the life of your unborn child
- Sudden and/or severe pain
- Sudden vision changes
- Loss of consciousness
- Head injury
If you have an emergency, go to the nearest emergency room or call 911 or the local emergency number. If you are not sure if you have an emergency, call your primary care medical provider.
Examples for when a trip to the urgent care center is appropriate include the following:
- Sprains or broken bones
- Fever, cough, ear aches, or sore throat
- Flu-like symptoms
- Minor burns or injuries
- Animal bites
- Mild allergic reactions
If you need urgent care, call your primary care medical provider’s office and follow their instructions. Call them even if it is on the weekend or after hours.
This is an approach in which all care and services within a community, like your doctor, your behavioral health provider, and/or your social worker, work together with you to make sure you get the services you need to stay as healthy as possible.
Find a primary care provider that you trust. RMHP can help you find a primary care provider if you do not have one. Call RMHP Customer Service at 888-282-8801.
When your health status changes, or when you go to the hospital, you might have questions. Your primary care provider, your community care team, and RMHP are here to help you get the care and the services and supports that you need.
Sometimes health is affected by problems such as no transportation to appointments, insufficient or poor quality food, or unsafe environments. Primary care providers, community care teams, and RMHP can refer you to other community and social services that can help you. Call RMHP Customer Service for help.
Communities throughout Western Colorado are working to help Members get connected with the healthcare they need. This includes help with medical, mental, behavioral, and social service needs. RMHP Customer Service is here for you to help you access these resources.
Primary care providers
Be sure to visit your primary care provider at least once a year, even if you are well. Your primary care provider will either provide the health and medical care you need, or will refer you to another provider or to services and supports that can help you. Many primary care practices in Western Colorado have participated in activities to be an advanced primary care practice or designated as a certified primary care medical home.
Community care teams
Throughout our region, community care teams help people navigate the healthcare system. Community care teams bring together people with different backgrounds and training to support Members of the community. Primary care providers and community care teams will assess your needs, refer you to people who can help, and will work together with you to reach your health and wellness goals. Primary care providers and community care teams work with you and any other providers who care for you to help coordinate the different services you receive, help when your healthcare needs change, and help you learn more about managing your condition and staying healthy.
Talk with your primary care provider, your community care team, or RMHP about any concerns to see if they can assist you and solve the problem. The Colorado Health First Colorado Managed Care Ombudsman is also available to help Members solve problems or file grievances (complaints) and appeals. You can contact the Ombudsman for Health First Colorado Managed Care at 877-435-7123 (TTY: 888-876-8864) or email firstname.lastname@example.org.
If you are also enrolled in RMHP Prime, contact RMHP Customer Service for help in resolving any complaints or appeals you have. RMHP will document your complaint and will help you resolve it, or will work with others involved in the Health First Colorado program to help to resolve the complaint as appropriate.
If you believe you have been wrongfully denied services, you can file an appeal and request a State Fair Hearing. Contact the Colorado Office of Administrative Courts at 1525 Sherman Street, 4th Floor, Denver, CO 80203, or call 303-866-2000. If you have Medicare and Health First Colorado, you can file an appeal with both Health First Colorado and Medicare.
What are my rights?
It is your right:
- To get information about RMHP and its services, doctors, and health care providers and to get information about your rights and responsibilities
- To be treated with respect and with recognition of your dignity and right to privacy
- To accept or refuse medical treatment to the extent provided by Colorado state law and to participate in making decisions about your health care
- To have open discussion with health care providers about appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage, and presented in a manner appropriate to your condition and ability to understand
- To make appeals, and to bring complaints to RMHP, the Insurance Commissioner of the State of Colorado, or the Department of Health Care Policy and Financing
- To be furnished health care services in accordance with federal health care regulations for access and availability, care coordination and quality
- To expect all communications regarding your care to be kept confidential as required by law
- To freely exercise your rights without being treated differently
- To be free from the use of physical restraint or being isolated. These methods may not be used to make you cooperate, to punish you, for the ease of the caregiver, or as a way of getting back at you
- To get family planning services from any Health First Colorado provider, in or out of RMHP’s network, with no referral
- To request and receive your medical records and to have them changed according to federal law
- To get a second opinion
- To be free from discrimination based on race, color, national origin, age, disability, sex, sexual orientation, or gender identity
- To make recommendations regarding RMHP’s rights and responsibilities policy
- To use any hospital or other setting for emergency care
What are my responsibilities?
Your responsibilities are:
- To choose a Primary Care Physician (PCP) for each member of your family and to let that PCP know of any advance directive regarding your medical care
- To let your PCP direct your care with specialists and other health care providers, except in cases of medical emergencies, urgent care when outside the service area, obstetrical or gynecological care, and eye care
- To learn about your RMHP health care benefits, procedures, and limitations and to be cooperative and considerate with health care providers and staff
- To notify RMHP Customer Service of membership or address changes, marriage, birth of a child, or adoption of a child
- To take responsibility for copayments and costs for certain health care services and any services that are not covered by Health First Colorado
- To understand your health problems and participate in making treatment goals
- To provide the health care provider with all information needed for you to receive appropriate care
- To follow the plans and instructions for care that you and your provider agreed on
- To tell your providers about any Advance Directives about your health care
- To tell RMHP about any other insurance you may have, including Medicare
- To follow any protocols of a responsible third party payor (such as other insurance) prior to receiving any non-emergency services
- To provide RMHP with written notice after filing a claim or action against a third party responsible for your illness or injury
- To file a complaint or grievance, please follow the rules as described in the Appeal and Grievance section in your Member Handbook