Learn About Benefits

Learn About Benefits

We know you might have questions about your benefits. So, we’ve put together some helpful information below. If you still have questions or would like a complete list of your benefits, refer to your Member Handbook, or call RMHP. We can help.


All Members in the regional organization and RMHP Prime receive the same benefits that are covered under Health First Colorado (Colorado's Medicaid Program). You can watch a video to learn more about the covered physical benefits and services available for Health First Colorado Members. You can manage your Health First Colorado benefits on the Colorado PEAK website or through the PEAKHealth mobile app. You can also read more in the Health First Colorado Member Handbook. Member handbooks for Health First Colorado, RMHP Prime, and CHP+ can all be found by visiting the link below.


Download Member Handbooks
View benefits at Health First Colorado
Watch a video
 

Health First Colorado (Colorado's Medicaid Program) covers some dental services for children and adults. Adults age 21 and older have an annual dental benefit of up to $1,000 in dental services per year. These benefits are covered by Health First Colorado. You can view a video to learn more about these benefits.

Read about the benefits
Watch the video

To find a participating dentist near you, visit the DentaQuest website or call 855-225-1729. 

Find a dentist

That depends. If you are part of the RMHP regional organization but not enrolled with RMHP Prime, Health First Colorado (Colorado's Medicaid Program) covers your medical benefits, and RMHP covers your behavioral health benefits. If you’re a Member of RMHP Prime, RMHP will cover both your medical and behavioral health benefits. Services not covered by RMHP are called wrap-around services. They include benefits like hospice care, skilled nursing facility services, private duty nursing, dental services, and others. Some services like acupuncture, experimental treatments, services outside of the United States, and others are not covered by RMHP or Health First Colorado.

Prenatal and postpartum care and provider visits before and after your baby is born are covered benefits. You can view a video about pregnancy benefits to learn more.

Watch the video

Long-Term Services and Supports (LTSS) help people who need ongoing medical or social support.  A person needs to be financially and medically eligible for LTSS benefits. Additional information about Long-Term Services and Supports is available through the Department of Health Care Policy and Financing website.

View the website

Home and community-based services (HCBS) provide additional Health First Colorado (Colorado's Medicaid Program) benefits to specific people that meet special eligibility criteria. These waivers provide opportunities for Health First Colorado Members to receive services in their own home or community. These programs serve a variety of targeted groups, such as the elderly, people with mental illness, intellectual or developmental disabilities, blindness, and/or physical disabilities. To qualify, Members must meet financial, medical and home and community based services program criteria.

To help choose between the various programs that could be available to you, please see the below flowcharts. These tools are designed to be used with the help of a Case Manager and/or Advocate.

Choosing an HCBS waiver - adults
Choosing an HCBS waiver - children

Additional information about these home and community-based services are available through the Department of Health Care Policy and Financing. 

Find more information

Yes. Health First Colorado pays for counseling to help you quit smoking. They also pay for any federal Food and Drug Administration (FDA) approved medications or products for two 90-day sessions each year that can help you quit.

These steps can help you get started:

  1. Talk to your doctor about your smoking habit and your goal to quit.
  2. Your provider may give you a prescription for a tobacco cessation product or medicine. All FDA approved prescription medications and over the counter tobacco cessation products (such as Chantix, nicotine gum or nicotine patch, etc.) are covered by Health First Colorado for a maximum of two 90-day sessions per year.
  3. Contact the Colorado QuitLine to talk with a QuitLine tobacco cessation counselor. Your provider and QuitLine tobacco cessation counselor are here to help!
Visit the QuitLine website

If you are pregnant, the Prenatal Plus Program can help you quit smoking and learn more about staying healthy while pregnant.

Learn about Prental Plus Program

Some services covered by Health First Colorado (Colorado's Medicaid Program) have a copay. Copays are dollar amounts some Members must pay to their provider when they receive certain services. Copays are different for different services.

There is a monthly copay maximum for Health First Colorado Members. This means once a Member has paid a certain amount in copays in a month, they are not required to pay any more copays for the rest of that month. Health First Colorado will automatically notify you when your household has reached its copay maximum for the month. The head of household will receive a letter showing the household has reached the monthly limit and how the limit was calculated. You can find out more on the Health First Colorado copays website.

Read more at Health First Colorado

Some Health First Colorado Members never have copays. These Members are:

  • Children who are ages 18 and under
  • Pregnant women (includes pregnancy, labor, birth and up to six weeks after delivery)
  • Members who live in a nursing home
  • Members who get hospice care
  • American Indian or Alaska Native Members
  • Former foster care children ages 18 through 26

Some services never have copays. Examples of these services include:

  • Emergency services
  • Family planning services and supplies
  • Behavioral health services
  • Preventive services, such as yearly checkups, and vaccines

EPSDT stands for Early Periodic Screening, Diagnosis & Treatment.

This program is for children and teens who are 20 years old and under enrolled in Health First Colorado (Colorado's Medicaid Program). When your child or teen is a part of the RAE or RMHP Prime, they are part of the EPSDT program. The EPSDT benefit provides comprehensive and preventive healthcare services for these children. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, developmental, and specialty services.

  • Early: Assessing and identifying problems early;
  • Periodic: Checking children's health at periodic, age-appropriate intervals;
  • Screening: Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems;
  • Diagnostic: Performing diagnostic tests to follow up when a risk is identified; and
  • Treatment: Control, correct or reduce health problems found.

There is no cost for those who meet the income guidelines; however, copays may apply to some services.

EPSDT Services

Your primary care doctor will examine your child and provide necessary screenings.

Covered screening services include:

  • A full health and developmental history
  • Comprehensive unclothed physical exam
  • Appropriate vision testing
  • Appropriate hearing testing
  • Appropriate immunizations
  • Laboratory tests (including lead toxicity screening)
  • Health education (including child development, healthy lifestyles, and prevention)
  • Screenings to check the child’s development
  • Dental screening (includes checking mouth and teeth, and referrals to a dentist)

You child should see a primary care doctor to get screenings based on the following frequency:

  • 3 to 5 days after birth and within 48-72 hours after discharge
  • by 1 month
  • 2 months
  • 4 months
  • 6 months
  • 9 months
  • 12 months
  • 15 months
  • 18 months
  • 24 months
  • 30 months
  • Once every year for ages 3 to 20

Your doctor will identify your child’s needs and will make referrals for treatment as necessary. Finding and treating even little problems helps your child grow up healthy. The following are EPSDT benefits:

  • Physical exams
  • Sick care
  • Developmental and depression screening
  • Lead Screening
  • Mental/behavioral health screening
  • All the shots your child needs
  • Vision exams and eyeglasses
  • Dental care starting at age 1, including examinations, cleanings, and fluoride treatments
  • Hearing exams, including diagnosis and treatment of children with hearing loss, and hearing aids for children
  • Limited Orthodontia for those with severe conditions
  • Home health
  • Durable Medical Equipment
  • Family planning
  • Help for children with disabilities
  • Case Management by a Healthy Communities family health coordinator, for all families as well as all pregnant women who have Health First Colorado coverage
  • Other necessary health care services – additional health care services that are described in the Federal Medicaid program and found to treat, correct or ameliorate illnesses and conditions, are covered regardless of whether the service is covered under what is known as Colorado’s State Health First Colorado plan. For these services, medical necessity is decided on a case-by-case basis.

Immunizations

Your child needs shots to protect him or her from serious illnesses. These are called immunizations. The following list shows the shots your child will need as he or she grows up. Your child may need other shots as well if your child has certain medical conditions. There is a catch up schedule for shots if your child misses some shots. Talk with your child's doctor to find out what shots your child should have and how many.

Age

Shots

Birth to 2 years old

Hepatitis B (HepB)

 

Rotavirus (RV)

 

Hib (prevents meningitis)

 

Pneumococcal (PCV)

 

Diphtheria, Tetanus, Pertussis (DTaP)

 

Polio (IPV)

 

Influenza (yearly starting at age 6 months – 18 years old)

 

Measles, Mumps, Rubella (MMR) Varicella (protects against chicken pox)

 

Hepatitis A (HepA)

4 to 6 years

Diphtheria, Tetanus, Pertussis (DTaP)

 

Polio (IPV)

 

Measles, Mumps, Rubella (MMR)

 

Varicella (protects against chicken pox)

 

Influenza (yearly)

11 to 12 years

Tetanus, Diphtheria, Pertussis (Tdap)

 

Human Papillomavirus (HPV)

 

Meningococcal Conjugate Vaccine (MCV)

13 to 18 years

Meningococcal Conjugate Vaccine (MCV) Booster at age 16

 

Your child should have shots they missed at an earlier age. Talk with your child's doctor about a catch up schedule.

 

Influenza (yearly)

Diagnostic Services

When a screening indicates the need for more evaluation, diagnostic services are provided.

Treatment

Necessary health care services are made available for treatment of all physical and mental illnesses or conditions discovered by any screening and diagnostic procedures.

Getting Help

RMHP is here to help. Call us and we can help you understand this benefit. Or, visit the Health First Colorado website.

Learn more at Health First Colorado

You can also get help through the Healthy Communities program. In Colorado, the Healthy Communities program helps by:

  • Providing information about EPSDT, including:
    • EPSDT services available
    • Age-appropriate screenings
    • Well child visits and immunizations
  • Providing or arranging screening services for all children
  • Arranging (through referral) for corrective treatment as determined by child health screenings
  • Following-up after missed appointments
  • Referring for transportation assistance

Learn about Healthy Communities
Contact a family health coordinator

For more information about what preventive care is recommended for your child at each age and stage, Colorado has adopted the American Academy of Pediatrics Bright Futures schedule.

View the schedule

How to Get Help


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Call us at 888-282-8801 (TTY: 711). Para asistencia en espanol llame al 888-282-8801.

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Email us. You'll receive a response from a rep within 24 business hours.

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Live chat with us,
Monday - Friday, 8 a.m. - 5 p.m.

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Visit  us at 2775 Crossroads Blvd in Grand Junction, Monday - Friday,
8 a.m. - 5 p.m.