Extensions, Reconsideration Period and Appeals
60 Day Extension for Vulnerable Populations
In September, Colorado implemented a 60-calendar-day extension for vulnerable populations, including long-term care (LTC), members on waivered services, and buy-in recipients. This extension was implemented to prevent procedural terminations (for failure to return the renewal packet) and allow extra time for members to complete their renewals. The extension is in effect through the remainder of the unwind period, June 2024. It does not affect members who have already submitted their renewal packet to the county or those who have completed the renewal process.
90 Day Reconsideration Period for All Members
The reconsideration period is a 90-day period after a procedural termination has occurred. All members can take advantage of the reconsideration period by turning in an existing renewal packet or supporting documents within 90 days of their renewal date to see if they still qualify. If they qualify for Health First Colorado during that 90-day period, coverage begins as of the 1st of the month they are determined eligible again. If there is a gap in coverage, members must ask the county to be enrolled retroactively or they can request retroactive coverage in PEAK once they are approved and their new eligibility date is known.
60 Day Appeal Window for All Members
When an eligibility decision is made, individuals have 60 calendar days from the date on the notice of action to appeal their eligibility decision (the exact deadline date is printed on the notice). Coverage will be automatically continued during the appeal for individuals who appeal timely. Individuals are always allowed to appeal any action taken on an eligibility decision. They can ask for a State Level Hearing (Formal), Dispute Resolution Conference (Informal), or both simultaneously. Information about the appeals process and how to appeal is part of the member letter known as a "notice of action."
To summarize the differences: an extension allows extra time for members to complete complex renewals and may prevent a procedural denial, whereas the 90-day reconsideration period allows members who were procedurally denied to submit their renewal packets late and perhaps reinstate their coverage. Once the renewal packet is received and processed by the county, an eligibility decision is made. The appeals process is available for members who disagree with their eligibility determination.