Medicaid provides health coverage to eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements and is jointly funded by states and the federal government. Colorado’s Medicaid program is known as Health First Colorado.
Enrollment
In Colorado, Kaiser Permanente serves more than 63,000 assigned patients in Health First Colorado (Medicaid). 91% are children and 9% are adults. (as of December, 2024).
Participation
Kaiser Permanente participates in Health First Colorado in 7 counties, specifically in the Denver and Boulder metropolitan area. Kaiser Permanente contracts with Regional Accountable Entities as a fee-for-service provider in the Denver and Boulder metropolitan area.
State Program Spotlight
Kaiser Permanente provides several Medicaid benefits that help address social needs and improve outcomes for our members, especially those with the most complex needs. Key benefits include:
- Financial incentives for closing care gaps
- Specialty virtual care consults
- Screening for social determinants and providing care coordination
- Blood pressure remote monitoring
- Prescription drug monitoring
- Breast pump distribution
Quality
Kaiser Permanente Health First Colorado performs in the National Committee for Quality Assurance (NCQA®) 95th percentile or above** for the following measures for the Medicaid Program:
- Cervical Cancer Screening
- Asthma Medication Ratio
These metrics are based on NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS), a tool used by more than 90% of America’s health plans to measure performance on important dimensions of care and service.
(**Measures reflect Kaiser Permanente Health First Colorado performance among all Medicaid plans nationally for reporting year 2023.)
Social Health
Many Kaiser Permanente members struggle with inadequate housing, hunger, financial stress, and other circumstances that create barriers to good health, particularly members enrolled in Medicaid. Kaiser Permanente works proactively to identify our members with these and other adverse social needs and to connect them to community-based programs and government assistance programs that can support their well-being.
Safety-Net Partnerships
Kaiser Permanente is committed to building partnerships with the health care “safety net” — institutions that play a critical role in delivering health care for the uninsured and underserved. Through grants, training, and technical assistance, we work with safety-net hospitals and health centers to help these institutions reach those who are low-income, uninsured, or under-resourced in our communities, and move the needle in eliminating health disparities. We do this by investing in quality improvement and other support efforts that aim to transform care and improve health access for those most in need.
Social Health Screening and Identification
Kaiser Permanente uses standard social health screening questions and data analytics to identify members vulnerable to food-insecurity, homelessness, financial strain, and other adverse social factors. In Colorado, we will begin screening all new Medicaid members for social needs as part of their new member onboarding this year.
By expanding social health screenings across an increasing number of clinical settings and member service touchpoints, with a focus on high-risk populations, Kaiser Permanente is steadily increasing the number of members screened for social needs each year. We screened nearly 3 million members for social needs in 2024, including 32% of our Medicaid members. These screenings and other data sources helped us identify over1 million members with social needs and connect nearly 500,000 members to public benefits and community-based programs that support overall health.
The Kaiser Permanente Community Support Hub™
The Kaiser Permanente Community Support Hub™ is dedicated to helping people meet their basic needs. The Hub operates proactively, using text, email, and phone calls to encourage members to complete social health screenings and to offer help finding and enrolling in community-based resources and government assistance programs that support overall health. The hub also provides on-demand services, including an online directory of resources that anyone can use to search for local programs that help with housing, food, paying utility bills, and more.
Medical Legal Partnerships
Working with local legal aid organizations in our communities, our care teams help patients facing housing-insecurity receive legal help at no cost. These medical-legal partnership programs build the capacity of the legal services sector and increase access to legal services to prevent people and families from losing their homes.
This program targets low-income members and patients with housing related legal needs. In 2024, legal consultation was provided to over 1,000 patients across our national footprint.