What Does That Mean?

young woman

Empowerment through better health care

Health care language is confusing. Plus, health care situations are stressful and everyone struggles to understand the forms, various applications and health care words. We’re here to help you better understand the basics.

Need help?

Contact the Colorado Criminal Justice Reform Coalition by calling 303-825-0122 or email us.

Behavioral Health

This term refers to both mental health and substance use.

Behavioral Health Organization (BHO)

Colorado has five Behavioral Health Organizations (BHOs). If you are on Health First Colorado (Colorado’s Medicaid Program), you are automatically assigned to one of the BHOs depending on where you live. The BHOs help those on Health First Colorado get mental health and drug treatment.

Care Management

Care management is when someone helps you access health care and other important services so that you can be as healthy as possible. Care management services can include helping you find a doctor, helping you schedule an appointment with a doctor, making sure you understand and stick to your treatment plan and learn more about self-care. Care management can help make sure all of your providers are working together. Care management services can also help you find community resources for things like food, transportation, housing, dental care and much more.

Child Health Plan Plus (CHP+)

The name of Colorado’s Children’s Health Insurance Program for people who qualify. CHP+ provides health coverage to children and pregnant women. Individuals who are covered by CHP+ may have to pay an enrollment fee and/or co-pays.

Chronic Disease

An illness or condition that is long-lasting. You might be able to control symptoms of a chronic disease, but most likely there is not cure.

Co-Pay

A set amount (for example, $5) you pay for a doctor visit or for medication that is covered under your health plan.

Community Health Centers (CHCs)

Also known as Federally Qualified Health Centers (FQHCs), these clinics provide comprehensive primary care services, which can include dental care and mental health on a sliding fee scale.

Community Mental Health Center (CMHC)

Also known as Community Behavioral Health Centers, CMHCs are the safety net providers for mental health care. Most CMHCs also provide drug treatment services and primary care.

Community Safety Net Clinic (CSNCs)

CSNCs provide primary care and other health care services to individuals and serve as a resource to individuals who are uninsured and underinsured. CSNCs may provide free care, low cost care and also take Health First Colorado and other health insurance plans.

Continuous Eligibility

When a person’s eligibility for a particular health insurance program does not need to be checked for a specific amount of time. Health First Colorado (Colorado’s Medicaid Program) must check to see if someone is still eligible at least once every 12 months.

Dependent

Dependents are typically children or spouses/partners. You claim “dependents” in regards to health insurance. You also may claim “dependents” on your taxes if you are financially responsible for them.

Enrollment Fee

The amount of money you must pay to be included in a program.

Essential Health Benefits

A set of 10 health benefits that must be covered by health insurance plans sold on the Health Insurance Marketplace. Essential Health Benefits must also be covered by Health First Colorado (Colorado’s Medicaid Program) for any newly eligible individuals. Essential health benefits must include items and services within at least the following 10 general categories:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

Federal Poverty Level (FPL)

Federal poverty levels are used to determine eligibility for certain programs and benefits.

Federally Qualified Health Centers (FQHCs)

See Community Health Centers (CHCs).

Formulary

A list of the prescription drugs your insurance plan covers.

Health Insurance Marketplace

Health Insurance Marketplaces (aka Marketplace) were established by the Affordable Care Act. Colorado’s Marketplace is called Connect for Health Colorado. A Marketplace is an online resource where you can shop for a bunch of different health plans. Depending on how much you make, you may be able to get help to buy health insurance on the Marketplace.

Integrated Care

Integrated care refers to one’s physical, behavioral, and oral health care.

Health First Colorado (Medicaid)

Health First Colorado (Colorado’s Medicaid Program) is low cost health insurance for Coloradans who qualify.  Health First Colorado can help pay for doctor visits, dental care, and drug and mental health treatment.

Open Enrollment Period

The period of time set up to allow you to purchase private health insurance, in and outside the Marketplace, usually once a year. The open enrollment period for Connect for Health Colorado will take place November 15, 2014 – February 15, 2015. Health First Colorado (Colorado’s Medicaid Program) does not have a set enrollment period, so you can sign up for Medicaid anytime during the year.

Preventive Services

Health care services that include screenings, checkups, and other testing to prevent or reduce serious illness.

Primary Care

Primary care can cover a lot of health care services including prevention, screening, physical health, mental health, dental care, and checkups. It is essentially health care that is meant to meet most of your needs.

Qualifying Life Event

A qualifying life event allows you to buy private health insurance outside of an open enrollment period. A qualifying life event can include getting married, having a baby or being released from prison or jail. Health First Colorado (Colorado’s Medicaid Program) does not have a set enrollment period, so you can sign up for Health First Colorado anytime during the year.

Regional Care Collaborative Organization (RCCO)

Colorado has seven Regional Care Collaborative Organizations (RCCOs). If you are on Health First Colorado (Colorado’s Medicaid Program), you can choose to be connected to a RCCO. Which RCCO you are in will depend on where you live. RCCOs can help you find a doctor and connect you with other community resources that you may need to help you stay healthy in the community. See Care Management.

Safety Net

Health care providers and clinics that provide health care services and other care whether or not a person can pay. Safety net providers serve individuals who are primarily uninsured or low-income.