Cost-Effectiveness and Eligibility
What does it mean to have a case that is cost-effective?
A case is cost-effective if it is determined that the State will save money by paying for a Health First Colorado (Colorado’s Medicaid Program) member’s portion of the monthly commercial health insurance premium. Your case is cost-effective if the annual cost of your commercial health insurance premiums is less than the annual cost that Health First Colorado would otherwise pay for the member’s medical care.
Do I need to have a catastrophic illness to be eligible for HIBI?
No. Any Health First Colorado member with a high-cost medical condition will be considered for the HIBI Program.
Will you give me some examples of a high-cost medical condition?
When a pre-eligible applicant has a high-cost medical condition, there is a good chance their case will be cost-effective. An applicant with high medical costs may have a catastrophic illness, but high costs may also be associated with other types of conditions, including:
- Pregnancy
- Asthma
- Kidney disease
- Autism
- Cancer
- Cerebral palsy
- Diabetes
- Lou Gehrig’s disease
- Low birth weight babies
- Muscular dystrophy
Will HIBI find my case to be cost-effective if I am on Medicare?
Typically, premiums for Medicare supplements and Medicare HMO plans are not cost-effective for the State to pay.