Health First Colorado, the state’s Medicaid program, covers contact lenses only when they are medically necessary and standard eyeglasses cannot correct your vision adequately. So the short answer to whether Medicaid covers contacts in Colorado is: sometimes, with prior authorization, and the rules differ sharply by age. Adults 21 and older face narrow eligibility; children and young adults under 21 have broader coverage under a federal mandate. There is no copay either way.
What Adults 21 and Older Get
If you are 21 or older, annual eye exams are covered at no cost. Routine eyewear — glasses or contacts prescribed to correct ordinary nearsightedness, farsightedness, or basic astigmatism — is not a standard adult benefit.1Department of Health Care Policy and Financing. Health First Colorado Vision Benefit
There are two paths to coverage. If you have had eye surgery at any point in your life, the program covers one pair of single-vision or multifocal clear plastic lenses and one frame, with eligibility for a new pair every 24 months.2Department of Health Care Policy and Financing. Vision Care and Eyewear Billing Manual Separately, contact lenses are covered when glasses alone can’t correct your vision adequately. That’s the medical necessity route, and it requires prior authorization from the state.
What Children Under 21 Get
Members under 21 receive much broader vision benefits through the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. Under EPSDT, states must cover all medically necessary screening, diagnosis, and treatment — including eyeglasses and contact lenses — even if those services wouldn’t be covered for adults.3Medicaid.gov. Early and Periodic Screening, Diagnostic, and Treatment
Vision screening is part of the required periodic schedule for children in Colorado. When a screening identifies a visual impairment, follow-up diagnosis and corrective hardware are covered, including contact lenses when clinically appropriate. Contact lenses and orthoptic vision treatment for children still require prior authorization, submitted by an ophthalmologist, optometrist, or optician.4Colorado Secretary of State. Colorado Code 10 CCR 2505-10 8.280 – EPSDT
What Counts as Medically Necessary
Contact lenses qualify when they serve a therapeutic purpose that glasses can’t achieve. Your eye care provider has to document that conventional spectacles are insufficient for functional vision. Conditions that commonly meet the standard include:
- Keratoconus, where the cornea thins and bulges into a cone and specialty contacts correct the distortion better than glasses.
- Aphakia, the absence of the eye’s natural lens (typically after cataract surgery), where contacts outperform thick aphakic spectacles.
- High anisometropia, where the refractive power differs so much between the two eyes that glasses create intolerable image-size differences.
- Irregular astigmatism or corneal scarring that prevents light from focusing properly through standard lenses.
The clinical benchmark is that your best-corrected visual acuity with glasses falls below a functional threshold, typically around 20/40.2Department of Health Care Policy and Financing. Vision Care and Eyewear Billing Manual Contact lenses prescribed as a cosmetic or convenience preference don’t qualify. Supplies like cleaning solutions and replacement insurance are not covered.
How Prior Authorization Works
Before the program pays for medically necessary contacts, your provider submits a Prior Authorization Request (PAR) electronically through the state’s portal. The documentation includes:
- Your Health First Colorado ID number (a letter plus six digits, shown on your member card).5Health First Colorado. Member Handbook
- The specific ICD-10 diagnosis code (for example, H18.6 for keratoconus or H27.0 for aphakia).
- A clinical narrative explaining why glasses aren’t adequate.
- Lens specifications (base curve, diameter, power).
- Evidence that lower-cost options were considered and found insufficient.
Standard reviews are generally completed within about 10 business days. You get a written decision by mail, and your provider can check status in the portal. If approved, the PAR generates a tracking number used to order and dispense the lenses.
Finding a Provider and Getting Fitted
You need a provider enrolled with Health First Colorado. The “Find a Doctor” tool at healthfirstcolorado.com lets you filter by optometrist or ophthalmology. For help, call the Member Contact Center at 800-221-3943 (state relay 711).6Health First Colorado. Find a Doctor
Once authorization is approved, the office orders the specialized lenses using the PAR number, schedules a fitting to confirm the lenses match the approved specifications, and has you sign an acknowledgment of receipt at dispensing. There is no copay; Health First Colorado pays the full cost of covered contact lenses.7Health First Colorado. Benefits and Services
Replacing Lost or Damaged Lenses
Replacement rules split by age. If you’re 20 or younger, the program covers replacement of contact lenses, eyeglasses, ocular prosthetics, and low-vision aids when they’re lost, when your prescription changes, or when damage repair would cost more than replacement.8LII / Legal Information Institute. Colorado Code 10 CCR 2505-10-8.203 – Vision Services
For adults 21 and older, eyewear replacement is not a covered benefit under current rules. If you lose or damage medically necessary contacts, the program won’t pay for replacements outside the standard authorization cycle. Ask your provider whether a new PAR is possible based on your clinical situation.
If Your Request Is Denied
You can appeal a denial. The Notice of Action you receive explains the reason and your appeal rights, and you generally have 60 days from the date on that notice to request a state fair hearing through the Office of Administrative Courts.9Health First Colorado. Appeals Submit by:
- Mail or in person: Office of Administrative Courts, 1525 Sherman St., 4th Floor, Denver, CO 80203
- Phone: 303-866-2000
- Fax: 303-866-5909 (10 pages or fewer; otherwise mail it)
- Email: oac-gs@state.co.us
- Online: the Office of Administrative Courts e-filing system (account required)
Include your name, mailing address, daytime phone, member ID, the decision you’re appealing, and why you disagree. Attach the denial letter. At the hearing, an administrative law judge reviews whether the denial was proper. Ask your eye care provider for additional clinical records supporting medical necessity; detailed provider documentation often carries the most weight.
If You Have Both Medicare and Medicaid
When you are dual eligible, Medicare pays first for services both programs cover. Medicare generally does not cover routine vision, glasses, or contacts, with one narrow exception: one pair of eyeglasses or contact lenses after cataract surgery.10CMS. Beneficiaries Dually Eligible for Medicare and Medicaid For vision services Medicare won’t cover, Health First Colorado can step in as secondary payer under the same rules described above: covered annual exams, and contacts only with medical necessity and prior authorization. Confirm with your provider that Medicare won’t cover the service, then have them submit the PAR through Health First Colorado.