What Does CHP+ Cover in Colorado: Benefits, Costs, and Plans

Colorado’s Child Health Plan Plus, known as CHP+, covers medical visits, hospital and emergency care, prescription drugs, mental health and substance use treatment, dental care through DentaQuest, vision services, and full maternity care for eligible children through age 18 and for certain pregnant Coloradans. There is no monthly premium. Some families pay an annual enrollment fee of up to $105 and small copays on non-preventive services, and total out-of-pocket costs are capped at 5% of annual family income.¹

Medical Care

The medical benefit covers primary care, specialist visits, hospital stays, emergency and urgent care, lab work and X-rays, immunizations, and emergency ambulance transportation.¹ Durable medical equipment such as wheelchairs, breast pumps, and diabetic supplies is covered, with a $2,000 annual cap on DME under Colorado Access.²

Outpatient physical, occupational, and speech therapy are included. The standard CHP+ benefit allows 30 visits per calendar year. Colorado Access members get 10 additional visits, for a total of 40 per diagnosis per year. Children from birth to age 3 have no visit limit for these therapies.² Family planning services and hearing aids are also covered.³

Mental Health and Substance Use Treatment

Behavioral health is a protected category under federal and Colorado parity laws, meaning insurers cannot treat it more restrictively than medical and surgical care.⁴ CHP+ pays for individual, family, and group therapy, inpatient and outpatient treatment, medication management, day treatment, residential treatment, and telehealth mental health support.⁵

Members usually do not need a referral from a primary care doctor to see a behavioral health specialist, though some services such as inpatient substance use treatment may require prior authorization.⁶ If a plan denies residential mental health treatment for a child under 18, parents can request an independent review by the Colorado Behavioral Health Administration under the Child Mental Health Treatment Act.⁵

Dental Care

Dental benefits for every CHP+ member are administered by DentaQuest, not by the medical plan. Covered services include annual exams and X-rays, cleanings, fluoride, sealants, fillings, stainless steel crowns, root canals, periodontic care, oral surgery including some extractions, and major services.⁷ Each member has up to $1,000 in covered dental benefits per calendar year.⁸

Orthodontia is covered only when medically necessary to correct a bite or jaw problem, never for cosmetic reasons. A member must have had 12 months of continuous CHP+ coverage before becoming eligible, and every orthodontic case requires prior authorization.⁷ Diagnostic and preventive dental services carry no copay; higher-income families may owe small copays on other procedures.⁸

The dental program does not pay for experimental or cosmetic procedures, hospital fees, general anesthesia or sedation, prescription medications, or treatment for jaw joint problems and facial pain.⁷

Vision Care

The standard CHP+ vision benefit provides $50 per calendar year toward lenses, frames, or contact lenses, plus one routine eye exam. Colorado Access adds another $100, bringing its members to $150 annually toward eyewear. Reimbursement is available for out-of-network vision providers up to the annual maximum.²

Prescription Drugs

CHP+ covers many prescription medications and some over-the-counter drugs. Each managed care organization keeps its own formulary, so the exact list of covered drugs varies by plan. Colorado Access uses Navitus Health Solutions and offers mail-order prescriptions in 90-day supplies. Rocky Mountain Health Plans publishes a quarterly preferred drug list through OptumRx.⁹¹⁰ Some members pay a copay depending on income, and prescriptions must generally be filled at an in-network pharmacy.

Maternity and Newborn Care

Pregnant Coloradans enrolled in CHP+ get prenatal care, labor and delivery, and postpartum care with no copays on any pregnancy-related service.¹ Doula services are covered. Kaiser Permanente, for example, covers 11 doula visits per pregnancy plus support during labor and birth.¹¹

Lactation support has been a covered benefit since December 2024 and includes education, counseling, and breastfeeding help in person or via telehealth. Both manual and electric breast pumps are covered, and there is no cap on the number of lactation visits.¹²

A separate prenatal waiver extends CHP+ to low-income pregnant adults between 141% and 195% of the federal poverty level who would not otherwise qualify. That track covers inpatient and outpatient hospital care, physician visits, emergency and urgent care, lab services, X-rays, prescription drugs, emergency transportation, and substance use treatment through 60 days postpartum.¹³ Once added to a parent’s case, newborns qualify for 12 months of coverage starting from their date of birth.¹

What CHP+ Does Not Cover

CHP+ does not pay for services received outside the United States. Experimental, investigational, or not-medically-necessary services are generally excluded. Non-emergency care from an out-of-network provider without a referral may not be covered, leaving the member responsible for the bill.¹⁴ Picking up other health insurance ends CHP+ eligibility, with limited exceptions for standalone dental or vision plans.² Coverage ends on the last day of the month a member turns 19, unless they are pregnant.

What You Pay

There is no monthly premium. Some families owe an annual enrollment fee of up to $105, which is mailed after enrollment and must be paid within 30 days. Copays on non-preventive services run from $2 to $50 depending on the service, family size, and income.¹⁵

Preventive care, including well-child checkups, immunizations, and every maternity service, has no copay. Pregnant women pay no enrollment fee or copays, and American Indian and Alaska Native members are exempt from all copays and enrollment fees. Total out-of-pocket costs for the entire household are capped at 5% of annual family income.¹

Which Plan You Get

CHP+ is delivered through four managed care organizations, each with its own network. Members are assigned to an MCO based on their county. In counties served by more than one MCO, members can switch plans within 90 days of enrollment.¹

Colorado Access serves 46 counties, including Adams, Arapahoe, Denver, El Paso, Jefferson, and Weld (800-511-5010).
Denver Health Medical Plan serves Adams, Arapahoe, Denver, and Jefferson counties (303-602-2100).
Kaiser Permanente serves Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, and Jefferson counties (303-338-3800).
Rocky Mountain Health Plans serves 22 counties on the Western Slope and beyond, including Mesa, Garfield, and La Plata (877-668-5947).¹

Supplemental benefits vary by MCO. Colorado Access offers the higher vision allowance and extra therapy visits noted above. Kaiser Permanente uses an integrated model where a doctor visit, lab work, and prescriptions happen at one location, with telehealth options that include online chat with a doctor seven days a week.¹⁶ Check your assigned plan’s handbook and formulary for the exact details that apply to your family.

1
Colorado Department of Health Care Policy and Financing. Child Health Plan Plus
2
Colorado Access. CHP+ Member Handbook
3
Colorado Access. CHP+ Member Information
4
Colorado Division of Insurance. Mental/Behavioral Health and Insurance
5
UnitedHealthcare Community Plan (Rocky Mountain Health Plans). RMHP CHP+
6
Denver Health Medical Plan. Elevate CHP+ Behavioral Health Benefits
7
DentaQuest. Colorado CHP+ Dental Member Handbook
8
Colorado Department of Health Care Policy and Financing. CHP+ Dental Care
9
Colorado Access. CHP+ Pharmacy Benefits
10
UnitedHealthcare Community Plan (Rocky Mountain Health Plans). RMHP CHP+ Pharmacy
11
Kaiser Permanente. Doula Care
12
Colorado Department of Health Care Policy and Financing. Lactation Support Services
13
Medicaid.gov. Colorado Adult Prenatal Coverage Fact Sheet
14
Denver Health Medical Plan. CHP+ Member Handbook
15
Northwest Colorado Health. Child Health Plan Plus
16
Kaiser Permanente. CHP+ New Member Guide