Understanding Colorado Medicaid and Your Behavioral Health Benefits

 
Colorado Behavioral Health Medicaid RAE Map
 

We get many comments and concerns regarding how difficult Medicaid is to navigate. We'd like to offer some clarity!

Simply put, Colorado medicaid is split into seven regions, and they’re called RAEs (Regional Accountability Entities).  These RAEs all have contracts with Medicaid and, from our understanding, they compete for counties just like we compete for your business (thank you for your business, by the way!)  

Above is the Colorado RAE map…

If you click below, you can learn how Colorado Medicaid fits everything together:

https://www.coloradohealthinstitute.org/research/route-raes

As of late, what’s been confusing for a lot of people (no, you’re not alone) is that on July 1, 2018 the contracts switched, and some new RAE’s came in.  Put another way, things got thrown out of whack and confused the junk out of everyone - including us.  However, we understand now, and hopefully, soon, you will too.

To make matters more hairy, they changed the way they assign (attribute) a person to a RAE.  Really, all you need to know concerning your behavioral health benefits is that how they assign you to a RAE is no longer based off the county you live in.  Now it’s figured by four different criteria, in a certain order.  Below are the four criteria:

  • Utilization

  • Family Connection

  • Proximity

  • Member contact with enrollment broker

In other words, based off of these four determinants, you may have gotten put into a RAE that is in a different county than you live. If this is the case, don’t fret.  It’s not a problem if you want to see a therapist that is in the RAE you live in.

For example, you may live in El Paso County (the green area) but be in the Colorado Access RAE (the dark blue area) because your primary doctor’s office is in Denver or Castle Rock.  One of the main ways they determine which RAE you’re in is by where your primary doctor is (utilization).  There is something you can do to see a therapist in El Paso County though.  In this case, you have two choices (that we know of anyway):

  1. Switch doctors (to one in your county), and see the therapist of your choice in your county.

  2. Keep your doctor, and see a therapist in the same county as him/her.

If you feel it best to switch to your own county, it’s simple.  Just call Health First Colorado (Colorado's Medicaid Program), 303-866-2993, and have them switch you to the RAE of the county you live in.  In our above example, for instance, the person would have to choose a primary doctor in El Paso County to see a therapist in El Paso County.  

It’s important to keep in mind, however, that they don’t switch you to the new RAE until the 1st of the following month.

We hope this helps!

More questions? Call us at 719-433-1407. We’d love to hear from you…

With gratitude,

Jeff Mowery, LPC  (CEO/President - Fellow Client)