Colorado expanded Medicaid in 2014 under the Affordable Care Act. That decision changed addiction treatment access for hundreds of thousands of residents. If you’re struggling with substance use and worried about affording treatment, Medicaid might be your answer. But navigating what’s covered, how to qualify, and where to get help can be confusing. Here’s what you actually need to know.
What Is Medicaid Expansion?
Traditional Medicaid only covered specific groups—children, pregnant women, people with disabilities, and very low-income parents. Most childless adults couldn’t qualify, no matter how poor they were.
Medicaid expansion changed that. Now, adults earning up to 138% of the federal poverty level can get coverage. In 2025, that’s about:
- $20,783 for an individual
- $28,207 for a couple
- $35,631 for a family of three
If you make less than these amounts, you likely qualify.
Why This Matters for Addiction Treatment
Before expansion, many people with substance use disorders had no insurance options. They were:
- Too “wealthy” for traditional Medicaid
- Too poor to afford marketplace insurance
- Stuck with emergency rooms as their only option
- Unable to access treatment until the crisis hit
Expansion changed the game. Colorado Medicaid (called Health First Colorado) now covers comprehensive addiction treatment services.
What Coverage Includes
Outpatient services:
- Individual therapy
- Group therapy
- Medication management
- Case management
Intensive outpatient programs (IOP):
- 9+ hours of treatment per week
- Therapy and skill-building groups
- Psychiatric services
Residential treatment:
- Short-term residential (up to 30 days typically)
- Medically monitored detox
- 24/7 care and supervision
Medication-assisted treatment (MAT):
- Methadone
- Buprenorphine (Suboxone, Sublocade)
- Naltrexone (Vivitrol)
- Associated counseling
Recovery support services:
- Peer support specialists
- Recovery coaching
- Care coordination
This is comprehensive coverage. The kind that saves lives.
Do You Qualify? Colorado Medicaid Eligibility
Basic Requirements
Income limits (2025):
- Must earn less than 138% of the federal poverty level
- Income includes wages, Social Security, unemployment, and most other sources
- Some income is excluded (like child support paid)
Residency:
- Must live in Colorado
- Must be a U.S. citizen or qualified immigrant
No asset tests:
- Medicaid expansion doesn’t look at savings, property, or assets
- Only income matters for most adults
Who Qualifies
- Childless adults (this is the expansion population)
- Parents and caretakers
- Pregnant women
- Young adults aging out of foster care
- People with disabilities
Who Doesn’t Qualify
- People earning above 138% of the poverty level (but may qualify for subsidized marketplace insurance)
- Undocumented immigrants (limited emergency coverage only)
- People enrolled in Medicare (different rules apply)
How to Apply for Health First Colorado
The application process is straightforward, and you can apply anytime.
Application Methods
Online (fastest):
- Go to Colorado.gov/PEAK
- Create an account
- Complete application (about 20-30 minutes)
- Upload documentation
By phone:
- Call 1-800-221-3943
- Someone walks you through the application
- They can answer questions in real-time
In person:
- Visit your county human services department
- Get help completing the application
- Submit documents on the spot
By mail:
- Download the application from Colorado.gov/HCPF
- Mail to the address on the form
- Slowest option (4-6 weeks processing)
Documents You’ll Need
- Proof of income (pay stubs, tax returns, benefit statements)
- Proof of identity (driver’s license, state ID)
- Proof of residency (utility bill, lease agreement)
- Social Security number
If you don’t have all the documents, apply anyway. You can submit missing items later.
How Long Does Approval Take?
- Expedited processing: Within days if you’re in crisis
- Standard processing: 45 days maximum by law
- Most approvals: 2-3 weeks
You can often get treatment started before full approval if you’re in an active crisis.
What Addiction Treatment Services Are Covered
Colorado Medicaid covers addiction treatment comprehensively, but there are rules about what’s “medically necessary.”
Assessment and Evaluation
Before treatment starts, you need an assessment by a qualified provider. Medicaid covers:
- Initial comprehensive assessment
- ASAM (American Society of Addiction Medicine) level of care determination
- Treatment planning
- Ongoing reassessments
This assessment determines what level of treatment you need.
ASAM Levels of Care
Colorado Medicaid uses ASAM criteria to determine appropriate treatment:
Level 0.5: Early intervention services
Level 1: Outpatient services (less than 9 hours per week)
Level 2.1: Intensive outpatient (9+ hours per week)
Level 2.5: Partial hospitalization (20+ hours per week)
Level 3.1-3.5: Residential treatment (24-hour care)
Level 3.7-4: Medically managed intensive inpatient
You’ll be placed in the level that matches your clinical needs.
Medication-Assisted Treatment (MAT)
Colorado Medicaid strongly supports MAT. Coverage includes:
Methadone:
- Dispensed through licensed opioid treatment programs (OTPs)
- Daily dosing initially
- Take-home doses as you stabilize
- Includes required counseling
Buprenorphine products:
- Suboxone (film or tablet)
- Sublocade (monthly injection)
- Prescribed through qualified providers
- Picked up at the pharmacy
Naltrexone:
- Oral daily medication
- Vivitrol (monthly injection)
- No prior authorization needed
Counseling and monitoring:
- Required alongside medication
- Covered as part of the MAT services
- Includes drug testing when clinically necessary
Detox Services
Medical detoxification is covered when medically necessary. Includes:
- 24-hour medical monitoring
- Medication to manage withdrawal
- Assessment for ongoing treatment needs
- Discharge planning
Detox alone isn’t treatment – it’s the first step. Medicaid covers the transition to ongoing care.
Residential Treatment
Coverage for residential treatment has specific requirements:
When it’s covered:
- Outpatient treatment has been tried and failed, or
- Your situation is too difficult for outpatient care, or
- Your home environment prevents recovery
Length of stay:
- Typically approved for 14-30 days initially
- Extensions are possible with clinical justification
- Prior authorization required
What’s included:
- Room and board
- All therapeutic services
- Medications
- Case management
- Aftercare planning
Finding Providers Who Accept Colorado Medicaid
Not all treatment facilities accept Medicaid. Finding the right provider matters.
How to Find Providers
Health First Colorado provider directory:
- Search at Colorado.gov/HCPF
- Filter by “substance use disorder services.”
- Shows location, services offered, and accepts new patients
Call the member services line:
- 1-800-221-3943
- They can identify providers near you
- Can check if specific facilities accept Medicaid
Contact facilities directly:
- Call the treatment centers you’re interested in
- Ask: “Do you accept Health First Colorado?”
- Ask: “What ASAM levels do you offer?”
2-1-1 Colorado:
- Dial 211 from any phone
- Free referral service
- Can help you find treatment options
Regional Accountability Entities (RAEs)
Colorado divides Medicaid behavioral health services into regions managed by RAEs. Your RAE helps coordinate care:
- RAE 1: Health Colorado Inc. (Western Colorado)
- RAE 2: Colorado Community Health Alliance (Northern Colorado)
- RAE 3: Colorado Access (Metro Denver)
- RAE 4: Northeast Health Partners (Northeast Colorado)
- RAE 5: Colorado Community Health Alliance (Colorado Springs area)
- RAE 6: Colorado Community Health Alliance (Southeast Colorado)
- RAE 7: Colorado Access (Southwest Colorado)
Your RAE can help you find treatment, coordinate services, and navigate the system.
Prior Authorization: What You Need to Know
Some addiction treatment services require prior authorization before they’re covered.
What Needs Prior Authorization
- Residential treatment (all levels)
- Partial hospitalization programs
- Some intensive outpatient programs
- Extended treatment beyond initial approval
What Doesn’t Need Prior Authorization
- Outpatient therapy
- Initial assessment
- Most MAT medications
- Emergency detox services
- Peer support services
Who Handles Prior Authorization
Usually, the treatment facility handles this, not you. They:
- Submit clinical documentation to your RAE
- Justify why you need this level of care
- Respond to any requests for additional information
- Get approval before treatment starts (except emergencies)
If prior authorization is denied, the facility can appeal. You have rights in the appeal process.
Costs: What You’ll Pay Out of Pocket
One of Medicaid expansion’s biggest benefits is low or no cost to you.
What You Pay
Most services: $0 copay for addiction treatment
Prescription medications:
- Generic: Usually $0-$3
- Brand name: Usually $0-$5
- MAT medications often have a $0 copay
No deductibles: Medicaid doesn’t have deductibles
No coinsurance: You don’t pay a percentage of services
What Medicaid Pays
Medicaid reimburses providers directly. You’re not billed. If a provider tries to bill you for covered services beyond small copays, contact member services immediately.
What If You Don’t Qualify for Medicaid?
If you earn too much for Medicaid, you have options.
Health Insurance Marketplace
If you earn 138-400% of the poverty level:
- You qualify for subsidized marketplace insurance
- Premium tax credits reduce monthly costs
- Cost-sharing reductions lower out-of-pocket expenses
- Apply at Connect for Health Colorado
Sliding Scale and Low-Cost Programs
Many Colorado treatment facilities offer:
- Sliding fee scales based on income
- Payment plans
- Scholarship programs
- State-funded treatment slots
Emergency Medicaid
Even without regular Medicaid, you can get emergency treatment for:
- Life-threatening withdrawal
- Medical emergencies related to substance use
- Emergency psychiatric care
Apply for full coverage after the crisis stabilizes.
Special Populations
Young Adults (Ages 18-26)
You might qualify for:
- Medicaid on your own (if income qualifies)
- Extended coverage if you aged out of foster care
- Parents’ insurance (up to age 26 under ACA)
Explore all options. Staying on a parent’s plan might offer better coverage than Medicaid, or vice versa.
People Leaving Incarceration
Colorado has special enrollment for people released from jail or prison:
- Can apply before release
- Coverage begins day of release
- Helps with reentry and continuing MAT
- Case managers at many facilities help with the application
Pregnant Women
Pregnant women qualify for Medicaid at higher income levels (up to 195% of poverty). Coverage includes:
- Substance use treatment
- Prenatal care
- Delivery
- Postpartum care
Treatment during pregnancy is critical and fully covered.
People Experiencing Homelessness
Lack of a permanent address doesn’t disqualify you. You can:
- Use a shelter address
- Use a care provider’s address
- Get help from healthcare navigators
- Still qualify based on income alone
Your Rights as a Medicaid Beneficiary
You have specific rights when receiving addiction treatment through Medicaid.
Right to Appeal
If services are denied, you can:
- Request an appeal within 60 days
- Get a state fair hearing
- Have services continued during the appeal (in some cases)
- Have representation (advocate or attorney)
Right to Treatment
Medicaid must cover “medically necessary” treatment. You can’t be denied based on:
- Type of substance used
- Number of previous treatment attempts
- Co-occurring mental health conditions
- Criminal justice involvement
Right to Privacy
Your addiction treatment records are protected by:
- HIPAA (medical privacy law)
- 42 CFR Part 2 (addiction treatment-specific privacy)
Providers can’t share information without your written consent (except in emergencies).
Common Problems and Solutions
Problem: Treatment Denied as “Not Medically Necessary”
Solution:
- Ask the provider to submit additional documentation
- Request a peer review of the denial
- File an appeal
- Contact your RAE’s member services
Problem: Can’t Find Providers Accepting New Medicaid Patients
Solution:
- Call your RAE directly for help
- Ask to be placed on waiting lists
- Check facilities slightly outside your immediate area
- Contact 211 Colorado for referrals
Problem: Approved Days Run Out While You’re in Treatment
Solution:
- Your provider requests an authorization extension
- Never leave treatment without a discharge plan
- Extensions are routinely approved if clinically justified
Problem: Lost Medicaid Coverage During Treatment
Solution:
- Contact member services immediately (1-800-221-3943)
- May be administrative error
- Re-apply if needed
- Most facilities will work with you during the gap
How Colorado Compares to Other States
Colorado is actually one of the better states for Medicaid addiction treatment coverage.
What Colorado Does Well
- Comprehensive MAT coverage
- No arbitrary limits on treatment days
- Strong residential treatment coverage
- Integration with the criminal justice system
- Support for peer recovery services
Where Colorado Could Improve
- Provider shortage in rural areas
- Wait times for residential treatment
- Reimbursement rates that limit participating providers
- Administrative burden on facilities
Overall, if you need addiction treatment and have Colorado Medicaid, you’re in better shape than residents of many other states.
Taking Action: Your Next Steps
If you think you qualify for Medicaid and need addiction treatment:
1. Apply for Medicaid today
- Don’t wait until you’re in crisis
- The application takes less than an hour
- You can get expedited coverage if needed
2. Contact your RAE
- They can help you find treatment
- They coordinate care
- They resolve coverage issues
3. Reach out to treatment providers
- Call facilities that interest you
- Ask about Medicaid acceptance
- Schedule assessments
- Don’t let lack of coverage stop you from calling—often solutions exist
4. Consider crisis services if you can’t wait
- Emergency departments can stabilize you
- Crisis centers provide immediate assessment
- Detox facilities accept walk-ins
- Treatment can start before coverage is fully approved
Getting Help at True North Recovery Services
At True North Recovery Services, we work with all Regional Accountability Entities to help you access the treatment you need. Our team understands Medicaid coverage, handles prior authorization processes, and helps you navigate the system while you focus on recovery. We offer outpatient treatment, intensive outpatient programs, medication-assisted treatment, and connections to sober living resources. Don’t let insurance confusion stop you from getting help. Contact us today, and we’ll figure out coverage together while getting you started on the path to recovery.