Colorado delivers most Medicaid coverage through the Accountable Care Collaborative (ACC), a hybrid model in which primary care is paid fee-for-service while behavioral health is capitated directly to four Regional Accountable Entities (RAEs) that bear real financial risk for it, a genuine structural distinction within the same ACC umbrella rather than a single uniform payment model. Colorado adopted the Affordable Care Act's Medicaid expansion effective January 1, 2014, extending eligibility to adults with incomes up to 138 percent of the federal poverty level. Per CMS's most recent managed care enrollment data, report year 2024, Colorado's Health First Colorado managed care programs covered approximately 1.08 million members. Long-term services and supports case management is handled separately from the RAEs by a statewide network of Case Management Agencies under the state's ongoing Case Management Redesign initiative, rather than folded into RAE care coordination.
Colorado delivers most Medicaid coverage through the Accountable Care Collaborative (ACC), organized into four regional service areas under Phase III. Physical health is paid fee-for-service, with Regional Accountable Entities (RAEs) contracting provider networks and coordinating care under an administrative per-member-per-month payment; behavioral health is capitated directly to the same RAEs, who bear financial risk for it and can earn up to an additional 5 percent of their behavioral health capitation rate by meeting state quality and outcomes metrics. Two separate managed care organizations, Elevate (Denver Health) Medicaid Choice and Rocky Mountain Health Plans PRIME, instead operate full-risk capitated physical health plans in specific counties rather than the RAE fee-for-service model. Per CMS's most recent managed care enrollment data, report year 2024, Colorado's managed care programs covered approximately 1.08 million members.
Members needing long-term services and supports are enrolled in the ACC alongside other Health First Colorado members, but waiver intake, person-centered support planning, and recertification for all 10 of Colorado's HCBS waivers are handled separately by Case Management Agencies (CMAs), one per catchment area, rather than by the RAEs. This structure, consolidating what were historically separate Single Entry Point, Community Centered Board, and private case management systems into roughly 20 CMAs statewide, is being implemented under the Case Management Redesign (CMRD) initiative as a conflict-free model, meaning a member's case manager cannot also be their own direct service provider.
Partially integrated into managed care
Behavioral health is not carved out to a separate vendor; it is capitated directly to the RAEs, who contract their own behavioral health provider networks and bear financial risk for the benefit, distinct from the fee-for-service physical health side of the same ACC structure. RAEs are also responsible for a per-member-per-month medical home payment to primary care practices, intended to support care coordination and integrated behavioral health at the practice level. RAEs can earn up to an additional 5 percent of their behavioral health capitation rate by meeting the state's behavioral health quality and outcomes metrics.
Carved in
DentaQuest administers Colorado's statewide Medicaid dental benefit for children, pregnant members, and adults; the state retains control over provider rates and program policy while DentaQuest processes claims, authorizes services, and operates the program's member and provider contact center. Adult dental services carry a $3,000 annual benefit-year limit, with exceptions for emergency treatment and dentures, while children's coverage includes additional medically necessary services through Early and Periodic Screening, Diagnostic, and Treatment (EPSDT).
MedImpact administers the fee-for-service pharmacy benefit for the large majority of Health First Colorado members enrolled through the Accountable Care Collaborative, processing claims and prior authorization review against the state's Preferred Drug List using Colorado's existing pharmacy network. The two capitated managed care organizations, Denver Health Medicaid Choice and Rocky Mountain Health Plans PRIME, are excluded from the state's Preferred Drug List and instead manage pharmacy benefits directly for their own enrollees.
MediDrive currently operates as Colorado's non-emergency medical transportation (NEMT) broker for the nine-county Denver metro area, handling ride scheduling, mileage reimbursement, and provider assignment for members in that region. The remaining 55 counties are not yet under a broker arrangement; members there continue to work directly with local NEMT providers rather than through MediDrive. HCPF has said a broker will eventually cover the rest of the state but has not published a firm date for that expansion.
Colorado's Medicaid Enterprise System is modular rather than single-vendor: Gainwell Technologies operates the core Medicaid Management Information System (Colorado interChange) and the Provider Web Portal, Optum operates the Provider Services Call Center, and Edifecs, a Cotiviti business, operates the Electronic Data Interchange module handling batch claims processing and trading partner enrollment.
Last updated: Oct 2, 2026
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