Health First Colorado Disability Determinations Frequently Asked Questions

Frequently Asked Questions for people with disabilities who are applying for Health First Colorado (Colorado’s Medicaid program) benefits and services

What is a disability determination?

A disability determination checks to see if an individual’s medical condition qualifies them for benefits and services for a disability.

I already receive help from SSI or SSDI. Do I need to complete a disability application?

No. If you are already receiving SSI or SSDI, you do not need to complete the disability application.

If you are already a Health First Colorado member, please make sure to let us know you are receiving SSI and SSDI. Report this information to your county or through Colorado.gov/PEAK.
If you are not already a Health First Colorado member, please complete the Health First Colorado application. You do not have to complete the separate disability application.

Who decides if I qualify for benefits and services for my disability?

Arbor E&T LLC dba Action Review Group (ARG) is the contractor that helps Health First Colorado (Colorado’s Medicaid program) make disability determinations on behalf of the state. They are part of the process that decides if a Health First Colorado member or applicant qualifies for benefits and services for a disability. ARG is only responsible for the disability determination portion of the application.

I’m already a Health First Colorado member but not on a program that requires a disability determination. Do I need to complete a disability application if I feel I have a disability?

Yes, unless you are already receiving Supplemental Security Income (SSI) or Social Security Disability Income (SSDI).

If you are not already receiving SSI or SSDI, the disability portions of the Health First Colorado application must be completed, signed and dated. If you did not fill out this part of the application when you applied before, you need to do it now. Contact your county department of human services.

I’m not a Health First Colorado member yet. What do I need to do?

Complete a Health First Colorado application online or contact your county to apply.

If you believe you may have a qualifying disability, please also complete the disability application. The disability application and release must be signed in ink. If you are unable to sign the application in ink, you can authorize a designated representative to sign it for you. The disability application explains how to authorize someone to sign for you.

When might I need to complete a disability application?

If you do not have SSI or SSDI, and you want to apply for a Health First Colorado program that requires a disability determination
If you do not have SSI or SSDI, and you are 65 or older, and re applying for a Medicaid Buy-In program and
If your SSDI ended due to your work activity and you have Medicaid Buy-In (Buy-in programs are for members/applicants that do not meet income eligibility requirements) but may qualify for buying into Health First Colorado programs with a monthly premium payment

I have had Health First Colorado and a disability for a long time. Suddenly I am told my disability determination needs to be reviewed or it will expire. Why?

The disability determination has a start and end date. When the end date approaches, the determination has to be reviewed/redetermined for continued eligibility.

What happens if the disability application is not signed and dated before it is sent to ARG?

The application is only complete if the applicant or their parent, guardian, or authorized representative hand signs and dates it. ARG cannot legally process the application without a legally approved signature.

How does ARG make its decision?

Licensed physicians who have experience and training in disability determinations will review your medical records and completed applications to make their decision. If you disagree with their decision, you can appeal it. Information on how to appeal will be in the letter you will receive that explains the decision.

How long does it take to get a response from ARG?

ARG has 60 days to make a decision. This timeline is dependent on many factors such as when ARG receives your medical records. ARG will contact the medical providers you listed on the application. Please remind your medical providers to send at least the last two years of your medical records to ARG. ARG cannot begin processing your application without the following:

A complete application that includes a hand signature and date.
Your medical records and all necessary hand signed and dated releases, such as Medical Power of Attorney, or guardianship papers, if applicable.

If ARG cannot fully process your application, they will contact your county or Medical Assistance/Eligibility Partner site to explain what they need to complete processing for the determination.

You can contact your county or Medical Assistance/Eligibility partner site ARG for a status update.

You can also contact ARG at 1-877-265-1864 or send them an email at argcoloradostatusinquiry@equusworks.com.

Contact ARG by phone if you have questions about sending personal information to them safely so your information will be protected from online security threats. Please do not send personal information to this email address, such as social security numbers or personal health information without first asking ARG how to do so without risk of security threats.

I am applying for Health First Colorado Buy-In for Working Adults with Disabilities. If I work, will I be denied?

No. This program was created for people with disabilities who work. People with Buy-In coverage make too much money and/or have too many resources to qualify for other Health First Colorado programs. Complete the Health First Colorado application and submit it to your county. Applying is the only way to know for sure if you qualify for the Buy-In program.

I’m having trouble getting help from my county or Medical Assistance/Eligibility Partner site. My situation is urgent. What should I do?

If you are having trouble getting help from your county or Medical Assistance/eligibility Partner site please complete the County and Eligibility Site Member Complaint and Escalation Webform to report your concern to the Colorado Department of Health Care Policy and Financing.

For information about your disability application, you can contact ARG at 1-877-265-1864 or send them an email at argcoloradostatusinquiry@equusworks.com. Please do not send personal information to this email address, such as social security numbers or personal health information. Contact ARG if you have questions about sending personal information to them safely so your information will be protected from online security threats.

What documents do I need to submit as part of the Disability Application?

ARG will need at least the past two years of your medical records or medical documents to process your application. This could also include copies of letters and notices from SSA about an existing disability application, if applicable. These records should be requested and provided as part of your disability application submission, but please do not provide the records before ARG has your disability application.

ARG cannot begin their review until they receive all of your documentation and medical records. The sooner you and your providers send all your records to ARG, the sooner they can start their review.

If you are sending any records, please be sure to send them securely so your privacy is protected. Contact ARG by phone if you have questions about sending personal information to them safely so your information will be protected from online security threats. Please do not send personal information to their email address, such as social security numbers or personal health information, without first asking ARG how to do so without risk of security threats. You can contact ARG at 1-877-265-1864 or send them an email at argcoloradostatusinquiry@equusworks.com.

I submitted my disability application to my county or Medical Assistance/Eligibility Partner Site. What happens next?

Your county of residence will send the application to ARG to complete the disability determination process. Counties and Medical Assistance/Eligibility Application Partner sites must process Disability Determination applications as soon as received, or within 5 business days as long as your Health First Colorado application is in process, pending or active. ARG has 60 days to complete the determination once all of your medical records and a signed and completed disability application have been received. Once the Disability Determination is completed, the County or Medical Assistance/Eligibility Application Partner will be notified and they will need to perform application processing steps.

You can contact your county or Medical Assistance/Eligibility Application Partner sites to verify if your disability application has been sent to ARG.

If you have not received satisfactory customer service from the County or Medical Assistance/Eligibility Application Partner site you may use the County and Eligibility Site Member Complaint and Escalation Webform to report your concern to the Colorado Department of Health Care Policy and Financing.

I received a letter from ARG that says I have a disability. What happens next?

Please contact your county for next steps. ARG only makes the disability decision. ARG cannot help you receive benefits and services. If you are having trouble getting help from your county, please let us know by providing feedback with the County and Eligibility Site Member Complaint and Escalation Webform.

I received a letter that says my disability determination is expiring, what does that mean?

This means it is time for your disabling condition to be re-evaluated. You will need to complete a disability application again to see if you will continue to qualify for a Health First Colorado program that requires disability criteria. Contact your county to complete the disability application again.

I received a letter that says I have a “limited disability.” What does that mean?

People with a limited disability have a disability, but they are also able to work.

I want to check on the status of my disability application. Who do I contact?

Contact your county or Medical Assistance/Eligibility Application Partner site for updates on the status of your disability application. If you are having trouble getting help from the county or Medical Assistance/Eligibility Assistance Partner site, please let us know by providing feedback with the County and Eligibility Site Member Complaint and Escalation Webform.

I’m completing a new Health First Colorado application in PEAK. How do I know that a disability application will be sent to me?

When completing the application in PEAK, make sure to answer the questions that ask if you want to apply for disability services. If you answer yes to those questions, you will have the opportunity to download the disability application, complete the disability application and return it to your county of residence office or Medical Assistance/Eligibility Application Partner site.

I received a disability determination in the mail from ARG, what happens next?

ARG sends your disability determination information to your county of residence. An eligibility site technician assigned to work on your case will update your case with the information to complete your determination so you can start getting benefits.

Where should my providers send my medical records?

Please have providers send your medical records to ARGcoloradoapps@equusworks.com. Please make sure your application has been sent to ARG before they send the medical records.