Colorado Medicare Savings Program Denied Appeal
A denial or termination notice from the county doesn't mean the answer is final. Colorado has a formal administrative hearing process specifically designed to challenge Medicare Savings Program decisions — and the odds favor applicants who show up with the right documentation.
Understanding the Notice of Action
Every denial or termination comes as a "Notice of Action" (NOA) from the county Department of Human Services. The NOA states the reason for the decision, the regulation it's based on, and your right to appeal.
Common denial reasons include:
- Income exceeds the program limit
- Resources exceed the asset threshold
- Missing verification documents that weren't submitted during the 10-30 day window
- Failure to return the renewal packet
Read the reason carefully. Income-based denials are often the most productive to challenge because they frequently involve calculation errors — the county used net Social Security instead of applying the $20 unearned income disregard, or counted a resource that should be excluded.
Your Right to a Fair Hearing
Under Colorado law, you can request an administrative fair hearing within 60 calendar days of the Notice of Action date. The hearing is conducted by the Colorado Office of Administrative Courts (OAC) and finalized by HCPF's Office of Appeals.
File the hearing request directly with OAC by mail, in person, telephone, fax, or email. OAC is at 1525 Sherman Street, 4th Floor, Denver, CO 80203; phone 303-866-2000 or 303-866-5626; fax 303-866-5909; email [email protected]. Identify the Notice of Action you're appealing and include its date and your case number.
Critical timing: If you request the hearing within 10 calendar days of the NOA date, aid paid pending may maintain the Medicare buy-in during the appeal. Miss the 10-day window and the termination can take effect while you wait for the hearing.
Preparing Your Case
Fair hearings are less formal than court but still require evidence. Bring:
- A copy of the Notice of Action being appealed
- Your own income calculation showing how the $20 unearned income disregard affects the result
- The Social Security Award Letter showing gross benefit amount
- Bank statements proving resources are within limits
- Any documents the county claimed were missing — if you submitted them, bring your proof of submission (PEAK upload confirmation, certified mail receipt, fax confirmation)
The most effective appeals demonstrate a specific error in the county's calculation. "My income is $1,360 gross. After the $20 disregard, countable income is $1,340. The QMB limit is $1,350. I qualify." That's the kind of concrete math that wins hearings.
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Getting Legal Help
Colorado Legal Services (CLS) provides free legal representation to low-income residents for Medicaid administrative appeals. They handle fair hearings, represent appellants, and understand the technical eligibility rules that county workers sometimes misapply.
Contact CLS at 303-837-1313 or coloradolegalservices.org. Their capacity is limited and prioritized for high-risk cases, so reach out early — don't wait until the hearing is scheduled.
The Colorado Division of Insurance SHIP program (1-888-696-7213) can also help you understand the denial and prepare informal resolution before the hearing.
What Happens After You Win
If the hearing officer rules in your favor, the county must carry out the decision. QMB entitlement begins on the first day of the month following the month eligibility is formally approved in CBMS and is not retroactive. SLMB and QI-1 can extend up to three calendar months before the application month if the applicant met the eligibility rules during those months.
If you lose, you can request an exception to the hearing decision within 15 calendar days, plus 3 days for mailing, for review by HCPF's Office of Appeals. For further review, contact Colorado Legal Services about your options.
Our Colorado Medicare Savings Programs & Extra Help Guide includes an appeals worksheet, the income calculation form to present at hearings, and contact information for Colorado Legal Services regional offices.
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Download the Colorado — Medicare Savings Program Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.