Income-Based Health First Colorado (Medicaid)

Is It Right for You?

Health First Colorado (Medicaid) is government-funded health coverage for people in certain situations. You may qualify if you:

• Have low to moderate income, no matter how much you have in resources or whether you have a disability. Income-based Health First Colorado (Medicaid) is explained on this page.
• Get Supplemental Security Income (SSI) benefits or qualify for SSI’s 1619(b) rule, which helps people who used to get SSI. In either case, you automatically get Health First Colorado (Medicaid) coverage and don’t need to worry about the rules discussed here. Learn more in DB101’s SSI article.
• Have low income, low resources, and a disability. Learn more about disability-based Health First Colorado (Medicaid).
• Have a disability and work, even if your income is higher. Learn more about the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In).

Answer the questions on this page to see if you might qualify for income-based Health First Colorado (Medicaid). If so, it’s probably your best health coverage option because it doesn’t usually have a premium, the copayments for services are generally lower than copayments required by private plans, and Health First Colorado (Medicaid) covers more services than most private plans. Also, if you qualify for Health First Colorado (Medicaid), you cannot get government help paying for an individual plan on Connect for Health Colorado.

Do You Meet the Basic Requirements for Income-Based Health First Colorado (Medicaid)?

To qualify for income-based Health First Colorado (Medicaid), you must:

• Be under 65 years old
  • You can be 65 or older if you are the parent or caretaker of a child.
• Not qualify for Medicare
  • You can be on Medicare if you are the parent or caretaker of a child or are pregnant.
• Be a U.S. citizen or meet specific noncitizen requirements

If you are under 65, do not qualify for Medicare, and are either a U.S. citizen or a noncitizen who qualifies, income-based Health First Colorado (Medicaid) might cover you.

Health First Colorado (Medicaid) Rules for Immigrants:

• Undocumented immigrants do not qualify for full Health First Colorado (Medicaid) coverage, but they may qualify for Emergency Health First Colorado (Medicaid).
• Most immigrants who have been lawfully present for less than five years do not qualify for full Health First Colorado (Medicaid) coverage. However, they may qualify for private coverage subsidized by the government.
• Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for the same programs that U.S. citizens can get.

Is Your Income Low Enough for Income-Based Health First Colorado (Medicaid)?

These are the main income rules for income-based Health First Colorado (Medicaid):

• If your family’s income is at or under 138% of the Federal Poverty Guidelines (FPG) ($20,783 per year for an individual; $43,056 for a family of four), you may qualify.
• If you are 18 or younger and your family’s income is at or under 260% of FPG ($81,120 per year for a family of four), you may qualify for Child Health Plan Plus (CHP+).
• If you are pregnant and your family’s income is at or under 260% of FPG ($81,120 per year for a family of four), you may qualify. The unborn baby is counted as a family member.

Income-based Health First Colorado (Medicaid), sometimes called "Medicaid expansion," is based on your Modified Adjusted Gross Income (MAGI), which includes most earned and unearned income. However, some income is not counted, including Supplemental Security Income (SSI) benefits, growth of the investments in an ABLE account, and some contributions to retirement accounts. Learn more about what types of income affect income-based Health First Colorado (Medicaid) eligibility.

Note: There are no limits to how much money or other resources you can have for income-based Health First Colorado (Medicaid).

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$15,060
	$5,380
	$15,060
	$5,380
Income-based Health First CO (Medicaid), adults (138% FPG)
Child Health Plan Plus (CHP+) (260% FPG)
Subsidized private plans, reduced fees (250% FPG)
Subsidized private plans (no income limit)	--
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). Disability-based Health First Colorado (Medicaid) eligibility is not included here. For private plans with subsidies, your monthly premium amount depends on your income.

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If your income is low enough and you meet all other requirements, you should sign up for Health First Colorado (Medicaid) or Child Health Plan Plus (CHP+).

More Ways to Qualify for Health First Colorado (Medicaid) if You Have a Disability

There are other ways to qualify for Health First Colorado (Medicaid) if you have a disability. You might qualify for disability-based Health First Colorado (Medicaid) if:

• You get Supplemental Security Income (SSI) benefits.
• You make more money at work than income-based Health First Colorado (Medicaid) allows. In that case, you could apply for Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In).
• You also get Medicare. Usually, Health First Colorado (Medicaid) doesn’t cover people getting Medicare, but disability-based Health First Colorado (Medicaid) does. It may even help pay your monthly Medicare premiums.
• You are 65 years old or older.

You might qualify for income-based Health First Colorado (Medicaid), even though you have a disability, if:

• Your disability does not meet Social Security’s definition of disability. Disability-based Health First Colorado (Medicaid) is only for people who have disabilities meeting this standard.
• You have more resources than are allowed by disability-based Health First Colorado (Medicaid) and do not work.
• You make enough money that you would have to pay a monthly premium for the Medicaid Adult Buy-In.

Learn more about disability-based Health First Colorado (Medicaid) and the Medicaid Adult Buy-In.

How to Sign Up

You can apply for Health First Colorado (Medicaid), Child Health Plan Plus (CHP+), and other Colorado programs:

• Online on the Colorado PEAK website
• With a paper application (available in English, Spanish, or large print). Fill it out and return it by mail, fax, or in person at your county human services department, or
• By phone at 1-800-221-3943.

Colorado PEAK lists the details you may need to fill out an application.

Staying on Health First Colorado (Medicaid)

Usually, once approved for Health First Colorado (Medicaid), you continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, or household size changes, let your county human services department know within 10 days of the change. You can do this in person, by phone, or by email. When you report your changes, the county tells you whether you continue to get Health First Colorado (Medicaid) or if you have new health coverage options, like individual coverage with subsidies or the Medicaid Adult Buy-In.