How Health Benefits Work

The Health First Colorado (Medicaid) Adult Buy-In

Look at the Medicaid Adult Buy-In if:

  • You are 16 years old or older
  • You have a disability
  • You work, and
  • You are a citizen or eligible immigrant.

Is It Right for You?

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

Answer the questions on this page to see if you might qualify for the Medicaid Adult Buy-In (sometimes called the WAwD for short). If so, it’s a good option to consider because it lets you work, earn a lot of money, and still get comprehensive coverage from Health First Colorado (Medicaid).

Note: There is also a Medicaid Children's Buy-In Program for children 18 and younger, which is much different than the Adult Buy-In. Read about the Children's Buy-In in DB101's Benefits for Young People article.

Important: If you qualify for Home and Community Based Services (HCBS) Waivers through Health First Colorado (Medicaid), you can usually get them through the Medicaid Adult Buy-In too. However, the Medicaid Adult Buy-In will not help you qualify for the Developmental Disabilities (DD) Waiver. Instead, see if another waiver might help you, such as the Supported Living Services (SLS) Waiver. Learn more about waivers in DB101's Waiver Programs article.

Do You Meet the Medicaid Adult Buy-In’s Basic Requirements?

To qualify for the Medicaid Adult Buy-In, you must:

  • Live in Colorado
  • Be 16 years old or older
  • Have a disability
  • Be working, and
  • Be a U.S. citizen or meet specific noncitizen requirements.

If you live in Colorado, are 16 years old or older, working, have a disability, and are either a U.S. citizen or a non-citizen who qualifies, the Medicaid Adult Buy-In might be an option for you.

Health First Colorado (Medicaid) Rules for Immigrants:

Do You Have a Disability That Meets Social Security’s Standards?

To qualify for the Medicaid Adult Buy-In, you must have a disability that meets Social Security’s definition of disability. For adults, Social Security says you have a disability if:

  • You have a physical or mental impairment or combination of impairments, and
  • Your condition has lasted or is expected to last for at least 12 months.

Note: For the Medicaid Adult Buy-In, Social Security’s disability rules related to earned income do not apply.

If you currently get disability benefits, like Social Security Disability Insurance (SSDI), you already meet Social Security’s disability standards. If not, the state will check to see if your disability qualifies for the Medicaid Adult Buy-In.

If you already have a disability determination from Social Security or think that your disability meets Social Security’s standards, the Medicaid Adult Buy-In might be an option for you.

Is Your Income Below the Medicaid Adult Buy-In’s Income Limit?

For the Medicaid Adult Buy-In, you must have countable income at or below $5,096 per month. Only your income is counted, not the income of other household members.

The Medicaid Adult Buy-In counts your income the same way as SSI does: almost all of your unearned income is counted, but less than half of your earned income is counted.

That means, you could earn as much as $10,278 per month ($123,330 per year!) and still qualify. And there's no resource limit, so it doesn't matter how much money you have in the bank or in other resources.

If your income is low enough and you meet all other requirements, you should apply for the Medicaid Adult Buy-In.

Monthly premiums based on income

If you have Medicaid Adult Buy-In coverage, you may have to pay a $0 to $200 premium each month (the higher your income, the higher your premium).

This is a lot less than the premiums most people pay for individual coverage, and the Medicaid Adult Buy-In covers more services than most private insurances.

How to Apply

You can apply for Health First Colorado (Medicaid), the Medicaid Adult Buy-In, and other Colorado programs:

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

Note: Due to COVID-19, there may be limits on in-person services. Contact your agency by phone to ask about this.

Staying on the Medicaid Adult Buy-In

Usually, once approved for Medicaid Adult Buy-In, you continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, disability status, 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.

State Medicaid Adult Buy-In resources

Learn more