The Health First Colorado (Medicaid) Adult Buy-In

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. Learn more about income-based Health First Colorado (Medicaid).
• 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, but don't get SSI. Learn more about disability-based Health First Colorado (Medicaid).
• Have a disability and work, even if your income is higher and you have lots of resources. The Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In) is explained on this page.

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). And, if you also have Medicare coverage, the Medicaid Adult Buy-In may help pay your Part B premium.

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.

Tip: For more information about the Medicaid Adult Buy-In, see DB101's Medicaid Adult Buy-In 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:

• 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.

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 $5,648 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 $11,380 per month ($136,560 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.

How to Apply

You can apply for Health First Colorado (Medicaid), the Medicaid Adult Buy-In, 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 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.