Health First Colorado (Medicaid) Adult Buy-In

Is It Right for You?

Almost everyone should be able to get health coverage, so you just need to see which option is right for you and your family. This page helps you see if the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In) might be a good choice for you.

If you don’t qualify for the Medicaid Adult Buy-In, you may still qualify for Health First Colorado (Medicaid) based on other rules or for other programs, like Medicare and private health insurance.

Note: The Medicaid Adult Buy-In will not help you qualify for the Developmental Disabilities (DD) Waiver, but can help you qualify for other Home and Community Based Services (HCBS) Waiver programs. If you need DD Waiver services and are interested in getting Health First Colorado (Medicaid) coverage through the Medicaid Adult Buy-In, talk to a Benefits Planner first.

Alternatives for employed people with disabilities

Depending on your situation, other ways for you to get health coverage could include:

Read more about them in DB101’s article about How Health Benefits Work.

Medicaid Adult Buy-In Basic Eligibility Requirements

To qualify for the Medicaid Adult Buy-In (sometimes called WAwD for short), you must:

Note: If get Supplemental Security Income (SSI) or qualify for SSI’s 1619(b) provision, you automatically get Health First Colorado (Medicaid) coverage, do not need to apply for the Medicaid Adult Buy-In, and do not need to worry about the rules discussed on this page.

Note: The Health First Colorado (Medicaid) Buy-In Program for Children with Disabilities (or the "Children's Buy-In" for short) is a different program for people who are 18 years old or younger. Learn about it in DB101's Benefits for Young People article.

Example

Tim has a brain injury. He’s had Health First Colorado (Medicaid) for years and needs the services it pays for. He wants to start working again and has a great job offer, but the job is part-time and doesn't offer health insurance.

Tim should consider the Medicaid Adult Buy-In. It pays for the same services that standard Health First Colorado (Medicaid) covers. With the Medicaid Adult Buy-In, Tim could take the job, earn some money, and be able to get his medical needs taken care of, while paying just a small monthly premium.

Disability Determination

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

Under these rules, 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.

Citizenship and Noncitizen Requirements

You must be a U.S. citizen or meet specific noncitizen requirements to be eligible for the Medicaid Adult Buy-In:

Income

The Medicaid Adult Buy-In is for people with disabilities who make money at work. You can earn a lot and still qualify: your countable income must be 450% of the Federal Poverty Guidelines (FPG) or less. That's $5,096 per month or less. 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. For example, if you make $4,000 per month at a job and have no other income, that’s only $1,957.50 in countable monthly income.

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.

Try this tool to see how much countable income you have:

Your Countable Income:

If you are working, paying taxes and have countable monthly income that is below the income limit, you may qualify for the Medicaid Adult Buy-In.

The Medicaid Adult Buy-In and Employer-Sponsored Health Coverage

You can have Medicaid Adult Buy-In coverage and employer-sponsored private coverage at the same time. There are two main advantages to this:

  • Employer-sponsored private insurance may cover some benefits that the Medicaid Adult Buy-In doesn’t or vice versa.
  • Employer-sponsored coverage may let you choose from more doctors.

The disadvantage is that you would probably have to pay premiums for both programs, and private coverage usually has higher copayments than the Medicaid Adult Buy-In, so it might not be worth the expense.

The Medicaid Adult Buy-In and Medicare

If you are eligible for both the Medicaid Adult Buy-In and Medicare, you can have both at the same time. This can help because the Medicaid Adult Buy-In will help pay for things that Medicare doesn't pay for.

With the Medicaid Adult Buy-In, if your income is low enough, you may also qualify for a Medicare Savings Program to help pay your Part B premium (and your Part A premium, if you have one), and the Part D Low Income Subsidy, to help pay for your prescription drugs.

Contact the Colorado State Health Insurance Assistance Program (SHIP) if you have questions about how your Health First Colorado (Medicaid) and Medicare benefits work together. To learn more, read DB101’s How Health Benefits Work article, which has detailed information on Medicare Savings Programs and the Part D Low Income Subsidy.

Who pays when you have more than one health coverage

Depending on your situation, you might have employer-sponsored coverage, the Medicaid Adult Buy-In, and Medicare all at the same time. This can sound confusing, but it can help you, because one form of coverage may pay for costs that your other coverage won't pay for.

The rules about how your different types of coverage pay for things are very complicated, so it’s important to check with your health coverage plans when you have questions about which plan will pay for what expenses.

Generally speaking, the Medicaid Adult Buy-In will only pay for expenses that it covers and that your other coverage won't pay for.

Note: If you use a health provider that is not covered by the Medicaid Adult Buy-In, the Medicaid Adult Buy-In will not pay any medical expenses. So, if your health care provider doesn’t take the Medicaid Adult Buy-In and your private insurance or Medicare won’t cover everything, the Medicaid Adult Buy-In won’t help pay the rest. Make sure to find providers who accept the Medicaid Adult Buy-In.

The Centers for Medicaid and Medicare Services (CMS) explains How Medicare works with other insurance.

Learn more