Example

Melanie’s Story

Melanie is 35 years old and has cerebral palsy. She hasn’t been able to work for the past six months due to her disability and has been living on the $850 in Social Security Disability Insurance (SSDI) benefits she gets every month. Health First Colorado (Medicaid) covers her health care expenses.

She’s been feeling better recently and wants to go back to work, so she talks to some friends and passes her resume around. Soon enough, a former coworker offers her a part-time job at his new start-up company. Unfortunately, the job does not come with health insurance and she’d be earning too much money to keep her Health First Colorado (Medicaid). She really wants to take this job, but cannot risk going without health insurance. Between her prescription drugs, physical therapy, and In-Home Support Services (IHSS), her total medical cost is several thousand dollars per month.

Melanie looks at getting an individual plan on Connect for Health Colorado. After filling out her information, it turns out that she could sign up for a plan that would cost her about $300 a month for the premium. The problem is that the plan has a deductible and also has copayments that are way higher than her Health First Colorado (Medicaid) copayments were. Furthermore, it wouldn’t pay for the IHSS she needs like Health First Colorado (Medicaid) does. She hopes to find another option.

She talks about the problem with her IHSS provider, Samantha, who mentions the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In).

“It’s designed for people like you,” Samantha says. “You can go back to work and earn thousands of dollars per month, while still keeping your health coverage.”

“But what about my savings? Can I keep them?” Melanie asks.

“I think so,” says Samantha, “but you should talk to a benefits planner to find out more.”

Together, Melanie and Samantha find a certified benefits counselor and set up an appointment. They learn that Melanie can have any amount of resources and still qualify for the Medicaid Adult Buy-In.

The benefits counselor tells them, “The Medicaid Adult Buy-In pays for all the same services that your Health First Colorado (Medicaid) coverage has been paying for. You may have to pay a monthly premium, but that wouldn’t be more than $200 each month. You’ll also be responsible for small copayments for some services.”

“Plus,” the benefits counselor tells her, “if your condition gets worse and you have to take some time off work, you won’t necessarily lose your coverage as long as you are an employee.”

“This all sounds great,” says Melanie. “I can go back to work! So what do I do now?”

“Take that job,” says the benefits counselor, “and when you get your first check, call your Health First Colorado (Medicaid) caseworker within 10 days to report your earnings and ask about Medicaid Adult Buy-In coverage.”

Melanie is ecstatic. She’ll be able to go back to work, doing something she really enjoys. And she’ll be able to keep her health coverage for a reasonable monthly cost.