Medicaid and Child Health Plan+ Eligibility

Health First Colorado (Medicaid) helps people with low to moderate income pay for their visits to the doctor, hospital stays, prescription drugs, medical equipment, and other medical services. Child Health Plan Plus (CHP+) offers health benefits to children and pregnant women who don't qualify for Health First Colorado (Medicaid).

If you get Supplemental Security Income (SSI) benefits or used to get SSI benefits and now qualify for SSI's 1619(b) status, you get Health First Colorado (Medicaid) coverage automatically and do not need to worry about the eligibility information discussed here.

If you don't get SSI benefits, Health First Colorado (Medicaid) and CHP+ rules depend on whether you are:

• 18 or younger (or pregnant for CHP+), or
• 19 or older.

Note: This page does not cover all ways you might qualify for Health First Colorado (Medicaid) or CHP+. The best way to check if you qualify is to apply.

Health First Colorado (Medicaid) and CHP+ if You Are 18 or Younger

If you are 18 or under (or pregnant for CHP+):

1. You may qualify for income-based Health First Colorado (Medicaid) or Child Health Plan Plus (CHP+) if your family has low income, regardless of whether you have a disability.
2. You may qualify for Health First Colorado (Medicaid) if you have a disability and...
   • Your family has low income and low resources, or...
   • You get Health First Colorado (Medicaid) through the Children's Buy-In because your family's income or resources are too high for regular Health First Colorado (Medicaid) or CHP+, or...
   • You get Health First Colorado (Medicaid) through the Medicaid Adult Buy-In. For the Medicaid Adult Buy-In, you must also work, and be 16 or older. Learn more about the Medicaid Adult Buy-In.

1. Income-based Health First Colorado (Medicaid) and Child Health Plan Plus (CHP+)

When you apply on Colorado PEAK, they first check to see if you qualify for health coverage based on your household's Modified Adjusted Gross Income (MAGI).

If your family's income is 138% of the Federal Poverty Guidelines (FPG) or less ($43,056 per year or less for a family of four), you may qualify for income-based Health First Colorado (Medicaid). It doesn't matter how much your family has in resources.

If you are 18 or younger and your family’s income is too high for income-based Health First Colorado (Medicaid), but is 260% of FPG or less ($81,120 per year or less for a family of four), you may qualify for Child Health Plan Plus (CHP+). It doesn't matter how much your family has in resources. Note: If you are pregnant, you may also qualify if you are over the age of 18.

Check if your family's income is low enough for you to get income-based Health First Colorado (Medicaid) or CHP+ coverage:

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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2. Disability-Based Health First Colorado (Medicaid) and the Children's Buy-In

If you don't qualify for income-based Health First Colorado (Medicaid) and don't get SSI benefits, Health First Colorado (Medicaid) checks to see if you qualify for disability-based Health First Colorado (Medicaid) or the Medicaid Buy-In Program for Children with Disabilities (called the "Children's Buy-In" for short).

For either, you must have a disability that meets Social Security Administration (SSA) standards for children. The differences are in the income and resources rules:

• If you have very low income and very low resources, you may qualify for disability-based Health First Colorado (Medicaid) with no monthly premium:
  • Your resources must be $2,000 or less.
  • Your countable income must be $943 per month or less. It includes your unearned income, some of your earned income, and a portion of your parents' income, which is deemed to you. Most income rules that apply to SSI also apply to disability-based Health First Colorado (Medicaid).
• If your income or resources are higher and you are under the age of 19, you may qualify to get coverage through for the Medicaid Children's Buy-In.
  • There is no resource limit.
  • The income limit is a lot higher (the amount depends on your family size) and not all income is counted against the limit (only about two-thirds of income is counted). Learn more about the Children's Buy-In income limit.
  • Depending on your income, you may need to pay a monthly premium to get coverage. The amount you pay for your monthly premium is based on your family's income. The most you might pay is $120 per month.

Note: The Children's Buy-In is different than the Adult Buy-In. For the Medicaid Adult Buy-In, you must have paid work and be 16 or older. Learn more about the Medicaid Adult Buy-In.

Health First Colorado (Medicaid) if You Are 19 or Older

If you are 19 or older, you may qualify for Health First Colorado (Medicaid) if:

1. You have low income, regardless of whether you have a disability, or
2. You have a disability, low resources, and low income. Note: You automatically qualify for disability-based Health First Colorado (Medicaid) if you get SSI benefits, so you do not need to read this section.

If you have a disability, work, and have higher income or resources, you may qualify for the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In) instead.

1. Income-Based Health First Colorado (Medicaid)

If you are 19 or older and your household's Modified Adjusted Gross Income (MAGI) is 138% of FPG or less ($20,783 per year or less if you are single), you may qualify for income-based Health First Colorado (Medicaid). It doesn't matter how much your family has in resources.

If you are pregnant, you can get Child Health Plan Plus (CHP+) coverage if your income is 260% FPG or less ($53,144 per year or less if you are single and pregnant with your first child; the baby counts as a family member for this program).

Check whether your income is low enough for you to get income-based Health First Colorado (Medicaid) or Child Health Plan Plus (CHP+) coverage:

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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Learn more about income-based Health First Colorado (Medicaid) for adults in DB101's How Health Benefits Work article.

2. Disability-Based Health First Colorado (Medicaid) and the Medicaid Adult Buy-In

If you don't qualify for income-based Health First Colorado (Medicaid), Health First Colorado (Medicaid) checks to see if you qualify for disability-based Health First Colorado (Medicaid) or the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In).

People who get Supplemental Security Income (SSI) benefits get Health First Colorado (Medicaid) coverage automatically. If you have a disability and don't get SSI benefits, you may still qualify for disability-based Health First Colorado (Medicaid) if you:

• Have a disability that meets Social Security’s adult definition of disability.
• Have countable income and resources below the SSI program's limits.
• Meet all other Health First Colorado (Medicaid) program rules, such as being a citizen or meeting noncitizen requirements.

If you have a disability, your resources or income are higher than SSI's limits, and you have paid work, you may instead qualify for the Medicaid Adult Buy-In. The Medicaid Adult Buy-In:

• Has no resource limit, and
• Has a much higher income limit; you could earn as much as $11,380 per month ($136,560 per year) and still qualify!

Learn more about the Medicaid Adult Buy-In.