Waivers and Medicaid Buy-in for Adults
Medicaid provides a variety of services for adults with disabilities or who are low-income. There are also specialty programs to help adults access additional options for eligibility or additional services.
Waiver programs provide additional benefits to specific populations who meet special eligibility criteria. For some people, a waiver is the only way to qualify for Medicaid. One must meet financial, medical, and program-targeting criteria to access services under a Waiver. Furthermore, to qualify, your income must be less than $2,094 (or 300% the Supplemental Security Income allowance) per month and countable resources must be less than $2,000 for a single person or $3,000 for a couple.
The applicant must also be at risk of placement in a nursing facility, hospital, or ICF/IID (Intermediate Care Facility for Individuals with Intellectual Disabilities).
To utilize Waiver benefits, clients must be willing to receive services in their homes or communities. Clients who receive services through a Waiver are also eligible for all basic Medicaid covered services except nursing facility and long-term hospital care. When a client chooses to receive services under a waiver, the services must be provided by certified Medicaid providers or by a Medicaid contracting managed care organization.
The cost of waiver services cannot be more than the cost of placement in a nursing facility, hospital, or ICF/IID.
Each waiver has an enrollment limit and there may be a waiting list for any particular waiver.
Applicants may apply for more than one waiver, but may only receive services through one waiver at a time.
Anyone who is denied Medicaid eligibility for any reason has a right to appeal. Talk to your County Department of Social/Human Services if you wish to exercise your right to appeal.
Types of Waivers
There are several different kinds of waivers for adults and each have different qualifications and specifications.
Please contact your local single entry point or community centered board for assistance. With some Waivers you can have private primary health insurance. Please note that copays do apply for all Waivers for those age 19 and older.
Medicaid Buy-in for Adults
The Medicaid Buy-In Program for Working Adults with Disabilities permits adults with a qualifying disability to "buy-into" Colorado Medicaid. To qualify, you must be between the ages of 16-64, employed, and have a qualified disability. Your adjusted family income must be below 450% of Federal Poverty Level, which you can find on the Medicaid website.
If you qualify, you will be required to pay a monthly premium, which is based on your income. You are eligible if you have a physical or mental disability that is expected to last at least 12 consecutive months.
The Colorado Medicaid Waiver and Buy-In Programs for Adults offer a variety of ways for adults with disabilities and/or lower income to access appropriate medical care within a set of guidelines. For more information, please visit the Health Care Policy and Financing website.