Home and Community-Based Services (HCBS) Waivers
Medicaid is a health care program for low-income Coloradans. Applicants must meet eligibility criteria for one of the Medicaid Program categories in order to qualify for benefits.
To apply for Medicaid, contact your local county department of social/human services. Waiver programs provide additional Medicaid benefits to specific populations who meet special eligibility criteria. For some people, a waiver is the only way to qualify for Medicaid.
Clients must meet financial, medical, and program criteria to access services under a waiver. The applicant’s income must be less than $2,094.00 (300%, or three times, the Supplemental Security Income allowance) per month and countable resources 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 intermediate care facility for the developmentally disabled (in federal regulation referred to as ICF/MR).
To utilize waiver benefits, clients must be willing to receive services in their homes or communities. A client who receives services through a waiver is also eligible for all 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 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/MR.
Each waiver has an enrollment limit. 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.
Children’s Medicaid Buy-in
The Medicaid Buy-In Program for Children with Disabilities (Children’s Buy-In) is a medical assistance program that provides Medicaid benefits for children who are under age 19, have a qualifying disability, and whose adjusted family income is at or below 300% of the Federal Poverty Level (FPL). Applications for the program are currently being accepted, click here to apply online.
Eligible families receive benefits for their child with a disability by paying a monthly premium based on their income. The program does not have an enrollment limit or waitlist.
Adult Medicaid Buy-in
The Medicaid Buy-In Program for Working Adults with Disabilities (Adult Buy-In) will provide adults with disabilities, who earn too much income or have too many resources to qualify for Regular Medicaid, the opportunity to purchase Medicaid. Regular Medicaid benefits include, but are not limited to, office visits, hospitalizations, x-rays, home health services, durable medical equipment, and prescription medications. Clients will pay a monthly premium based on their income.