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How to Get Medicaid for a Child with Autism in Colorado

Team Member
Abby Care
If you’re a Coloradan wondering how to get Medicaid for a child with autism, this guide has all the details you need.

We get it ― navigating the healthcare maze for your little one can be a bit overwhelming, especially if they have autism. Not to worry, though; Abby Care has your back with this guide on how to get Medicaid for your child with autism in Colorado.

If you live in Colorado and your income is on the low side, you might qualify for low-cost or free health insurance benefits. And even if you earn a bit too much, you could still be eligible through waivers or buy-in programs.

The best part? Applying for Medicaid is easy ― you can do it online, drop by in person, or chat with someone over the phone. Let’s kick things off with a sneak peek into Colorado’s Medicaid program.

How Medicaid Works in Colorado

Medicaid is a team effort involving both the federal and state governments. The health insurance program ensures families with incomes below a certain level can easily access essential healthcare through low-cost or free health insurance.

Health First Colorado is Colorado’s Medicaid program administered through the state’s Department of Health Care Policy and Financing. The program covers a wide range of essential healthcare services, ensuring that individuals and families receive comprehensive care to support their well-being. This includes:

  • Family planning
  • Preventive and wellness services
  • Lab services
  • Dental services
  • Maternity and newborn care
  • Healthcare provider visits
  • Pharmacy and durable medical equipment
  • Emergency medical services and transportation
  • Physical, occupational, and speech therapy

In addition, Medicaid covers services to treat autism spectrum disorder for children under 21.

How to Apply for Medicaid in Colorado

Applying for Medicaid in Colorado is a breeze with just three easy steps:

1. Choose Your Application Method.

You’ve got choices in deciding how to apply. Select the one that works best for you:

  • Online: Creating an account on Colorado PEAK is the quickest way to apply for the health plan. They even have a chatbot for any questions along the way.
  • Phone: If you prefer to speak with someone over the phone, give a ring to the Health First Colorado Member Contact Center at 1- 800-221-3943 from Monday to Friday between 7:30 a.m. and 5:15 p.m.
  • In Person: To apply in person, check out the Department of Health Care Policy and Financing website to find a list of locations where you can submit your paper application.

2. Get Your Important Documents and Information Together.

Usually, you’ll be asked to provide a few key documents, so it’s best to get them ready before applying. Gather your important documents such as:

  • Proof of identity and citizenship (like a passport, driver’s license, or visa)
  • Health insurance policies or cards for your household
  • Pay stubs or benefit check stubs for your household
  • Social security number (if available)

3. Complete the Application.

Whether you’re going digital or old-school paper, completing the application usually takes around 30 minutes to an hour. Once done, the local office will process and review it. They might need to speak with you in person or over the phone if they need more information.

Keep an eye out for your case number, typically beginning with “1B.” It usually takes about 45 days to receive this number. Once you have it, use the number to easily check your application status online, regardless of the method you used to apply.

Who Is Eligible for Health First Colorado?

Qualifying for Health First Colorado depends on your income, family size, and other factors. Essentially, the following persons may be eligible for Colorado’s Medicaid program:

  • Kids 18 and under
  • Pregnant women 19 and over
  • Grown-ups aged 19-64 with income at or below 133% of the FPL
  • Older adults aged 65 and over
  • Individuals with disabilities
  • Parents and caretaker relatives of kids under 19 with income at or below 133% of the FPL

This way, Health First Colorado covers many individuals, ensuring everyone gets the healthcare support they need.

Colorado Buy-In Programs for Higher-Income Families

Navigating health insurance coverage for your family, especially when there’s a bit more on the income side, can be quite a journey. In Colorado, there are options for families whose children don’t quite fit the traditional Medicaid coverage criteria due to excess parental income or resources.

For the grown-ups in the family, there’s the Health First Colorado Buy-In Program for Working Adults with Disabilities. This program lets eligible individuals aged 16 or older with disabilities “buy into” Health First Colorado. By paying a premium, they can access Medicaid coverage and maintain their employment while getting the health care benefits they need.

Now, for children under 19, there’s the Medicaid Children’s Buy-In Program, which is a bit different from the adult version. This program is tailored to provide healthcare coverage to children with disabilities and special needs whose family income is above the Health First Colorado threshold but still below 300% of the Federal Poverty Level (FPL). Think of it as a helping hand for families making a bit too much for Health First Colorado but not quite enough for private insurance coverage.

To qualify for the Medicaid Children’s Buy-In Program:

  • Your child must be under 19
  • They need medical care typically provided in a skilled nursing facility and/or an acute hospital
  • Due to your income/resources, your child wouldn’t typically be eligible for Health First Colorado
  • Your child must have a qualifying disability per the Social Security Administration (SSA) listings
  • Your monthly income must not exceed thrice the existing Federal Supplemental Security Income (SSI) limit

Children in the program get all the regular Health First Colorado benefits. And the best part? No co-payments for them!

However, on the family side of things, there are monthly premiums based on income to keep the program rolling. As your income goes up, the premium increases a bit, too. It’s just a way to keep things fair while making sure your child gets the care they need.

HCBS Waivers in Colorado

Colorado brings a touch of sunshine into the lives of families with kids facing developmental challenges. The state does this through a handful of Home and Community Based Services (HCBS) waiver programs.

The Children with Autism Waiver (HCBS-CWA) is one such program specifically designed to assist kids with autism in Colorado. This waiver ensures children with autism can stay happily in their homes and communities by providing services such as:

  • Respite care
  • Therapeutic integration
  • Intensive individual support services
  • Environmental accessibility adaptations to their home

There are also many other HCBS waivers similar to the Children with Autism Waiver that are available to support you and your child:

  • Children’s Habilitation Residential Program Waiver (CHRP)
  • Children’s Extensive Support Waiver (CES)
  • Children with a Life-Limiting Illness Waiver (CLLI)
  • Children’s HCBS Waiver (CHCBS)

To kick off the waiver application process, simply reach out to one of these agencies for guidance:

  • Community Centered Board (CCB)
  • Single Entry Point (SEP) Agency
  • Private Case Management Agency

Abby Care: Expert Medicaid Assistance for Your Child With Autism

At Abby Care, we understand that navigating the healthcare system can be a challenge, especially when it comes to ensuring the best for your child with autism. Our top priority is your child’s well-being, and we’re here to offer the support and expertise you need to secure Medicaid.

Feel free to reach out to us today, and let’s start this important journey together.


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