Navigating Medicaid can feel overwhelming for families raising children with disabilities. Between acronyms, income limits, and multiple application steps, it’s easy to get lost in the process. But the good news is that Colorado offers several entry points into Medicaid—most importantly, the Medicaid Buy-In Program for Children with Disabilities and the Home and Community-Based Services (HCBS) Waivers. Both can provide life-changing support, but they work in different ways.

In this article, we’ll break down how each option works, who qualifies, and why both programs matter for families.

Medicaid as a “House”: Different Doors and Windows

Think of Medicaid like a house with multiple ways to get inside.

• Front Door: Income-Based Medicaid (MAGI Medicaid)
  Families qualify based on household income, with no disability requirement.

• Window: SSI-Based Medicaid
  Children who qualify for Supplemental Security Income (SSI) gain Medicaid coverage. But since SSI considers family income, many kids won’t qualify through this route.

• Window: Medicaid Buy-In for Children with Disabilities
  Designed for families who earn too much to qualify for SSI but still have a child with significant needs.

• Back Door: HCBS Waivers
  These waivers “waive” the usual family income test and instead consider only the child’s income and assets (which must be under $2,000). They provide extra supports for children with intensive needs.

• Child Welfare Entry
  Children in foster care or adopted from foster care often receive Medicaid through adoption subsidies.

The Medicaid Buy-In for Children with Disabilities

The Buy-In Program is a game changer for many families. Here’s why:

• Eligibility:

  • Child must meet Social Security’s definition of disability.

  • Family income below 300% of the federal poverty level (roughly $16,000/month for a family of four).

  • No asset limit—important if your child has savings or inheritance.

• Costs: Sliding-scale monthly premium, usually far lower than private insurance. Example: one family paid just $90/month for their child’s Type 1 diabetes care, which covered all supplies and therapy.

• Coverage:
  Children get access to State Plan Medicaid benefits plus the powerful EPSDT mandate (Early and Periodic Screening, Diagnostic, and Treatment). EPSDT requires Medicaid to cover all medically necessary services for children up to age 21—without arbitrary limits. That means things like ABA therapy, multiple therapy sessions per week, medical equipment, or even multiple pairs of glasses if needed can all be covered.

• Application Process:

  1. Start with a family Medicaid application through Colorado PEAK (even if you know you’ll be denied based on income—it gets your child into the system).

  2. Complete a disability determination application with your county Department of Human Services (about 12 pages). Include supporting documentation from providers, schools, and therapists.

  3. A third-party reviewer (Arborview) decides whether your child meets disability criteria.

  4. Once approved, your child can enroll in the Buy-In program.

HCBS Waivers: Extra Support for Children With Higher Needs

Waivers provide Medicaid access plus extra benefits for children who need intensive medical, developmental, or behavioral support.

• Financial Eligibility: Only the child’s income/assets are counted. Child must have less than $2,000 in assets.

• Disability & Functional Criteria: Must meet Social Security disability standards and need significant help with activities of daily living (toileting, bathing, dressing, feeding, mobility, cognition, or behavior).

Types of Waivers for Children in Colorado

1. Children with Complex Healthcare Needs (CWCHN)

   • For children with intensive, high-cost medical needs (e.g., ventilator dependence, severe epilepsy).

   • Includes services like palliative care, expressive therapies, and skilled respite.

2. Children’s Extensive Support (CES) Waiver

   • Often called the “Cadillac waiver.”

   • Requires significant functional delays and the need for overnight interventions every 3 hours.

   • Provides robust services: respite, adaptive recreation, music therapy, home modifications, specialized equipment, and more.

3. Children’s Habilitation Residential Program (CHRP) Waiver

   • For children with intellectual/developmental disabilities or serious emotional disturbances.

   • Targets children at risk of out-of-home placement due to high behavioral or medical support needs.

   • Offers “wrap-around” services to help families keep children safely at home.

Buy-In vs. Waivers: Which Path is Right?

• Choose Medicaid Buy-In if:
  Your child has a disability but doesn’t meet the very high functional needs criteria for waivers, or your family income is too high for SSI. It provides full Medicaid coverage plus EPSDT.

• Choose a Waiver if:
  Your child requires significant day-to-day assistance, overnight interventions, or has extraordinary behavioral/medical needs. Waivers unlock additional supports like respite, in-home therapy, and adaptive equipment.

• Some Families Use Both:
  The disability determination required for the Buy-In overlaps with waiver eligibility. Many families apply for both to ensure access to the full range of benefits.

Why This Matters

Private insurance often limits therapy sessions or denies certain equipment. Medicaid, through Buy-In or Waivers, ensures that children with disabilities can access medically necessary services consistently. These programs help families focus less on battling insurance red tape and more on helping their children thrive.

If you’re in Colorado and unsure where to start, organizations like Family Voices Colorado and local case management agencies can guide you step by step—for free.

👉 Key Takeaway:
Medicaid in Colorado isn’t one-size-fits-all. Families can access it through the Buy-In Program for broader eligibility and affordability, or through HCBS Waivers for children with intensive support needs. Both routes open doors to critical care and services that private insurance often won’t cover.