Colorado Medicaid Buy-In for Children With Disabilities (2026 Guide)

If your family earns too much for regular Medicaid but your child has a disability and needs ABA, occupational therapy, or other ongoing services, the Colorado Medicaid Buy-In for Children program is often the right fit. Your child gets full Health First Colorado (Medicaid) benefits, and you pay a monthly premium based on your income. Premiums run from $0 to $120 per month, with the top tier reserved for families between 251% and 300% of the federal poverty level (HCPF OM 25-011). If your child also has private insurance, Medicaid picks up what the private plan doesn't cover.

This guide covers who qualifies, what the 2026 premium tiers look like, how to apply through PEAK, and how the Buy-In compares with Colorado's Home and Community-Based Services (HCBS) waivers. Most families with a disabled child end up needing both.

Key Takeaways

• Who qualifies: The program covers children under 19 with a qualifying disability whose family income falls under 300% of the federal poverty level after applicable disregards.
• Premiums based on income: Monthly premiums range from $0 to $120 under HCPF OM 25-011, and families at or below 133% FPL pay nothing.
• ABA therapy is covered: ABA is a Medicaid-covered benefit through the federal EPSDT rule, which requires Health First Colorado to cover any medically necessary service for children under 21.
• How to apply: Apply through PEAK at colorado.gov/PEAK and submit a separate Health First Colorado Disability Application, with processing typically taking 45 days.
• Most families need both: The Buy-In covers your child's ongoing therapy and medical care now, while HCBS waivers fund additional in-home and community supports with multi-year waitlists.
• Start ABA without delay: Once your child is enrolled in Health First Colorado, you can match with a Colorado BCBA who accepts Medicaid through Alpaca's intake form.

Who Qualifies for the Colorado Medicaid Buy-In for Children

Age and Disability Requirements

The program covers children under 19 whose disability meets the Social Security Administration's (SSA) childhood disability listings. Your child does not need to be receiving SSI payments to qualify. They need a documented disability determination, which can come from a separate Health First Colorado Disability Application submitted alongside the PEAK application.

Autism spectrum disorder qualifies under the SSA listings when it results in marked limitations in social functioning, communication, or daily activities. If your child has an existing autism diagnosis from a licensed clinician, that documentation supports the disability application directly.

Income Limits

The Buy-In uses 300% of the federal poverty level as its upper income limit, calculated after standard income disregards (work-related expenses, certain disability costs, and child care). The table below shows estimated 2026 figures based on updated FPL guidelines. Verify exact amounts at hcpf.colorado.gov before applying.

Figures verified against HCPF OM 25-011 and the official HCPF children's Buy-In page.

Families earning above 300% FPL after disregards do not qualify for the children's program. The adult Buy-In program has a separate, higher income cap for working adults aged 16 to 64.

When a Family Doesn't Qualify

Your child won't qualify if they're 19 or older (in which case look at the adult Buy-In program), if SSA denies the disability determination, or if family income exceeds 300% FPL after disregards. Private insurance is fine. Medicaid simply pays second on the same claim.

How Much Does the Buy-In Cost? 2026 Premium Tiers

Colorado uses a tiered premium structure based on household income. The published tiers under HCPF OM 25-011 are:

These tiers come from HCPF OM 25-011. The 2026 update for the children's program isn't published yet, so verify current numbers at hcpf.colorado.gov before applying. Verify current values at hcpf.colorado.gov before applying.

For context: a single week of private-pay ABA at 20 hours runs $2,000 to $3,000. Even the top tier of $120 a month is a small share of one week of out-of-pocket ABA. If your child's ABA is out of network or capped under your private plan, the premium usually pays for itself in the first session.

Call the Health First Colorado Member Contact Center at 1-800-221-3943 to ask about your specific income tier before applying. They can give you a premium estimate based on your household size and income without you submitting a full application first.

What the Buy-In Covers

EPSDT and ABA Therapy

The most important thing to know: Medicaid covers ABA therapy for children under 21 under a federal rule called EPSDT (Early and Periodic Screening, Diagnostic, and Treatment). EPSDT requires Health First Colorado to cover any service that is medically necessary for a child, even if that service isn't explicitly listed in the state's standard Medicaid plan.

In practice, this means ABA therapy is a covered benefit for your child under the Buy-In. Speech therapy, occupational therapy, physical therapy, and behavioral health services are all covered under the same rule. Your child doesn't need to exhaust other options before Medicaid will pay.

Other Covered Services

Beyond therapy, the Buy-In covers the full scope of Health First Colorado benefits:

• Physician visits, specialist care, and diagnostics
• Prescription medications
• Durable medical equipment and assistive technology
• Mental health and behavioral health services
• Dental and vision care for children
• Non-emergency medical transportation (ride to and from appointments)

If your child has private insurance, that plan still pays first. Health First Colorado then covers what's left over, which for ABA can add up if your commercial plan has session caps, high copays, or out-of-network providers.

How to Apply: 5 Steps

Step 1: Gather your documents

Collect these before opening the application. Missing documents cause the most common delays:

• Proof of Colorado residency (utility bill, lease, or government-issued ID with address)
• Social Security numbers for all household members
• Proof of household income (recent pay stubs, most recent tax return)
• Your child's current autism or disability diagnosis documentation
• Existing insurance information (policy number, carrier name)

Step 2: Apply through PEAK

Go to colorado.gov/PEAK and create an account or log in. Select "Apply for Benefits" and choose Health First Colorado. The application takes approximately 30 to 60 minutes. You can save and return if needed.

Step 3: Submit the Health First Colorado Disability Application

The Buy-In requires a separate disability determination. After submitting the PEAK application, you'll receive instructions to complete the Health First Colorado Disability Application. This documents your child's disability against the SSA listings. Submit your child's diagnostic evaluations, physician records, and any prior SSI documentation with this form.

Step 4: Complete the eligibility interview

HCPF or your county human services department may call you for a short phone interview to confirm eligibility details. Respond promptly. The 45-day processing clock pauses if they're waiting on documentation from you.

Step 5: Set up your monthly premium payment

Once approved, HCPF will notify you of your monthly premium amount. Premiums are billed monthly and can be paid online through colorado.gov/PEAK or by mail. Missing a premium payment can result in coverage termination, so set up autopay if you can.

If you need help at any point during the application, call 2-1-1 (Colorado's statewide helpline) or the Member Contact Center at 1-800-221-3943.

Buy-In vs. HCBS Waivers: Which Path Is Right for Your Family?

The Buy-In and Colorado's HCBS waivers are not the same thing, and the right answer for most families is to pursue both simultaneously.

When the Buy-In is the right first step

The Buy-In is the faster path. Processing takes about 45 days. It covers your child's therapy, medical care, and prescriptions right now. If your child needs ABA therapy and doesn't have adequate coverage through private insurance, the Buy-In is what you apply for today.

When a waiver is worth the wait

HCBS waivers fund services the Buy-In doesn't cover: in-home behavioral support, respite care, day habilitation, residential supports, and community integration services. They require a separate eligibility process and carry waitlists that can run several years. For children with intensive support needs, getting on a waiver waitlist early matters because the clock starts at application, not at approval.

Comparison table

Waiver data should be verified at kidswaivers.org/co and hcpf.colorado.gov for current slot counts and waitlist status.

Why some families do both

A family that qualifies for the Buy-In may also qualify for the CES or CwCHN waiver. The Buy-In covers medical care and therapy right away. The waiver, once approved, layers in-home supports on top. Getting on the waiver waitlist while enrolled in the Buy-In costs nothing and keeps the option open.

Colorado HCBS Waivers for Children, Explained

Children with Complex Health Needs (CwCHN)

This waiver was updated in 2025 to consolidate Colorado's previous waiver programs for children with complex medical needs. It covers children with complex medical conditions requiring ongoing skilled nursing, specialized equipment, or intensive medical monitoring. Eligibility is based on medical complexity, not primarily on diagnosis.

Children's Extensive Support (CES) Waiver

CES is the waiver most relevant to families of autistic children with significant support needs. CES is for kids who need intensive supports. That sometimes means overnight care like feeding, suctioning, repositioning, or medications given every few hours. If your child's nighttime care needs are significant, CES is worth exploring. As of 2026, CES does not have a state-level waitlist; slot availability fluctuates locally, and some services are transitioning to Community First Choice (CFC) on a rolling basis through June 2026 (per Kids' Waivers Colorado).

Children's Habilitation Residential Program (CHRP) Waiver

CHRP is for children with intellectual and developmental disabilities who need residential placement or intensive family support services. It covers a broader set of habilitation services than the Buy-In.

Other waivers to know

Colorado also operates the Children's Waiver for Autism (CWA), the Children's Habilitation and Community-Based Services (CHCBS) waiver, and the Children's Long-Term In-Home Services (CLLI) waiver. Each has specific eligibility criteria and its own waitlist. A full waiver comparison is available at kidswaivers.org/co.

How the Buy-In Works With Private Insurance and CFC

Medicaid operates as the secondary payer when your child has private insurance. Your commercial plan pays first. Health First Colorado covers what's left, including cost-sharing, out-of-network gaps, and services private insurance excludes like ABA therapy when caps are hit. You don't need to cancel private insurance to enroll.

Colorado's Community First Choice (CFC) program, which became available to children in July 2025, is worth knowing about if your child needs personal care or attendant services at home. CFC can also pay family members to provide certain types of care. See our Colorado Medicaid CFC guide for how to stack CFC with Buy-In enrollment.

Annual renewal is required. HCPF sends a renewal notice by mail. Missing it is one of the most common reasons families lose coverage. If your income changes during the year, report it to HCPF within 10 days. Premium tiers adjust at renewal, not mid-year, unless income changes dramatically.

How Alpaca Health Helps Colorado Families

Getting Buy-In coverage approved is step one. Finding an ABA provider who accepts Health First Colorado and can start quickly is step two. Alpaca Health connects Colorado families with local, independent BCBAs who take Health First Colorado and can usually start within a week of your first call. If your child's Buy-In application is in progress or just approved, you can match with a Colorado BCBA and start ABA before the paperwork fully settles.

For a broader look at Colorado autism grants, including programs that can cover costs the Buy-In doesn't, see our Colorado funding guide.

Frequently Asked Questions About Colorado Medicaid Buy-In

Does the Colorado Medicaid Buy-In for Children cover ABA therapy?

Yes. ABA therapy is a Medicaid-covered benefit in Colorado under the federal EPSDT rule, which requires Health First Colorado to pay for any medically necessary service for children under 21. Your child doesn't need to exhaust private insurance options before Medicaid will authorize ABA.

What's the income limit for the Colorado children's Medicaid Buy-In?

The upper limit is 300% of the federal poverty level, calculated after applicable disregards. For a family of four in 2026, that's approximately $8,250 per month, or $99,000 per year (2026 HHS Poverty Guidelines). Families at or below 133% FPL pay no monthly premium.

Does my child need to be on SSI to qualify?

No. Your child needs a disability determination that meets SSA childhood disability listings, but they don't need to be receiving SSI payments. If your child's SSI was denied based on family income rather than disability, that determination letter can still support the Buy-In application.

How long does the Buy-In application take?

The PEAK application takes 30 to 60 minutes to complete. Once submitted with the accompanying Disability Application, HCPF has 45 days to make a determination. Responding quickly to any requests for additional documents keeps the clock running.

What's the difference between the Buy-In and a Colorado HCBS waiver?

The Buy-In covers medical care and therapy for your child now, with a 45-day processing window and no waitlist. HCBS waivers fund in-home and community supports like respite care and residential services, but have waitlists that can run several years. Most families with a child who has significant support needs should apply for both.

Will enrolling in the Buy-In affect my child's private insurance?

No. Private insurance stays primary. Health First Colorado pays what private insurance doesn't cover. You don't need to cancel or reduce commercial coverage to enroll.

Can I get help applying?

Yes. You can call 2-1-1 for free application assistance from a benefits navigator, and once your coverage is in place you can match with a Colorado BCBA to start ABA quickly. You can also call the Health First Colorado Member Contact Center at 1-800-221-3943 to get a premium estimate and application guidance before you start.