Health First Colorado Buy-In
Program for Working Adults with
Disabilities (WAwD) & Health First
Colorado Buy-In Program for
Children with Disabilities (CBwD)
Presented by:
Beverly Hirsekorn
Health Care Policy & Financing
Our Mission
Improving health care access and
outcomes for the people we serve
while demonstrating sound
stewardship of financial
resources
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Thank you for Partnering to Help our
Citizens in accessing Health Services.
We rely on you and other partners to be the
front line helping applicants understand
what they may be eligible for and
completing applications.
We appreciate being able to share what we
know from each of our unique perspectives
and hopefully will answer some of your
questions.
Objectives:
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:
• Access needed medical services when one
is over income or resources for regular
Medicaid
• Access to services that may not be
covered by commercial insurance
• Able to pair with commercial insurance
(Medicaid will be secondary)
• Services are the same as regular Medicaid*
• Earn more/Build Resources/No Trusts
needed
Disability Determination Application
• ARG aka Arbor aka State Disability Determination vendor- specially certified
medical personnel that make determinations
• Uses a number of factors including medical conditions identified by medical
records, work challenges, and educational challenges
• Considers physical, mental health and behavioral challenges
• A signed release must be included with this application to allow the vendor
to access records at no cost to the applicant
• Currently a manual process, sent out by the county upon initial application
or when the disability determination is ending (end date=diary date)
• Tip: Do not pre-screen as many people have hidden disabilities and even
medical professionals may not find qualifying medical conditions found by
the Disability Determination vendor
• Coming in 2021, an updated, automated application
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Health First Colorado
Buy-In Program for
Working Adults with
Disabilities (WAwD)
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• Ages 16-64; Considered a Household of One
• Must work however no minimum number of hours or amount of wages
• Must be disabled either through Social Security (SSDI), or State Vendor
determination which can be full disability or limited (not considering
substantial gainful employment)
• Monthly sliding scale premium (0-$200) based on a calculation that
disregards a portion of income- in 2020, a person can have a monthly
income of $9,655 and still qualify
• Retroactive Coverage when qualified; Medical Savings Program when
qualified (QMB or SLMB)
Buy-In Program for Working Adults
with Disabilities (WAwD)
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Elderly Blind and
Disabled (EBD)
Brain Injury (BI)
Community Mental
Health Supports (CMHS)
Spinal Cord Injury
(SCI)
Some WAwD members are eligible for additional Long-
Term Care (LTC) services under the following Home and
Community-Based Services (HCBS) Waivers
Once found eligible for WAwD, no additional
financial review!
Supported Living
Services (SLS)
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Health First Colorado
Buy-In Program for
Children with
Disabilities (CBwD)
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Children under age 19 with a Disability Determination
through Social Security or the State Vendor
• Monthly Sliding scale premium (0-$120) based on family
income calculation that disregards a portion of income- in
2020, a family of four can have a monthly income of $9,924
• Regular Medicaid benefits (including EPSDT)
• Waiver Services are not available for Children’s Buy-In
members
• Retroactive Coverage when qualified
Health First Colorado Buy-In Program for
Children with Disabilities (CBwD)
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1. Apply for Medicaid, not for a particular
program like Buy-In
2. Everyone is entitled to apply- Do not
prescreen
3. Assist people to answer key questions that
will cause a disability determination
application to be sent if a person has not
already been determined through Social
Security or through the state vendor
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Sarah Brantley
Program Enrollment Manager
Salud Family Health Centers
sbrantley@saludclinic.org
Assisting with Health First Colorado
Buy-in Applications
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Our Mission
To provide a quality,
integrated health care home
to the communities
we serve.
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Agenda
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Eligibility Job Aids
How to talk to clients about the program
Completing the application
Eligibility Job Aid-Adults
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Tip: an adult can be making up to $9,655 a month in
employment income and still qualify for the program
and assets/resources are not looked at
Eligibility Job Aid-Children
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Tip: a family of 4 can be making up to $9,924 a month
and the child would still qualify for the program and
assets/resources are not looked at
How to Talk to Clients About the Program
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Your client(s) would be eligible for Health First
Colorado/CHP+ BUT is over income:
“There is a program for working adults and children who
have a health condition that has lasted or is expected to last
12 months or longer. Many types of conditions may qualify,
for example anxiety/depression, borderline diabetes, high
blood pressure, an old injury that is still painful etc. The
program includes full Medicaid benefits and the monthly cost
of the program (the premium) depends on your income and is
often more affordable than regular private insurance.
(Premiums are waived during the PHE). For lower income
clients there is no monthly cost at all. Are you (or your child)
currently experiencing any health conditions that might make
you eligible for this program?”
How to Talk to Clients About the Program
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To help staff and clients understand the
program, your organization may want to
offer an informative handout.
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Application
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3 Components:
Health First Colorado Medicaid Application
Health First Colorado Disability Application
Medical Records Release Form
2 Pathways to Complete the Application:
Answer “yes” to question asking if
client has “a medical, physical,
mental or developmental condition
that has lasted or is expected to last
more than 12 months, including
blindness”
Application will be pended
County should then send client a
disability application and medical
release in the mail for client to
complete and send back
Exception: if client already has a
Social Security disability
determination, they will not need to
complete a disability application.
Answer “yes” to question asking if
client has “a medical, physical,
mental or developmental condition
that has lasted or is expected to last
more than 12 months, including
blindness”
Help client complete paper Health
First application, disability
application and medical release
form
Exception: if client already has a
Social Security disability
determination, they will not need to
complete a disability application.
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PEAK Paper Application *RECOMMENDED*
Disability Application
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To complete the disability application, the client will
need to be ready to provide the following:
List the jobs they’ve had in past 15 years
Names and addresses of any doctors, hospitals and
behavioral health providers they have seen regarding
their health conditions (including the date they first
saw them, the date they last saw them and the date of
their next appointment)
Any tests they have had performed regarding their
health conditions (including the name, date of the test
and where it was performed)
The names of any medications they are taking
Disability Application
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Some of the questions assume client is not working,
although you have to be working to qualify for the
Adult Buy-in Program
The word “disabling or disabilities” is used although
you do not have to have a full disability to qualify
This is because the disability application is used for
other programs as well, not just the Buy-in Programs
This can be confusing for staff and clients
Do not leave any questions blank, put N/A if a question
is not applicable
Examples of Disability App Questions
That Can Be Confusing
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“What are your disabling conditions?”
“When did you become unable to work because of
your conditions?”
“Have you been seen by a doctor/hospital/clinic or
anyone else for the conditions that limit your ability
to work?” Yes/No
TIP: answer YES even if client’s ability to work is not impacted
Be thorough and list all clinics/hospitals and
providers client has seen for their conditions- this
list will be used to request medical records to verify
health conditions and determine eligibility
Colorado Access Eligibility Application Partner (EAP Site)
10/8/2020
Eligibility Sites
All application materials should be sent to an
eligibility site:
• County Department of Human Services where the
client resides
• Medical Assistance Site (MA Site)
• Eligibility Application Partner Site (EAP Site)
TIP: You can write “WAwD?”, “CBwD?” or “Health First Colorado Medicaid
Buy-in Application?” at top of first page of application.
HCPF Mapping Tool
https://apps.colorado.gov/apps/maps/hcpf.map
Eligibility Site Actions
• Applications are stamped upon receipt by an Eligibility Site
If assisted by a Presumptive Eligibility Site (PE Site) Certified
Application Assistance Site (CAAS Site) they will stamp the
application.
• The application will be processed as presented in the state
eligibility system Colorado Benefits Management System
(CBMS) from the earliest of the 2 dates above.
• The site is required to provide a determination within 45 days.
• If a Disability Application is needed from the state vendor a
determination is required in 90 days.
Scenario 1: 45 Day Determination
• Application received is complete with all
necessary declarations. The applicant is
receiving Social Security Disability
Income (SSDI).
• The Eligibility Technician will enter the
information from the application for
assistance in CBMS.
• The SSDI income is verified in the
interface in CBMS.
• Because the application is complete, a
determination will be provided within 45
days.
• Client will receive a Notice of Action
(NOA) to explain the determination
Health First
Application
Complete
Confirmed
Disability
Client has SSDI or Open
ARG Determination
Timely Processing
Determination
required in 45
Days
Scenario 2: Determination up to 90 Days
Health First Application is Complete
Disability Application (complete)
Please note this should be
submitted at the same time with the
Health First application.
Application is entered as submitted
in CBMS
Disability Application is forwarded
to ARG for processing.
Please note the eligibility site is a
pass through for this application and
it is not retained with site records.
Case in CBMS will remain in
pending status awaiting Disability
Determination by ARG.
ARG Notification
Applicant and Eligibility Site are
notified of determination. This
could be full or limited.
The Eligibility Technician will enter
the determination in CBMS and run
eligibility, CBMS will provide the
determination based on the
information entered from the
application.
A Notice of Action (NOA) of the
eligibility determination will be
generated by CBMS and sent to the
applicant.
A premium notice will be generated
by CBMS with amount due and
dates due.
