For the nearly 1.4 million Coloradans who are enrolled in Medicaid, a salary increase can mean the loss of critical health insurance.

Sometimes this fear can keep participants from pursuing employment, or even force them to limit their weekly hours to stay below the income threshold. However, Jaime Harrell, independent living program manager at The Independence Center in Colorado Springs, said there are employment options available for Medicaid participants that many are not aware of.

“We’re finding more and more that people just don’t know what’s available out there,” Harrell said. “People don’t know that if they are receiving disability benefits, they can go back to work.”

To qualify for Medicaid, a household income must be under 138 percent of the federal poverty level — which, in 2019, is $12,490 for a household with one person, according to the Disability Secrets website.

However, people who are denied Medicaid coverage are often surprised to learn that eligibility requirements for various programs take into account factors other than salary, said Karen Logan, employment and family support services director for the El Paso County Department of Human Services.

“We have income thresholds, and some are different than others. Some include unearned income like retirement, Social Security, disability benefits — we look at it differently than just income from an employer,” Logan said. “Some programs have resource limits and other have no limits, so if I have a checking account and I fall in one of the categories where there is a resource limit, I might have to verify how much money I have in my account.”

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For individuals with disabilities — who, along with elderly residents, account for more than half of Colorado’s Medicaid spending — one of those factors is Supplemental Security Disability Income, Harrell said.

Clients often walk into The Independence Center asking how — or even if — they can work and still be guaranteed health insurance coverage. There are several ways to do that, Harrell said.

“If you want to maintain those benefits, you do have to know how much you can work,” Harrell said. “If you are working full time, it’s limiting.”

Work incentives counselors at The Independence Center help clients navigate the process of going back to work in order to maximize both their income and their benefits, Harrell said.

“There really is a positive way to make this happen,” she said. “It is set up so they can go back and work 10, 15, 20 hours a week — it depends on what is appropriate for each individual — but they can go back to work and keep their benefits, and a lot of times they can truly make more money. That’s such a healthier environment for so many people — to be emotionally healthy and contributing is a great place to be.”

One option The Independence Center steers its patients toward is the Health First Colorado Buy-In Program for Working Adults with Disabilities, which allows qualifying adults with a disability to “buy into” Health First Colorado, Colorado’s Medicaid Program. Qualifying participants who work and earn too much to qualify for Health First Colorado can pay a monthly premium based on gross monthly earned and unearned income after any applicable disregards, according to colorado.gov.

Income after disregards — which often include retirement accounts — must be below 450 percent of the federal poverty level, according to colorado.gov. Monthly premium rates range from nothing to $200, depending on where the participant falls in relation to the federal poverty level.

“The Medicaid buy-in program is a great opportunity for people who have disabilities and may not qualify otherwise,” Harrell said. “They can still get quality health care at reasonable premiums that are based on income.

“That’s not as accessed as much as individuals could access that. But it is an outstanding way to access health care when individuals don’t qualify in other ways. It is much more reasonable to support individuals in the health care system.”

Although going back to work may mean Medicaid recipients with disabilities may no longer be eligible for all of that income, that is “the way it’s supposed to be,” Harrell said, adding Medicaid is not intended to be a lifetime supplement, but rather a critical support system in addition to any money they are able to earn.

“It really is a work incentive to, ‘If I can go back to work 40 hours a week, then that’s awesome,’” Harrell said. “That’s the intent of helping support people with disabilities — the system is set up to help people who want to go back to work.

“It’s not so much that if people go back to work 40 hours a week, it will limit the amount of income they get from SSDI,” she added.

“That’s the point of it. If people can go back to work, they should and they can.”

Often, for The Independence Center’s clients, the key to maintaining health insurance coverage and still being able to work is not a dollar amount, but simply knowledge and support, Harrell said.

“I think that when people have the knowledge that these programs are out there and have the support they need to help apply, it eases a lot of those fears and they can actually get what they need,” she said.

“People are always nervous about losing health care in general, with Obamacare coming in and [mandating that] everybody is now required to have health care or pay a penalty, people are nervous about not having health care — especially people with disabilities, because they tend to have higher health care needs. I think if people have the support they need to walk through that process, it makes it a little less scary. Knowledge is a good thing.”