Colorado Assisted Living and In-Home Care Medicaid Waiver Information for 2017

Introduction

Colorado has a couple pathways to get assistance for seniors needing assisted living and in-home care. There are private-public partnerships like the Long-Term Care Partnership (LTC) that help people become eligible for Medicaid faster while holding private health insurance. The program works by using every dollar paid out of a LTC Partnership insurance policy as a disregarded asset for purposes of determining Medicaid eligibility.

Additionally, for Medicaid eligible persons, the Home and Community Based Services (HCBS) waivers are additional benefits within Health First Colorado (Colorado’s Medicaid program) designed to allow individuals who are at risk for institutional placement to remain in the community. A person is said to be at risk for institutional care/placement if his/her needs require care that would typically be provided through a hospital, nursing facility, or intermediate care facility. Colorado has one waiver that provides benefits to seniors (65+) who qualify for Medicaid for long-term care, known as the Elderly, Blind and Disabled Waiver or HCBS-EBD.

Medicaid Waiver Program for Assisted Living and In-Home Care

Colorado Elderly, Blind, and Disabled Medicaid HCBS Waiver (HCBS-EBD)

The Colorado HCBS-EBD waiver provides the elderly (aged 65+), blind, and/or disabled population a home or community based alternative to nursing home care if they meet certain health and financial requirements. The program is administered by the Department of Health Care Policy and Financing and is simply called the HCBS Elderly, Blind, and Disabled Waiver or HCBS-ED. There is currently no enrollment cap and no waiting list for the HCBS-EBD waiver (as of February, 2017).

Services

The following servicesare offered under the HCBS-EBD waiver: Adult Day Services; Alternative Care Facilities; Community Transition Services Consumer Directed Attendant Support Services (CDASS); Home Modifications; Homemaker Services; In-Home Support Services (IHSS); Non-Medical Transportation; Medication Reminder; Personal Care; Personal Emergency Response System (PERS); and, Respite Care

Eligibility

Eligibility for the HCBS-EBD waiver is determined by both health and financial criteria, and includes certain limits for both health care needs and financial income and resources.

  1. Health: The applicant must require as nursing home level of care. To utilize waiver benefits, members must be willing to receive services in their homes or communities. A member who receives services through a waiver is also eligible for all basic Health First Colorado covered services, except nursing facility and long-term hospital care.
  2. Financial: For 2017, the applicant's income and assets must be below certain limits. The applicant’s income must be less than $2,205 (300%, or three times, the Supplemental Security Income allowance) per month and countable resources less than $2,000 for a single person or $3,000 for a couple. If an applicant’s income is too high, then a Miller Trust (also known as a Qualified Income Trust), can allow them to access the benefits by funneling their income into the trust for the purpose of paying for care. An individual cannot make more income than the total cost of care.

Practical Considerations

When a member chooses to receive services under a waiver, the services must be provided by certified Health First Colorado providers or by a Health First Colorado contracting managed care organization. The cost of waiver services cannot be more than the cost of placement in a nursing facility, hospital, or ICF/IID. There is currently no enrollment cap and no waiting list in Colorado (as of Feb. 2017).

In order to apply for the waiver benefit, the applicant must contact the Single Entry Point (SEP), or local agency. Single Entry Point (SEP) Agencies provide case management, care planning, and make referrals to other resources for Health First Colorado (Colorado's Medicaid Program) waivers.

Conclusion

The Colorado HCBS-EBD waiver is a great option for assisted living and in home care, considering there are currently no caps on enrollment and no waitlist as of February, 2017. Furthermore, for applicants who meet all the criteria other than the financial income limit, a Qualified Income or “Miller Trust” is available to allow income in the trust to be used to pay for care while qualifying for Medicaid.