Colorado’s 10 Medicaid Waivers: Which is Best for Your Disabled Loved One?
As the Badass of Colorado’s Medicaid waiver system, I’m passionate about educating people about their waiver options so they are empowered to apply for the one that’s the best fit for their disabled loved one and their family.
This post provides an overview of Colorado’s ten Medicaid waivers, their criteria and more. A Colorado Medicaid waiver supports the unique needs of disabled people by funding both medical insurance and a wide variety of provider services. Waivers can also provide additional annual income: Live-in family members often earn $50,000 each year or more in federally tax-free income for providing care, and this income can be much higher when caring for disabled loved ones with more complex conditions. When you consider the immense value that waivers provide each year over the course of a disabled loved one’s entire life, the return on the investment for taking NDC’s courses is priceless.
Four Huge Benefits of Waivers
1) Mandatory State Plan Medicaid Medical Insurance
This medical coverage has no co-pays or deductibles, and can be used alone or in addition to any private insurance. Coverage includes: inpatient and outpatient hospital services; physician services; laboratory and x-ray services; nursing facility services; home health and more.
2) Optional Medical Benefits
This includes prescription drugs, case management, physical therapy, occupational therapy, mental health services, and more.
2) Home and Community Based Services (HCBS)
These are the non-medical, complementary services that support living a good life. Depending on the waiver, they may include respite, transportation, employment supports, homemaker services and so much more. The specific possible waiver services are listed for each waiver.
4) Additional Income for Caregivers
Eligible caregivers can apply to become Certified Nursing Aides (or similar roles) and get training that will improve the care they are already providing for their disabled loved one. Based on your loved one’s care needs, you can earn up to $50,000 per year or more in income to support your family. Also there is potential for family caregivers to be paid for some of the waiver benefits such as transportation, support in the community, homemaker services and a daily rate for residential support. These vary depending on the waiver.
About Medicaid Waivers
Medicaid waivers were created in 1965. Each state creates and manages its own waivers, so they vary from state to state. All Medicaid waiver programs and changes must have federal approval and be in compliance with federal rules and regulations. The federal government matches state funding to help pay the costs. Waivers must go through a renewal process every five years. Colorado is a progressive Medicaid expansion state, so fortunately, there are more options than in many other states.
Waivers originated to provide institutional levels of care for disabled individuals who prefer to live in their homes or communities, as opposed to hospitals or segregated institutions. This is where the term ‘home and community based services,’ or HCBS, was derived.
The waiver process allows the state to offer Medicaid medical benefits, as well as additional benefits including the HCBS services, to help disabled people live and thrive in their homes and communities. Waivers can also offer payment for the services that live-in caregivers provide (this income is free from federal income tax too). Waivers also provide the funding to pay caregivers hired from the outside and many other service providers for a variety of services that can easily provide a value of $100k a year or more.
Waivers offer life-transforming benefits and services that empower and support disabled family members and their caregivers to live full and independent lives!
Home and Community Based Services (HCBS) Waivers give states the flexibility to:
Waive certain income/eligibility criteria (waivers evaluate the disabled person as a single household, so parental income/household isn’t considered)
Provide specific services to target groups or geographic regions
Create waiting lists or enrollment caps
Provide disabled individuals more choice and independence
Colorado’s 10 Medicaid Waivers: Four for Children, Six for Adults
Colorado has ten Medicaid waivers, which we describe below. Please download this state brochure for detailed information: https://hcpf.colorado.gov/sites/hcpf/files/Waivers%20101%20wide.pdf
To find out if you’d benefit from getting on a Colorado Medicaid waiver, take our free assessment HERE. If you’re already on a waiver, find out if you’re leaving funding on the table and if you could be getting more out of it by taking our free assessment HERE.
1. CLLI Waiver: Children with Life Limiting Illness Waiver
This waiver is for children whose projected life expectancy is shortened to due to a medical condition that is documented by medical professionals. There are many services available and parents/family can be paid for some HCBS services as well as home health nursing or CNA support. There is no official service plan annual limit or ‘SPAL’ however most of the services have caps of units allowed.
All six available waiver services, which include family members in some cases, are listed here: https://hcpf.colorado.gov/children-life-limiting-illness-waiver-clli
2. CES Waiver: Children's Extensive Support Waiver
This waiver is for children ages 0-17 with a significant developmental and/or intellectual disability (DD). The criteria includes behavioral issues as well as sleep challenges. There are many services available and parents/family can be paid for some HCBS services as well as home health nursing or CNA support. The CES waiver service plan annual limit, or ‘SPAL,’ for non-Denver residents is $61,176.. Denver City and County residents have a higher SPAL due to a higher minimum wage, so the SPAL is $63,807.
All eleven available waiver services are listed here:
https://hcpf.colorado.gov/childrens-extensive-support-waiver-ces
3. CHRP Waiver: Children's Habilitation Residential Program Waiver
This waiver is for children ages 0-20 with a significant developmental and or intellectual disability (IDD).They have an intellectual or developmental disability or developmental delay if under age five (5) and have intensive behavioral or medical support needs that put them at risk, or in need of out-of-home placement.
The criteria includes behavioral issues to the level that an out-of-home placement may be needed, but a person does not need to be in county custody or part of child welfare to qualify. Families can retain parental rights or guardianship. There are many services available and parents/family can be paid for some HCBS services as well as home health nursing or CNA support. The CHRP is a 24/7 support waiver that does not have a service plan annual limit, or ‘SPAL.’ but it does have caps on different categories of services.
All six available waiver services are listed here:
https://hcpf.colorado.gov/childrens-habilitation-residential-program-waiver-chrp
4. CHCBS Waiver: Children's Home and Community Based Services Waiver
This waiver is available for children with significant medical needs and who are at risk for institutional care in an acute hospital or skilled nursing facility. There are just a few services on the CHCBS waiver, including case management, in-home support service (IHSS) and the brand-new health education benefit. The health education benefit is a monthly educational email sent to a member's home.
Family members can be paid for caregiving that they provide for their disabled family member under the IHSS services. Because IHSS encompasses both tasks similar to those of skilled Certified Nursing Aides (CNAs), as well as non-skilled tasks like homemaker, the number of hours per day usually exceeds what one might qualify for under CNA. No license is required for IHSS services, but the caregiver is supervised by the caregiver’s home health agency nurse. There is no service plan annual limit, or ‘SPAL,’ since the IHSS hours are determined using a standard assessment.
All available waiver services are listed here:
https://hcpf.colorado.gov/childrens-home-and-community-based-services-waiver-chcbs
5. BI Waiver for Adults: Brain Injury Waiver
This adult waiver helps people, 16 years of age or older, with a brain injury who need extra support to live in their communities. You can get these extra services along with your regular Health First Colorado Medicaid Covered services as long as they are not duplicative. Nursing facilities and long-term hospital care services are not covered. Getting waiver services won't change the support that you may get from other public programs, your family, or the community. There is no service plan annual limit, or ‘SPAL,’ however most of the services have caps of units allowed.
All twenty available services are listed here:
https://hcpf.colorado.gov/brain-injury-waiver-bi
6. CMHS Waiver for Adults: Community Mental Health Supports Waiver
This waiver provides assistance to people with a mental illness that requires long-term supports and services in order to remain living within their communities. There is no official service plan annual limit, or ‘SPAL,’ however most of the services have caps of units allowed.
All available 14 services are listed here:
https://hcpf.colorado.gov/community-mental-health-supports-waiver-cmhs
7. CIH Waiver for Adults: Complementary and Integrative Health Waiver
Effective July 1, 2022, all services on the Complementary and Integrative Health (CIH) waiver (formerly Spinal Cord Injury (SCI) Waiver) are available statewide to HCBS eligible Coloradans living with a spinal cord injury (traumatic or nontraumatic), multiple sclerosis, brain injury, spina bifida, muscular dystrophy, or cerebral palsy with the inability for independent ambulation over the age of 18.
Family members can be paid for caregiving that they provide for their disabled family member under the IHSS services. Because IHSS encompasses both tasks similar to those of skilled Certified Nursing Aides (CNAs), like tasks as well as non-skilled tasks like homemaker, the number of hours per day usually exceeds what one might qualify for under CNA. No license is required for IHSS services, but the caregiver is supervised by the caregiver’s home health agency nurse. For the CHI waiver, there is no official service plan annual limit, or ‘SPAL,’ however most of the services have caps of units allowed.
All available 15 services are listed here:
https://hcpf.colorado.gov/complementary-integrative-health-waiver-cih
8. DD Waiver for Adults: Developmental Disabilities Waiver
This waiver is for people with developmental disabilities (DD) and provides access to 24-hour, seven-days-a-week supervision through Residential Habilitation and Day Habilitation Services and Supports. The service provider is responsible for supporting individuals in finding living arrangements, which can range from host homes settings with 1-2 persons, individualized settings of 1-3 persons, and group settings of 4-8 persons, as well as residential supports for participants who live in their own home or who live with and/or are provided with caregiving services by members of their family. This program currently has a waitlist, but emergency situations are considered for immediate enrollment.
Live-in family caregivers can be paid the daily rate for providing support services under the Colorado Family Caregiver Act. The DD waiver is a 24/7 support waiver and does not have a service plan annual limit or ‘SPAL,’ but does have many caps on different categories of services.
All available 13 services are listed here:
https://hcpf.colorado.gov/developmental-disabilities-waiver-dd
9. EBD Waiver for Adults: Elderly, Blind and Disabled Waiver
This waiver is for people who are elderly, blind, or disabled (EBD) and provides assistance to people ages 65 and older who have a functional impairment, or are blind, or to people ages 18-64 who are physically disabled or have a diagnosis of HIV or AIDS, and require long-term supports and services in order to remain living within their communities. Effective April 1, 2014, this program incorporated services formerly provided under the Persons Living with AIDS/HIV (PLWA) program.
Family members can be paid for caregiving that they provide for their disabled family member under the IHSS services. Because IHSS encompasses both tasks similar to those of skilled Certified Nursing Aides (CNAs), like tasks as well as non-skilled tasks like homemaker, the number of hours per day usually exceeds what one might qualify for under CNA. No license is required for IHSS services, but the caregiver is supervised by the caregiver’s home health agency nurse. The EBD is a 24/7 support waiver and does not have a service plan annual limit, or ‘SPAL,’ but it does have caps on different categories of services.
All available 15 services are listed here:
https://hcpf.colorado.gov/elderly-blind-disabled-waiver-ebd
10. SLS Waiver for Adults: Supported Living Services Waiver
This waiver provides necessary services and supports for adults with intellectual or developmental disabilities (IDD) so they can remain in their homes and communities with minimal impact to these individuals' community and social supports. The SLS waiver promotes individual choice and decision-making through the individualized planning process and the tailoring of services and supports in order to address prioritized, unmet needs. In addition, this waiver is designed to supplement existing natural supports and traditional community resources with targeted and cost-effective services and supports.
The person receiving services is responsible for his or her living arrangements, which can include living with family or in their own home. Up to three persons receiving services can live together. Participants on this waiver do not require twenty-four hour supervision on a continuous basis for services and supports offered under this waiver. The SLS waiver service plan annual limit, or ‘SPAL,’ depends on SIS level, and for non-Denver residents ranges from $22,275 to $60,695. Denver City and County residents have higher wages due to a higher minimum wage, so their SPAL ranges from $29,031 to $79,103.
All available 24 services are listed here:
https://hcpf.colorado.gov/supported-living-services-waiver-sls
Ready to Explore Applying for a Waiver, or Maximizing the One you Have?
Our courses are the only ones in Colorado specifically designed to walk people – step-by-step – through the process of successfully applying for a waiver or maximizing the one they already have.
To find out if you’d benefit from our course, Apply for a Waiver, take our free assessment HERE. If you are already on a waiver, find out if our course, Maximize your Existing Waiver, could take your services to a new level by taking our free assessment HERE, or contact us with questions!