How do you know which waiver to choose?
Which waiver should your disabled loved one be on? Colorado has 10 different waivers, four for children and six for adults, so it’s an important question!
To help NDC program participants determine this, I always start by asking: what are the biggest and most immediate needs of both the disabled individual and the family? Is it one or more of these?
Medical Medicaid coverage and covered therapies
Respite (getting a break from caregiving duties)
Income for family caregivers to stabilize basic needs (housing, utilities, transportation)
Out-of-home residential placement (short, medium or long-term)
If the dire need is medical coverage, then these are the primary ways to get needs-based Medicaid medical coverage:
Needs-based ‘MAGI’ Medicaid details HERE
The Health First Colorado Buy-In Program, which is a Medicaid program with premiums. Program details for adults and children
Long-term care Colorado Medicaid waivers HERE - waivers are the BEST option, and this is what we help families with!
If the need is emergency access to resources for basic needs, there are options for very low-income individuals or families for SNAP food assistance, as well as Aid to the Needy programs for disabled adults (the AND programs).
These options are for families with a loved one who has intellectual and developmental disabilities:
The Family Support Services Program (FSSP) supports children with intellectual and developmental disabilities/delays. FSSP’s primary purpose is to ensure that children with IDD can remain within their family setting and avoid out-of-home placements. Ask about it at your Case Management Agency .
Local Mill Levy Funding for unmet needs: If the person has an intellectual and/or developmental disability and lives in Metro Denver or Boulder, there may be funding available for your request. Ask about it at your Case Management Agency
All of the resources listed above can be helpful in the short-term, but they all have limitations. The long-term and absolutely most beneficial solution is to get on one of the 10 Colorado Medicaid waivers!
The best way to compare the different waivers, services and eligibility criteria is to read this article.
There are also comparison charts of the waivers, created by our State Medicaid agency, Colorado Healthcare Policy and Financing ‘HCPF.’ The adult waiver comparison chart link is HERE. The children’s waiver chart link is HERE
There are many nuances to choosing the right waiver for your situation! Here’s an example of how our program, Roadmap for the Waiver Journey, helped a client get the BEST waiver for their needs: An autistic adult with a brain injury was applying for the brain injury (BI) waiver. The family’s major need was funding to adapt a van to accommodate her mobile scooter. Even though the brain injury waiver appears to be the logical choice, our program taught them that the only waiver that offers funding for vehicle modification is the Supported Living Services (SLS) waiver. So, we helped the family change their request to apply for the SLS waiver instead, which offered exactly what they wanted most.
Many families are seeking more therapy for their disabled children, but their incomes are over the very low Medicaid income maximum, so they do not qualify for needs-based MAGI Medicaid. The medical therapies are available in the medical State plan Medicaid, which can also be accessed through the Medicaid disabled buy-in program. There are income thresholds, but they are much more generous than the MAGI low-income limits and the State does charge a nominal monthly premium for the buy-in program.
The disabled child or adult Medicaid buy-in programs require disability determination from the State which, once approved and qualified for nursing support, also allows families to seek CNA (Certified Nursing Aide) services. This allows them to use a Medicaid-contracted home health agency. For disabled adults, having home health support can be essential in enabling them to remain living independently in the community.
Parents and family caregivers can also get certified to become the paid caregivers of their disabled loved one. This income is life-changing when a family member has stopped working outside the home due to caregiving. Their Medicaid home health agency will often pay the cost for family members to get certified as a CNA or PDN. Due to high medical needs, a disabled loved one may qualify to receive skilled nursing, called Private Duty Nursing (PDN). The income that family caregivers can earn by becoming a CNA or PDN helps families stabilize their finances and save more for retirement.
Long-term, Colorado Medicaid waivers have so many advantages over the other funding options, and that’s why we help clients get them:
Waivers only count the income and assets of the disabled applicant, versus full household income for other programs.
Any CNA or PDN Medicaid income to a live-in caregiver is tax-free on the federal IRS level.
There is peace of mind knowing that once in the waiver system, if conditions and needs change or increase, there are options for more support.
Waivers empower a person with disabilities to build skills, do activities they enjoy, and get more involved in their communities. Many waivers cover employment services and transportation–check out the comparison charts.
These two State flow charts can help you determine which waivers may be best. The adult flowchart is HERE. And the children's flowchart is HERE.
I suggest also utilizing this HCPF PAGE afterwards to dive deeply into waiver specifics.
If you want to see if waivers might be a good fit, we have an online Navigating Disability Colorado assessment for you to complete HERE .
We also encourage you to sign up for our next live online info session, which I host on Wednesday evenings at 7pm, about once a month. Visit this page for more info and to RSVP for a future session. Attendees get the first spots that open up in our transformational program, Roadmap for the Waiver Journey, which gives you unlimited access to everything you’ll ever need to know to apply for, or utilize, a Colorado Medicaid waiver.
Thanks, and feel free to comment or share about your own adventures trying to get Medicaid disability assistance! Your stories may help others out there!