Waivers
Home and Community Based Services (HCBS) Waivers
Medicaid is a health care program for low income Coloradans. Applicants must meet eligibility criteria for one of the Medicaid Program categories in order to qualify for benefits.
Major program categories include Aid to Families with Dependent Children/Medicaid Only, Colorado Works/TANF (Temporary Assistance for Needy Families), Baby Care/Kids Care, Aid to the Needy Disabled, Aid to the Blind, and Old Age Pension.
To apply for Medicaid, contact your local County Department of Social/Human Services. Waiver programs provide additional Medicaid benefits to specific populations who meet special eligibility criteria. This chart summarizes those benefits and criteria, and tells you how to apply for Medicaid under a waiver. For some people, a waiver is the only way to qualify for Medicaid.
Clients must meet financial, medical, and program criteria to access services under a waiver. The applicant's income must be less than $1,986.00 (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. The applicant must also be at risk of placement in a nursing facility, hospital, or ICF/MR (intermediate care facility for the mentally retarded). To utilize waiver benefits, clients must be willing to receive services in their homes or communities. A client who receives services through a waiver is also eligible for all basic Medicaid covered services except nursing facility and long-term hospital care. When a client chooses to receive services under a waiver, the services must be provided by certified Medicaid providers or by a Medicaid contracting managed care organization. The cost of waiver services cannot be more than the cost of placement in a nursing facility, hospital, or ICF/MR.
Each waiver has an enrollment limit. There may be a waiting list for any particular waiver. Applicants may apply for more than one waiver, but may only receive services through one waiver at a time. Anyone who is denied Medicaid eligibility for any reason has a right to appeal. Talk to your County Department of Social/Human Services if you wish to exercise your right to appeal.
Children's Extensive Support Waiver
Children's Habilitation Residential Program Waiver
Pediatric Hospice Waiver (HOPEFUL Program)
HCBS Waiver for Persons with Brain Injury
HCBS Waiver for Persons with Mental Illness
HCBS Waiver for Persons Living with AIDS
HCBS Waiver for Persons who are Elderly, Blind, and Disabled
Supported Living Services Waiver
Waiver for Persons Developmentally Disabled
To provide Medicaid benefits in the home or community for disabled children who would otherwise be ineligible for Medicaid due to excess parental income and/or resources. Children must be at risk of nursing facility or hospital placement.
Population:
Birth through age 17
Disabled children in the home at risk of nursing facility or hospital placement.
Medical Criteria:
Nursing facility or hospital level of care.
Services:
Case management
In home support services (IHSS)
Regulations:
C.R.S. 25.5-6-901, as amended; 42 C.F.R. 441.300 - 310;
Department of Health Care Policy and Financing,
10.C.C.R. 2505-10, Section 8.506
State contact person:
Lois Jacobs
HCPF
303-866-4770
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To provide Medicaid benefits in the home or community for children with a medical diagnosis of Autism who are most in need due to the severity of their disability. Children must meet additional targeted criteria.
Population:
Birth through age 5
Children medically diagnosed with Autism with intensive behavioral needs who are at risk of institutionalization.
Medical Criteria:
Diagnosed with Autism under 6 years of age
Services:
Case Management
Behavioral therapies
Regulations:
C.R.S. 25.5-6-801-805, as amended
Department of Health Care Policy and Financing,
10.C.C.R. 2505-10, Section 8.519
State contact person:
Michelle Rogers
HCPF
303-866-3895
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Children's Extensive Support Waiver
To provide Medicaid benefits in the home or community for children with developmental disabilities or delays, that are most in need due to the severity of their disability. Children must meet additional targeted criteria.
Population:
Birth through age 17
Children with intensive behavioral or medical needs who are at risk of institutionalization. Children, birth through age 4, must have a developmental delay. Children, 5 through 17, must have a developmental disability.
Medical Criteria:
Intermediate care facility for the mentally retarded level of care.
Services:
Specialized Medical Equipment & Supplies
Community Connection Services
Home modifications
Personal assistance
Professional services (incl. behavioral)
Regulations:
C.R.S. 27-10.5-401, as amended; C.R.S. 25.5-6-401-411, as amended; 42 C.F.R. 441.300-310
Department of Human Services, Developmental Disabilities Services,
2 CCR 503-1;
Department of Health Care Policy and Financing,
10.C.C.R. 2505-10, Section 8.503
State contact person:
Sheila Peil
DDD
303-866-7467
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Children's Habilitation Residential Program Waiver
To provide residential services for children and youth in foster care who have a developmental disability and extraordinary needs. Children must be at risk for institutionalization. The waiver is designed to assist children/youth to acquire, retain, and/or improve self-help, socialization, and adaptive skills necessary to live in the community with a plan to include services.
Population:
Birth to 21 years of age
Children from birth to 21 years of age who are placed through a County Department of Social Services, have a developmental disability and extraordinary service needs, and for whom services cannot be provided at the county negotiated rate.
Medical Criteria:
Children/youth must be determined to be at risk of institutionalization in an intermediate care facility for the mentally retarded level of care by his/her physician
Services:
Cognitive services
Communication services
Community Connection Services
Counseling and therapeutic services
Emergency assistance training
Independent living training
Personal care services
Self-advocacy training
Supervision services
Travel services
Regulations:
C.R.S. 25.5-5-306(1) (1995 Supp); C.R.S. 27-10.5-102(11) (1995 Supp)
Department of Human Services, Child Welfare Services,
10.C.C.R. 2505-10, Section 8.508
State contact person:
Connie Fixsen
DHS
303-866-4393
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Pediatric Hospice Waiver (HOPEFUL Program)
This waiver provides access to Medicaid services for children with a life-limiting illness. The HCBS Pediatric Hospice Waiver (HCBS PHW) is for children from birth to age nineteen with a medical diagnosis of a life-limiting illness who meet the institutional level of care for inpatient hospitalization. The HCBS PHW allows children to live in their community while keeping them out of institutions.
Who is eligible:
Children who:
- Are determined financially eligible for Medicaid by the local County of Social/Human Services;
- Are determined to meet Social Security Administration definition of disability;
- Are at risk of institutionalization into a hospital as determined by the SEP case manager using the ULTC 100.2 and physician's statement.
- Have a diagnosis of a Life-Limiting Illness certified by a physician and has not reached 19 years old;
- Are determined by the case manager to be safely served in the community,
- Receive at least one HCBS-PHW waiver benefit per month to maintain enrollment in the waiver
Medical Criteria:
- Have a diagnosis of a Life-Limiting Illness certified by a physician and has not reached 19 years old.
Services:
- Palliative /Supportive care (does not require a six month terminal prognosis for the client).
- Expressive therapy includes, but is not limited to, book writing, painting, music therapy and scrapbook making. Expressive therapy is limited to 39 hours per year.
- Client/Family/Caregiver Counseling provided in individual or group setting
Client/Family/Caregiver Counseling is limited to 98 hours per year.
- Client/Family/Caregiver Counseling is a benefit if it is not available under Medicaid EPSDT coverage, Medicaid State Plan benefits, and third party liability coverage or by other means.
- Respite Care provided in the home of an eligible client on a short term basis, not to exceed 30 days per year. Respite Care shall not be duplicated on the same date of service as state plan Home Health or Palliative/Supportive Care services.
How does someone apply:
- The applicant must go to a Single Entry Point agency (SEP) to be evaluated. SEPs provide case management services and assessments for the HCBS PHW.
- An applicant must go to their local County of Social/Human Services to apply for Medicaid and to submit a Disability application (CEL). Disability determination may take up to 90 days.
- Once the child is eligible for PHW, the SEP case managers work with the Hospice and or Home Care agency along with the physician to create a service plan.
What is the enrollment limit:
- Two Hundred children may be served at this time.
- When the CAP of 200 is reached a Waitlist will be developed
Where can a child get benefits:
- Benefits are available through a certified provider that is enrolled in the Pediatric Hospice Waiver.
- The SEP will assist the family to locate a provider.
State contact person:
Liz Svedek
HCPF
303-866-3674
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HCBS Waiver for Persons with Brain Injury
To provide a home or community based alternative to hospital or specialized nursing facility care for persons with brain injury.
Population:
Age 16 through 64
Persons with brain injury as defined in the Colorado Code of Regulations with specific diagnostic codes.
Medical Criteria:
Hospital or nursing facility level of care.
Services:
Adult day services
Specialized Medical Equipment & Supplies
Behavioral management
Day treatment
Home modifications
Mental health counseling
Non-medical transportation
Personal care
Respite care
Substance Abuse Counseling· Supported Living Program
Transitional Living
Personalized Emergency Response System
Regulations:
C.R.S. 25.5-6.701-706, as amended; 42 C.F.R. 441.300-310
Department of Health Care Policy and Financing,
10.C.C.R. 2505-10, Section 8.515
State contact person:
Brittany Kipp
HCPF
303-866-4654
HCBS Waiver for Persons with Mental Illness
To provide a home or community based alternative to nursing facility care for persons with major mental illness.
Population:
Age 18 and older
Persons with a diagnosis of major mental illness.
Medical Criteria:
Nursing facility level of care.
Services:
Adult day services
Alternative care facilities
Consumer Directed Attendant Support
Personal Emergency Response System
Home modifications
Homemaker services
Non-medical transportation
Personal care
Respite care
Regulations:
C.R.S. 25.5-6-601-607, as amended; 42 C.F.R. 441.300-310
Department of Health Care Policy and Financing,
10.C.C.R. 2505-10, Section 8.509
State contact person:
Laurie Jensen
HCPF
303-866-5942
HCBS Waiver for Persons Living with AIDS
To provide a home or community based alternative to hospital or nursing facility care for persons living with HIV/AIDS.
Population:
All ages
Persons with a diagnosis of HIV/AIDS.
Medical Criteria:
Nursing facility or hospital level of care.
Services:
Adult day services
Personal Emergency Response System
Homemaker services
Non-medical transportation
Personal care
Private duty nursing
Regulations:
C.R.S. 25.5-6-501-508, as amended; 42 C.F.R. 441.300-310
Department of Health Care Policy and Financing,
10.C.C.R. 2505-10, Section 8.496
State contact person:
Laurie Jensen
HCPF
303-866-5942
HCBS Waiver for Persons who are Elderly, Blind, and Disabled
To provide a home or community based alternative to nursing facility care for elderly, blind, and disabled persons.
Population:
Age 18 and older
Elderly persons with a functional impairment (aged 65+) or blind or physically disabled persons (aged 18-64).
Medical Criteria:
Nursing facility level of care.
Services:
Adult day services
Alternative care facilities
Community transition services
Consumer Directed Attendant Support
Personal Emergency Response System
Home modifications
Homemaker services
In home support services (IHSS)
Non-medical transportation
Personal care
Respite care
Regulations:
C.R.S. 25.5-6-301-313, as amended; 42 C.F.R. 441.300-310
Department of Health Care Policy and Financing,
10.C.C.R. 2505-10, Section 8.485
State contact person:
Laurie Jensen
HCPF
303-866-5942
Supported Living Services Waiver
To provide to persons with developmental disabilities supported living in the home or community.
Population:
Age 18 and older
Persons who can either live independently with limited supports or who, if they need extensive supports, are already receiving that high level of support from other sources, such as family.
Medical Criteria:
Intermediate care facility for the mentally retarded level of care.
Services:
Specialized Medical Equipment & Supplies
Counseling and therapeutic services
Dental services
Day habilitation services (specialized, community access)
Hearing services
Home modifications
Personal assistant services
Supported living consultation
Transportation
Vision services
Employment (pre-vocational and supported employment)
Regulations:
C.R.S. 27-10.5-101-103, as amended;
C.R.S. 25.5-6-401-411, as amended;
42 C.F.R. 441.300-310
Department of Human Services, Developmental Disabilities Services,
2 CCR 503-1;
Department of Health Care Policy and Financing,
10.C.C.R. 2505-10, Section 8.500.90
State contact person:
Jo Kammerzell
DHS
303-866-7462
Waiver for Persons Developmentally Disabled
To provide to persons with developmental disabilities services and supports out of the family home which allow them to continue to live in the community.
Population:
Age 18 and older
Persons who require extensive supports to live safely, including access to 24-hour supervision, and who do not have other resources for meeting those needs.
Medical Criteria:
Intermediate care facility for the mentally retarded level of care.
Services:
Day habilitation (specialized day, community access)
Residential habilitation (24 hour individual or group)
Transportation
Specialized medical equipment and supplies
Supported employment
Skilled nursing
Behavioral services
Dental
Vision
Regulations:
C.R.S., 27-10.5-101-103, as amended;
C.R.S. 25.5-6-401-411, as amended;
42 C.F.R. 441.300-310
Department of Human Services, Developmental Disabilities Services,
2 CCR-503-1;
Department of Health Care Policy and Financing,
10.C.C.R. 2505-10, Section 8.500
State contact person:
Jo Kammerzell
DHS
303-866-7462