Approved for Services… and Still Alone? Welcome to the Capacity Crisis.
You finally got approved.
You open the waiver paperwork.
You scan the list of services.
Respite. Community connector. Therapies. Support.
You exhale.
Then you start making calls.
And that’s when it hits you.
“No staff.”
“Waitlist.”
“We don’t have capacity.”
“You can find the worker and we’ll hire them.”
Wait. What?
You fought for years to get on a Colorado Medicaid or HCBS waiver… and now you’re being told to build your own workforce?
Yeah. That’s the service provider capacity crisis. And you’re not crazy for being frustrated.
How Did We Get Here?
Colorado runs a privatized Medicaid system. The state agency — Health Care Policy & Financing (HCPF) — contracts out:
Case Management Agencies (CMAs)
Program Approved Service Agencies (PASAs)
Consumer-Directed Attendant Support Services (CDASS)
Years ago, one agency could manage both case management and direct services. But in 2014, federal conflict-of-interest rules required separation (with some rural exceptions).
The intention? Protect families from being “steered.”
The reality? A fragmented system where no one is truly responsible for ensuring you actually get staffed.
Add to that:
State-controlled reimbursement rates
Chronic underfunding
Decades of minimal increases (2% raises against massive inflation)
A workforce that is majority women, non-union, and wildly undervalued
And now Medicaid rates can sit 30%+ below market wages.
So providers leave.
Agencies can’t compete.
Families are told to “source their own staff.”
When you’re already exhausted from caregiving.
It’s backwards.
Let’s Say the Quiet Part Out Loud
The HCBS system is structured to protect large contractors — not families.
Disabled individuals and their caregivers are left navigating:
Staff shortages
Therapist scarcity
Long waitlists
Agencies that don’t recruit
Meanwhile, the demand for home and community-based services is exploding. People want independence. Families want sustainable support. Aging populations need care.
The workforce pipeline? Shrinking.
The host home model is strained under Colorado’s cost of living.
Medical providers drop Medicaid.
Therapists move to private pay.
And here you are. Approved. Eligible. Still scrambling.
3 Badass Ways We Start Fixing This
1️⃣ Create Direct Access to Providers
Families should not have to play recruiter.
That’s why Navigating Disability Colorado is building an online membership platform to connect caregivers directly with Colorado service providers — showing:
Skills
Location
Which PASAs do they bill through
Availability
The goal? Cut out the endless phone tag and simplify connections.
When agencies expect families to source their own staff, we build the tool to make that possible without burnout.
2️⃣ Demand Real Medicaid Rate Increases
The rate review process is broken.
HCBS waiver services need a 40–100% rate increase to reflect reality. Medical reimbursements need serious review, especially adult specialty care and mental health services.
If leadership won’t listen, families and workers will organize.
Because this workforce crisis is policy-driven — and policy can be changed.
3️⃣ Widen the Employment Pool
Colorado allows 16-year-olds to earn a CNA license…
But not to work as an HCBS waiver provider.
Make that make sense.
Lowering the minimum age for certain waiver services would:
Expand workforce options
Build early career pathways
Support families now
Other waivers have already done this. It’s possible.
What You Can Do RIGHT NOW
While the system catches up (slowly), here’s how you survive the moment:
✔ Review Your PASA Carefully
Some agencies make onboarding new providers simple. Others… don’t. Choose wisely.
✔ Skill Up
Watch the free “Building Your Respite Bench” workshop from NDC and learn how to source providers strategically.
✔ Find Medicaid Medical Providers
Use Health First Colorado’s provider search tool or contact your Regional Accountability Entity (RAE) for referrals.
✔ Stay Connected
Plug into communities that share real-time solutions, openings, and resources.
You’re Not Failing. The System Is Strained.
Let me be clear:
If you can’t find staff, it is not because you’re bad at this.
It’s because the structure is underfunded, fragmented, and lagging behind real-world demand.
But families are powerful.
Workers are powerful.
Communities are powerful.
And when we stop quietly absorbing the burden and start naming the problem?
That’s when change accelerates.
If you’ve hit a wall trying to staff services — what has worked for you?
Where have you found providers?
What needs to change?
Let’s stop pretending this crisis is invisible.