A waiver is an extra set of Health First Colorado (Colorado's Medicaid program) benefits that you could qualify for in certain cases. The waiver member gets medical insurance via Medicaid, plus additional home and community based services for non-medical living supports.

There are 10 Colorado: six waiver programs for adults and four waiver programs for children. Each program has its own eligibility rules around types of disabilities, personal needs, housing, and financial situation. They also have different ways to apply and some waiver programs have waiting lists. Some people may qualify for more than one waiver program and can choose the best waiver for their life situation.

A waiver member gets medical insurance via Medicaid and non-medical services that support living in the home and community. Each waiver has different services but they might include transportation, employment supports, respite, massage therapy, music therapy, residential supports for 24/7 waivers and much more.

A waiver member gets medicaid medical with zero copays, coinsurance or deductibles as long as they use medicaid contracted providers. They may qualify for skilled supports from a private duty nurse or certified nursing assistant which can be a family member, should they complete the training and qualify for hiring by a medicaid agency.

There is needs-based Medicaid or a ‘state plan’ that is just medical insurance, without the additional waiver home and community-based supports (HCBS) that waiver members receive. But waivers look at disability qualifications and specific disability waiver criteria, NOT household income.

Yes, Medicaid is the payer of last resort, meaning you will choose providers who take BOTH your private insurance AND Medicaid. They work well in tandem.

This was a branding name change made in 2016 to Colorado Medicaid and is the same as what many call state Medicaid. So, it is the same thing as saying Colorado Medicaid program or state plan.

CMAs provide eligibility and enrollment services as well as ongoing case management, to allocate the service plans of home and community based services for enrolled medicaid waiver members. They ensure that rules and regulations are followed for setting up and maintaining active waiver enrollment. In Colorado, case management agencies are contractors for the state Medicaid system. They serve catchment areas, and may be private non-profits or local county human services departments. The new case management agency entity serves all 10 HCBS Colorado Medicaid waivers. The contracts for these organizations are in the midst of shifting from our previous model of having two entities providing case management, each covering different waivers.

These are the state contracted entities that provide case management to only some of the 10 Colorado waivers. These two entities are being phased out and replaced by super Case Management Agencies which cover all 10 waivers in one entity. Learn more: https://hcpf.colorado.gov/case-management-redesign

These are the regulated agencies who can be the billing entity for home and community-based services, which are the additional set of services and supports that come with the waiver. HCBS services are non-medical. Learn more:

https://cdphe.colorado.gov/program-approved-service-agency-pasa

Consumer-Directed Attendant Support Services (CDASS) lets you direct and manage the attendants who provide your personal care, homemaker and health maintenance services, rather than working through an agency. Through CDASS, you are empowered to hire, train and manage attendants of your choice to best fit your unique needs or you may delegate these responsibilities to an authorized representative. A member on certain waivers can opt to use CDASS instead of using a PASA for some limited services

CDASS is available in the following Home and Community Based Services (HCBS) waivers:

Brain Injury (BI) waiver

Community Mental Health Supports (CMHS) waiver

Complementary and Integrative Health (CIH) waiver

Elderly, Blind, and Disabled (EBD) waiver

Supported Living Services (SLS) waiver

Learn more: https://hcpf.colorado.gov/consumer-directed-attendant-support-services

Our NDC online self-paced course, Maximize Your Existing Waiver, covers services for each waiver in depth. Each waiver has its own ‘deep dive’ lesson into each service, and the course also covers delivery options like using a Program approved service agency (PASA) or Consumer-Directed Attendant Support Services (CDASS). We encourage you to take our program to learn more.

YES! Our program. Roadmap for the Waiver Journey, will empower you with the right information so you can succeed this time. Our course has simple lessons that include all the steps, forms and advice you need to navigate the process. Once you understand the process, it is easier to get it done. Knowing the roadmap makes all the difference, so even if you’ve tried before, the benefits are worth trying again!

You can schedule a free 15 minute call with founder Maureen Welch to discuss specifics of your case, or you can use the Choosing a HCBS waiver flow chart from the HCPF website. Adult flowchart is Adult Waiver Flowchart and Children’s flowchart is Children's Waiver Flowchart.

Yes, you will want to also consider whether your family member might qualify for a waiver based on disability and meeting waiver criteria. Once on a waiver, the income restrictions are ‘waived,’ meaning you don’t have to worry about going over the income criteria and losing that disabled family member’s Medicaid coverage.