Summary
Medicaid’s rules, benefits and even its name can all vary by state. In Colorado, Medicaid is called Health First Colorado. This article focuses on Colorado Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. These programs are different from regular Medicaid, which is for financially limited people of all ages.
Colorado Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited Colorado seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:
Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.
Colorado Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover the nursing home expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $95.97/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible“, and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.
Colorado Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.
Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help financially limited Colorado seniors who require a Nursing Facility Level of Care remain living in the community instead of moving to a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services and supports for Colorado residents who live in their home, the home of a loved one or an alternative care facility (similar to an assisted living residence). While Colorado’s HCBS Waivers will cover some long-term care services and supports in those settings, it will not cover room and board costs.
The HCBS Waiver relevant to Colorado seniors is the Elderly, Blind and Disabled (EBD) Waiver.
Elderly, Blind and Disabled (EBD) Waiver
Colorado’s Elderly, Blind and Disabled (EBD) Waiver should not be confused with Aged, Blind, and Disabled (ABD) Medicaid in Colorado, which is detailed in the next section. The EBD Waiver is intended to delay nursing home placement for elderly (age 65+), blind or disabled Colorado Medicaid beneficiaries who require a Nursing Facility Level of Care but live in their own home, the home of a loved one or an alternative care facility. While the EBD Waiver will cover some long-term care services and supports in those settings, it will not cover the cost of room and board.
EBD Waiver program participants receive benefits depending on their needs and circumstances. These benefits can include adult day care, meal delivery, home modifications, housekeeping services, Personal Emergency Response Systems and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).
EBD Waiver benefits can be provided by licensed caregivers, but program participants also have the option to self-direct some of their care by hiring relatives (including spouses) or friends as providers for certain services like personal care assistance and housekeeping. EBD Waiver beneficiaries can do this through Consumer-Directed Attendant Support Services (CDASS) or In-Home Support Services (IHSS). If the beneficiary uses CDASS, they are considered the self-directed caregiver’s employer. They also manage their own budget and set their caregiver’s rate of pay, but they do have the help of a financial services agency to deal with responsibilities like tax withholding, payments and background checks. With IHSS, the EBD Waiver program beneficiary is not considered the employer. Program participants who do not have the cognitive ability to direct their own care can have a representative make choices for them using either CDASS or IHSS.
Unlike Nursing Home Medicaid, the EBD Waiver is not an entitlement. Instead, there are a limited number of enrollment spots (29,399 per year as of 2023), and once those spots are full, additional applicants are placed on a waitlist.
Colorado’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care benefits to financially limited Colorado residents who are aged (65 and over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially limited people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive the benefits without any wait.
1. ABD Long Term Care Benefits
Eligible Colorado seniors who show a medical need for long-term care services and supports can receive some of them through ABD Medicaid. These long-term care benefits can include in-home personal care, adult day care, meal delivery, home modifications and Personal Emergency Response Systems (PERS). ABD Medicaid recipients qualify for these benefits one at a time. This is different from Nursing Home Medicaid, which makes all of its benefits immediately available for anyone who qualifies. Instead, Colorado seniors will be evaluated by the state to determine what kind of long-term care benefits they need and will receive.
2. Program of All-Inclusive Care for the Elderly (PACE)
Colorado residents who are age 55 or older and have ABD Medicaid can cover their medical, social service and long-term care needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. Colorado’s PACE programs can be used by people who are “dual eligible” for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care, and PACE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. Colorado’s PACE programs are located in Colorado Springs (Rocky Mountain PACE), Denver (InnovAge Colorado PACE), Grand Junction (HopeWest PACE), Lafayette (TRU PACE) and Montrose (Senior CommUnity Care of Colorado). To learn more about PACE, click here.
To be eligible for Health First Colorado (Colorado Medicaid), a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.
Just For You: The easiest way to find your specific Health First Colorado (Colorado Medicaid) eligibility criteria is to use our Medicaid Eligibility Requirements Finder.
Financial Requirements
Colorado residents have to meet an asset limit and an income limit in order to be financially eligible for Colorado Nursing Home Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for Colorado Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Colorado Nursing Home Medicaid recipients are required to give most of their income to the state to help cover the cost of care. They are only allowed to keep $95.97/month of their income as a “personal needs allowance,” plus enough to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.
For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through Health First Colorado is a combined $3,000 if the couple will live in separate rooms, and a combined $4,000 if they will live in a shared room. And the income limit for married applicants with both spouses applying for nursing home coverage is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $ 2,829/month for the applicant, and the income of the non-applicant spouse is not counted.
Plan Ahead: There are alternative pathways to eligibility for Colorado Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Colorado has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for nursing home coverage through Health First Colorado (Colorado Medicaid) is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home. To determine if the Nursing Facility Level of Care requirement is for Medicaid purposes, Colorado uses the Level of Care (LOC) Determination Screening Instrument. This takes into consideration the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications), as well as cognitive ability.
Financial Requirements
Colorado residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Services (HCBS) Waivers. For a single applicant in 2024, the asset limit for HCBS Waivers in Colorado is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for HCBS Waivers in Colorado for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Colorado is $3,000 combined, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.
Plan Ahead: There are alternative pathways to eligibility for Colorado HCBS Waivers applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Colorado has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers through Health First Colorado (Colorado Medicaid) is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. To determine if the NFLOC requirement is met for Medicaid purposes, Colorado uses the Level of Care Determination Screening Instrument. This takes into consideration the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications), as well as cognitive ability.
Financial Requirements
Colorado residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid through Health First Colorado (Colorado Medicaid). For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for Colorado’s ABD Medicaid for a single applicant is $943/month. Almost all income is counted, including IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. The only income sources exempt from the limit are things like COVID-19 stimulus checks and Holocaust restitution payments.
For married applicants, the 2024 asset limit for Colorado ABD Medicaid is $3,000 combined between the two applicants/spouses, and the income limit is $1,415/month combined. These limits apply to married couples with both spouses applying and married couples with just one spouse applying.
Plan Ahead: There are alternative pathways to eligibility for Colorado ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Colorado has a Look-Back Period of five years for Nursing Home Medicaid and HCBS Waivers applicants to make sure they don’t give away their assets to get under the limit, the Look-Back Period does not apply to ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.
Functional Requirements
The only functional requirements to receive basic healthcare coverage through Colorado ABD Medicaid are being aged (65 or over), blind, or disabled. For ABD Medicaid applicants who require long-term care services and supports, Health First Colorado will conduct an assessment of their ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications) to determine what kind of benefits the applicant needs and the state will cover.
One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:
These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status.
Colorado Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Colorado and how you can protect your home from it, click here
The first step in applying for Health First Colorado (Colorado Medicaid) Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid.
The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Health First Colorado when not financially eligible will result in the application, and benefits, being denied.
During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Health First Colorado applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.
After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Colorado residents can apply for Health First Colorado online here. They can also call the Colorado Department of Human Services at 1-800-221-3943, or they can download, complete and submit an Application for Health Insurance & Help Paying Costs.
For a comprehensive guide that will take you through the application process for all three types of Medicaid Long Term Care, click on the program you want: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.
Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.
After being approved for nursing home coverage through Health First Colorado (Colorado Medicaid), seniors need to choose which Medicaid-accepting nursing home best meets their needs. Even though Medicaid nursing home coverage is an entitlement, not all nursing homes take Medicaid, and those that do may not have available spaces. Finding the right nursing home can be tiresome, especially if you are looking for one in a specific geographic area.
There are roughly 200 nursing homes in Colorado that accept Medicaid, and more than half of them are located in and around the state’s four major cities that are all along I-25: Fort Collins, Denver, Colorado Springs and Pueblo. There are about 80 nursing homes that accept Medicaid within 25 miles of Denver, which includes Boulder and Brighton to the north, and Parker to the south. There are approximately 20 nursing homes in the Fort Collins area, and Colorado Springs has about the same number, and Pueblo has around 10. The options are thinner in the mountains and the western part of the state with just six nursing homes in Grand Junction and only three within 50 miles of Eagle.
TOOLS: This Colorado Department of Public Health & Environment webpage can help you find and compare Medicaid-approved nursing homes across the state. Colorado residents can also use Nursing Home Compare, a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information about more than 15,000 nursing homes across the country.
Once you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by overall rating, health inspections, staffing and quality measures, which can be a helpful place to start. You can also use the Colorado Department of Public Health & Environment facility locator to look at inspection reports for each facility. The healthcare professionals who work with you are another great resource. And you can find out more information about nursing homes by contacting your local Area Agency on Aging.
After doing your research, you or someone you trust should also visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive prepared with a list of questions. Some things you might ask are: Does the residence coordinate social activities? Does it provide transportation? Who are the staff doctors? What are the meals like? How will the residence provide access to oral and eye care? CMS has a thorough “Nursing home checklist” you can use to evaluate a nursing home while visiting.
According to data collected by CMS, Colorado nursing homes were in line with national averages when it came to resident-to-staff ratio and overall quality of care, with a couple of notable exceptions. First, Colorado nursing homes reported an average of 18.1 fire deficiencies that led to citations from 2019-2022, which is more than the national average of 13.5. On the plus side, only 3.8% of residents in Colorado nursing homes reported depressive symptoms during that same three-year time span, which is well below the national average of 8.1%.
If you need Medicaid long term care but do not meet the financial eligibility criteria, consider working with a Medicaid Planning professional. These fee-based experts help families structure their finances to become eligible, while streamlining the application process and preserving assets for spouses and family members.
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