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Colorado agency reviews HCBS waivers, Community First Choice eligibility and case‑management timelines
Summary
Department of Health Care Policy and Financing staff gave a high‑level walkthrough of Colorado’s nine HCBS waivers, how Community First Choice differs, financial thresholds and the timelines case management agencies and counties must follow for eligibility determinations.
The Department of Health Care Policy and Financing on a recorded TSAC call walked through how Colorado’s home‑ and community‑based services (HCBS) waivers and the Community First Choice (CFC) program work, what makes applicants eligible and the timelines for assessments and county processing.
Carly Altman, who identified herself as a member of the department’s Office of Community Living and the head of its training team for case management agencies, said Colorado operates nine HCBS waivers that must be run in a cost‑neutral, person‑centered way to prevent institutionalization. She described three concurrent paths for members seeking services: contact the local case management agency (CMA) for a level‑of‑care assessment, determine which waiver or program best meets the member’s needs, and use the PEAK portal to apply for Medicaid or long‑term care benefits.
Altman explained eligibility has multiple parts: financial eligibility (processed by county human services), a Social Security Administration disability determination when applicable, and a CMA assessment to establish a level of care. She noted waivers have targeting criteria—age, diagnosis or regional program differences—that affect which waiver fits, and that a person may only be enrolled in one waiver at a time but can be enrolled in CFC and a waiver concurrently.
On income rules, Altman used a 2024 example to illustrate the principle rather than present a fixed number: long‑term care financial thresholds are tied to SSI multiples (she cited a recent monthly example of about $2,982 at 300% of SSI, a figure that changes annually) and counties make the final determination. For CFC‑only applicants, financial eligibility follows Health First Colorado state‑plan Medicaid rules and uses household MAGI (modified adjusted gross income) with a 133% federal‑poverty threshold, Altman said. She also described options such as ‘‘buy‑in’’ arrangements and income trusts for people whose incomes exceed usual thresholds.
The presentation set out required timelines: CMAs must complete level‑of‑care assessments within 2 days for hospital referrals, 5 days for nursing facility referrals and 10 days for community referrals; counties generally have 45 days to complete financial eligibility reviews and may have an additional 45 days when a Social Security disability determination is required. Altman cautioned that waivers and CFC are not emergency services and the assessment-to‑authorization process can take time.
Altman directed listeners to the Long‑Term Services and Supports (LTSS) training page on the department website for waiver charts, side‑by‑side comparisons (adult and children’s charts), regulatory citations and an enrollment guide available in English and Spanish. She said CMAs should use the department’s Direct Care Service Calculator to authorize task‑based hours and clarified that case managers do not authorize long‑term home health or private‑duty nursing.
In response to a chat question, Altman said the department discontinued the nurse assessor program (announced in mid‑December) and transitioned authorization work to the Direct Care Service Calculator used by case managers.
The department said slides and the recording will be posted to the TSAC page and encouraged attendees to raise additional questions by email or through the HCBS resources links.
Next steps: the department will keep LTSS resources and waiver documentation updated online and attendees were reminded how to find CMA contact information and the transitions referral form.
