When Medicaid in Colorado Will Pay for a Nursing Home, Assisted Living, or Home Health Care

Long-term care (LTC) services in Colorado are expensive, including nursing homes, assisted living facilities, and home health care. In 2023, the average cost of a private room in a nursing home in Colorado was over $10,000 a month, or $120,000 per year. The average cost of assisted living in Colorado was about $5,000 a month.

Private health insurance policies generally don't cover long-term care, and Medicare coverage for LTC services is limited. LTC insurance policies can help pick up some of the tab, but few people purchase LTC insurance. If patients can't afford to pay privately and don't have LTC insurance, Colorado's Medicaid program might pay for their care.

What Is Colorado's Medicaid Program?

Health First Colorado is Colorado's Medicaid program, which is administered by the Colorado Department of Health Care Policy and Financing.

Medicaid is a medical assistance program funded by the federal and state governments to pay for, among other things, long-term care for persons who meet certain requirements, such as being over 65, disabled, or blind. Other types of Medicaid services have different eligibility guidelines than the rules for long-term care.

Health First Colorado provides long-term care assistance under certain circumstances, discussed below.

Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care may qualify for Medicaid benefits, if they meet certain income and resource qualifications.

Medicaid Coverage for Nursing Homes in Colorado

To obtain coverage for nursing home care under Health First Colorado, you must be financially eligible, and you must need the kind of care nursing homes provide. Nursing homes provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, and other services.

For more information and to apply for Medicaid coverage for nursing home services, you can seek assistance from the state's Health First Colorado web page or call Health First Colorado at (800) 221-3943. Typically, your nursing care facility can assist you with the Medicaid application process. You can also contact your local county Department of Human Services office for assistance.

Medicaid Income Rules in Colorado

In Colorado, a single person can have a monthly income up to only $2,829 (in 2024) and qualify for Medicaid-paid nursing home care. (This is 300% of the SSI payment level.)

The Medicaid income limit for a married couple, with both spouses applying, is $5,658 per month (in 2024). These long-term care income limits may be higher than the income limit for those applying for other health care benefits from Medicaid.

For purposes of determining Medicaid eligibility, any income an applicant receives, from any source, is considered. However, when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse isn't counted, so the non-applicant spouse has enough funds to live on.

Additionally, the non-applicant spouse is entitled to a monthly maintenance needs allowance, which may range from $2,465 to $3,853.50. (If the non-applicant spouse doesn't have this amount of income, part of the applicant spouse's income can be saved for this purpose.)

If you qualify for Medicaid and live in a nursing home, you'll be expected to spend almost all income on your care. Colorado allows nursing home residents receiving Medicaid to keep only $105.56 per month as a personal needs allowance.

Medicaid Asset Rules in Colorado

Health First Colorado Medicaid has certain resource rules that govern eligibility for long-term care programs. Resources are assets like real property, personal property, life insurance with a cash value, vehicles, motor homes, boats, IRAs, bank accounts, and cash. You'll have to total up all of these to determine how much you have in resources.

If you're a single person, you can have only up to $2,000 in assets, with a few allowable exclusions such as a car and your home. (Your home equity can actually have a value of up to $1,071,000 in 2024).

If you're married, your non-applicant spouse at home can keep up to $154,140 worth of joint assets.

Medicaid-Paid Home Health Services in Colorado

Colorado has state Medicaid waiver plans, known as Home and Community-Based Services (HCBS) waivers, which are plans that provide additional benefits for which an individual might qualify in certain cases.

Colorado Medicaid HCBS Waiver Program

Colorado has a particular HCBS waiver program designed to provide assistance to eligible individuals so that they can remain living independently—at home or in assisted living facilities—instead of in nursing homes.

Assistance offered under this program, called the Elderly, Blind, and Disabled (EBD) Waiver, can include adult day care, personal care assistance, in-home support services, and personal emergency response systems.

The EBD Waiver program offers services that accompany or add to services applicants receive through Health First Colorado, other government programs, and family- and community-based supports.

Does the EBD Waiver Cover Assisted Living?

The EBD Waiver will pay for certain assistive living services in an alternative care facility (ACF), though the resident is responsible for the costs of room and board. The waiver will pay for the following assisted living services:

• 24-hour oversight
• personal care
• medication administration, and
• homemaker services.

Who Is Eligible for Services Covered by the Waiver?

In general, the EBD Waiver provides assistance to individuals who are:

• 65 and older who have a functional impairment
• blind, or
• aged 18-64 and who are physically disabled and require long-term supports and services to remain in community settings.

To qualify for the EBD Waiver, applicants must meet certain financial and program criteria, and they must be willing to receive services in the home, community, or alternative care facilities (rather than a nursing home). The EBD Waiver program has rules and requirements in addition to those of Health First Colorado, and the program may have waitlists.

If you're already enrolled in Health First Colorado, you can start the waiver application process by contacting your local Single Entry Point (SEP) Agency. Individuals not yet enrolled in Health First Colorado can apply on Colorado's website.

Colorado's Consumer-Directed Attendant Support Services

The Consumer-Directed Attendant Support Services (CDASS) program is an option available to EDB Waiver participants in Colorado who live in their own homes. CDASS allows recipients to direct and manage the LTC services they receive and to hire, train, and manage caregivers of their choice. Participants who are in stable health and able to direct their own services may do so, instead of working through an agency, or participants can otherwise assign an Authorized Representative to whom they would delegate certain management responsibilities.

The CDASS program option gives individuals greater control over their Medicaid-funded home services, as they can use those funds for hiring and paying for attendant services. Attendants can be friends and family members, or agency staff meeting an individual's specific qualifications, and program recipients determine payment for services.

For more information, visit the Colorado CDASS web page.

Colorado's In-Home Support Services Program

Colorado offers another program allowing EDB Waiver participants to self-direct care: In-Home Support Services (IHSS). Like the CDASS program, the IHSS program gives eligible participants the option to direct and manage the LTC services and supports, and the providing attendants of those services and supports, they need to live at home.

For more information, visit the Colorado IHSS web page.