Colorado Medicaid Resources

• State Medicaid Website: Colorado
• Colorado Developmental Disabilities Council Website
• The Arc of Colorado

Colorado Medicaid Facts: From Kaiser Family Foundation Medicaid Fact Sheet (2009)

There are 76,700 people with a disability using Medicaid in Colorado. The state spent $15,447 on each Medicaid recipient with a disability in 2007.

14% of the people covered by Medicaid in Colorado have a disability, which is almost the same as the national percentage of 15%.

Colorado spends 43% of all of the money it spends on Medicaid on services for people with disabilities, which is also almost the same as the national percentage of 42%.

Colorado Medicaid Community Mental Health Services Program

This program provides access to mental health services for children and adults with disabilities. You may not always get to choose your provider under this plan.

• Community: community treatment, school-based services
• Health: clinic services, inpatient and outpatient mental health services, medication management, rehabilitation and recovery services, support and prevention programs, psychiatric treatment, rehabilitation
• Home: home-based services for children and adolescents
• Social Services: intensive case management

Primary Care Physician Program

This program provides access to a basic level of primary care services only. It covers adults and children with disabilities including those who are eligible for Medicare, but not including those living in nursing or intermediate care facilities.

• Health: early and periodic screening, diagnosis, and treatment, hearing, immunization, hospital services, inpatient substance abuse treatment, laboratory, pharmacy, physician, x-ray
• Social Services: case management

Managed Care Program

This program provides basic medical services to adults and children with disabilities. It does not cover some people who are also eligible for Medicare.

Restrictions: Not all services are available in all areas, and prices change by county. Also, services marked with an * are covered under a different payment plan.

• Community: transportation*
• Health: medical equipment, early and periodic screening, diagnosis, and treatment, family planning, hearing, immunization, hospital services, laboratory, occupational therapy, pharmacy, physical therapy, physician services, speech therapy, telemedicine, vision, x-ray services, disease management*
• Home: home health care
• Social Services: case management*

Program of All-Inclusive Care for the Elderly (PACE)

PACE programs are designed for people 55 and older who might require nursing home placement. This includes many people with disabilities. These programs provide integrated care and support including a high level of preventive care. PACE programs must provide all services otherwise included in a person’s Medicaid or Medicare benefit, as well as all other services deemed medically necessary. Services are provided through PACE centers, so people must live close enough to an approved center to be eligible.

Ages: 55 and older

Level of Care: nursing

Restrictions: You must live close enough to a PACE center.

• Community: day care, health-related transportation
• Health: primary and specialty care, nursing, physical therapy, occupational therapy, speech therapy, recreation therapy, prescription drugs,
• Home: home health care, home and environmental modifications
• Social Services: social services

Children’s HCBS waiver

This waiver provides services to children with disabilities whose parents make too much to otherwise qualify for Medicaid. It is intended to help children who are at risk of being placed in a nursing home or intermediate care facility to remain at home with their families and still get the services they need.

Ages: 17 and under

• Home: in-home support services
• Social Services: case management

Children with Autism waiver

This waiver is directed at children under the age of 6 who have been diagnosed with autism. In addition to this diagnosis, children must have behavioral needs severe enough to put them at risk of institutional placement.

Ages: 6 and under

• Health: behavioral therapy
• Social Services: case management

Children’s Extensive Support waiver

This waiver is directed at children whose disabilities are serious enough to need a high level of extra support. In addition to being at risk for out-of-home placement, children must meet extra criteria to qualify for this waiver since it is designed to help those most in need of extra support.

Ages: 17 and under

Level of Care: nursing

• Community: community connection services
• Health: specialized medical equipment and supplies, professional services including behavioral therapy
• Home: home modifications, personal assistance services

Children’s Habilitation Residential Program

This waiver applies to children who are in foster care and have severe developmental disabilities. The program is designed to teach these children life skills such as self-help, socialization, and adaptive skills so that they can move to living in community settings instead of institutions.

Ages: 21 and under

Restrictions: This program is for children who are in foster care.

• Community: community connections travel
• Health: cognitive services, communication services, counseling and therapy, emergency assistance training, supervision
• Home: independent living training, personal care services
• Social Services: self-advocacy training

Pediatric Hospice waiver (HOPEFUL Program)

This waiver allows children diagnosed with a life-limiting illness to receive home care instead of going into a hospital.

Ages: 19 and under

Restrictions: This waiver has only 200 slots, so there may be a waiting list for services.

• Health: palliative care, expressive therapy (including writing, painting, music, and scrapbooking)
• Home: family and caregiver counseling, respite care

HCBS waiver for persons with Brain Injury

This waiver provides home or community-based care for people who have experienced brain injuries that make them eligible for institutional placement.

Ages: 16 to 64

Level of Care: nursing

• Community: non-medical transportation, transitional living, adult day care
• Health: specialized medical equipment and supplies, behavioral management, day treatment, mental health counseling, substance abuse treatment, personal emergency response systems
• Home: personal care, respite care, home modifications

HCBS waiver for the Elderly, Blind and Disabled

This waiver provides an alternative to nursing home care for people with disabilities.

Ages: 18 and over

Level of Care: nursing

Options for Self-Direction: Yes. This program will pay for an attendant who is managed by the person with the disability.

• Community: adult day services, community transition services, non-medical transportation
• Health: personal emergency response systems
• Home: alternative care facilities, consumer-directed attendant support, home modifications, homemaker services, in-home support, personal care, respite care

Supported Living Services Waiver

This program is intended to help people with developmental disabilities who need low to moderate levels of support to live in their own homes or with families who also provide support.

Ages: 18 and older

Level of Care: Intermediate

• Community: day habilitation, transportation
• Health: specialized medical equipment and supplies, counseling and therapeutic services, dental services, hearing services, vision services
• Home: home modifications, personal assistance, supported living consultation
• Work: pre-vocational services and supported employment

Developmental Disabilities Waiver

This waiver is for adults with intellectual and developmental disabilities. This waiver can provide support from low levels up to levels that include access to 24-hour supervision.

Ages: 18 and older

• Community: day habilitation, transportation
• Health: specialized medical equipment and supplies, skilled nursing, behavioral services, dental, and vision
• Home: residential habilitation
• Work: supported employment