With the average monthly cost of a private room in a nursing home in Colorado exceeding $9,000 in 2019, those who are likely to need long-term care (LTC) should pay serious attention to ensure they have a way to pay for that care. LTC is usually paid for by private funds, nursing home insurance, or Medicaid. If a patient cannot afford to pay privately and does not have LTC insurance, Colorado's Medicaid program might pay for his or her care.
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 LTC. Health First Colorado, Colorado's Medicaid program, administered by the Colorado Department of Health Care Policy and Financing, provides LTC assistance under certain circumstances, discussed below. Additionally, in Colorado, the state's LTC Partnership, an alliance between the private insurance industry and the state government, helps residents plan for future LTC needs without depleting all of their resources to fund their care.
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.
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.
In Colorado, a single person can have a monthly income up to only $2,313 in 2019 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 $4,626 per month in 2019. These LTC 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 is not counted, so that he or she has enough funds on which to live. Additionally, the non-applicant spouse is entitled to a minimum monthly needs allowance, which may range from $2,113.75 to $3,160.50 (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 will be expected to spend almost all income on your care. Colorado allows nursing home residents receiving Medicaid to keep only $84.41 per month as a personal needs allowance.
Medicaid for long-term care has different resource rules than those for other Health First Colorado programs. Resources are assets like real property, personal property, life insurance with a cash value, vehicles, motorhomes, boats, IRAs, bank accounts and cash. You will have to total up all of these to determine how much you have in resources.
If you are 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 (up to a value of $585,000 in 2019). If you are married, your non-applicant spouse at home can keep up to $126,420 worth of joint assets.
Colorado offers a Long-Term Care Partnership program, under which qualified LTC policyholders can protect a portion of their assets if they choose to apply for Health First Colorado. Under this program, for each dollar that a policy pays in LTC benefits, the policyholder who applies for Medicaid can protect a dollar of personal assets. To the extent protected, those assets are disregarded during eligibility review and at estate recovery. To be eligible to receive the asset protection offered under the LTC Partnership program, an applicant must hold an LTC insurance policy that meets specified program requirements.
For more information about the Colorado LTC Partnership, visit the state's program web site.
Colorado has a state Medicaid waiver plan, known as a Home and Community-Based Services (HCBS) Waiver, that allows elderly individuals in need of assistance to remain living independently instead of in a nursing home.
Colorado has a Medicaid Home and Community-Based Services (HCBS) waiver program, which is designed to provide assistance to eligible individuals so that they can remain living independently – at home and in assisted living facilities – instead of in nursing homes. Assistance offered under this program, called the Elderly, Blind, and Disabled (EBD) Waiver, may include adult day care, personal care assistance, alternative care facilities, in-home support services, and personal emergency response systems.
Generally, 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. 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 or community. The EBD Waiver program has rules and requirements in addition to those of Health First Colorado, and the program may have waitlists.
If you are 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 here.
The CDASS program is an option available to EDB Waiver participants 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.