Colorado Medicaid Waiver for Dementia: Denver

Colorado's main Medicaid long-term care waiver for many older adults and people with disabilities who want to stay at home is the Home and Community-Based Services Waiver for persons who are Elderly, Blind, or Disabled (HCBS-EBD). For Denver households living with dementia, this is the state program most often used to fund home and community supports when someone needs care at a nursing-facility level but can live outside an institution.

The sections below explain the functional standard Colorado uses (including the fact that there is no separate, lower dementia threshold), typical countable resource limits, how local Case Management Agencies handle applications and annual reviews, and how consumer-directed attendant care works. This is general information, not a benefits decision or medical advice.

What Is Colorado's HCBS-EBD Waiver?

Colorado's HCBS-EBD waiver is the Home and Community-Based Services Waiver for persons who are Elderly, Blind, or Disabled, a Health First Colorado (Medicaid) program that can pay for long-term support at home and in the community instead of in a nursing facility.

The program is administered by the Colorado Department of Health Care Policy and Financing. You can learn more about the HCBS-EBD waiver on the department's program overview, which describes the waiver's overall structure. Level-of-care decisions are made by local Case Management Agencies and are reviewed each year.

HCBS-EBD is not limited to one diagnosis. It is built around functional need and financial eligibility, so Denver families exploring dementia support still go through the same waiver framework as other older adults and people with disabilities who need ongoing help with daily living.

Is There a Dementia-Specific Eligibility Threshold?

Colorado does not publish a separate, lower functional threshold for dementia on the HCBS-EBD waiver. Applicants age 65 and older must be determined to have a significant functional impairment, and applicants age 18 to 64 must be blind, physically disabled, or have an HIV or AIDS diagnosis. Everyone on the waiver must need long-term support at a level comparable to a nursing facility.

Dementia is a general term for impaired ability to remember, think, or make decisions that interferes with doing everyday activities, as described by the CDC's overview of Alzheimer's disease and dementia. That kind of day-to-day impact is often why families look at home-based help, but it does not create a shortcut around Colorado's nursing-facility-comparable standard.

A dementia diagnosis alone does not replace the Case Management Agency's level-of-care determination. The agency looks at whether the person has a significant functional impairment (for those 65 and older) or meets the disability-related path (for those 18 to 64), and whether the need for support is comparable to what a nursing facility would provide.

What Asset Limits Apply to HCBS-EBD?

HCBS-EBD uses countable resource limits of $2,000 for a single applicant and $3,000 for a couple. Income rules, which assets count, and spousal protections can be more detailed than these headline figures, so families should confirm current financial rules when they apply.

A waiver-specific look-back period is not published as its own number for this program. Standard Medicaid transfer-of-asset rules still apply. Large gifts or transfers made before an application can affect eligibility, which is why many families review finances before they start the waiver process.

These resource figures are program information, not a promise that every household with dementia in Denver will qualify. Financial eligibility for Health First Colorado is separate from the functional assessment, and both must line up before waiver services can be authorized.

How Do You Apply for the Waiver in Denver?

A local Case Management Agency determines level of care for HCBS-EBD and reviews that determination annually, and all waiver services need prior approval before Health First Colorado will pay for them.

Denver residents generally begin by contacting a Case Management Agency that serves their area, completing a functional assessment, and working through Health First Colorado financial eligibility. Useful documents often include identification, income and resource records, and information about how much help the person needs with everyday activities.

Nothing is paid as an HCBS-EBD service until it has prior approval. Families in Denver should treat the assessment and the prior-authorization step as two distinct gates: first the agency confirms nursing-facility-comparable need, then specific services must be approved before billing can occur.

The Colorado Department of Health Care Policy and Financing oversees the waiver. The Case Management Agency is the local partner that actually measures level of care and revisits it each year, so changes in memory, mobility, or safety at home should be reported when they affect daily function.

What Is CDASS on the EBD Waiver?

The EBD waiver includes Consumer Directed Attendant Support Services (CDASS), which lets families direct and hire their own attendant care rather than being assigned an agency. The same waiver also includes In Home Support Services and adult day health.

CDASS can matter for dementia care because a familiar attendant, hired and directed by the family, may be easier for someone with memory loss to accept than a rotating agency schedule. It is still a waiver service: the person must be eligible, the plan must be approved, and Health First Colorado will not pay without prior approval.

In Home Support Services and adult day health give households other ways to assemble a week of support. Adult day health can add daytime structure and supervision, while attendant services focus on help in the home. Which mix is authorized depends on the assessed need, not on a dementia-only menu.

How Can Denver Families Combine Waiver Coverage With Home Care?

Denver families can use approved HCBS-EBD attendant and community services for the hours the waiver authorizes, then add private in-home help when the authorized plan does not cover nights, extra supervision, or specialized dementia routines.

Private memory care at home focuses on familiar routines, safety, and cueing for someone living with memory loss. Waiver attendant hours and private memory support are not the same product: one is a state-authorized Medicaid service, and the other is arranged directly with a home care provider.

Personal care can help with bathing, dressing, toileting, and other hands-on tasks that often become harder as dementia progresses. Companion care can add supervision, conversation, and help with simple household activities when the main need is presence and structure rather than skilled medical treatment.

Some households keep private help in place while the Case Management Agency completes its review, because waiver services cannot be billed until they have prior approval. Others use companion or personal care to fill gaps around adult day health or CDASS attendant schedules. None of these private services is a substitute for the official level-of-care decision.

Families who want research-oriented information about Alzheimer's disease can find NIA-funded Alzheimer's Disease Research Centers through the National Institute on Aging. Those centers support research and clinical work. They do not decide HCBS-EBD eligibility in Denver.

Frequently Asked Questions

Does Colorado Medicaid cover dementia care at home for Denver residents?

HCBS-EBD can fund home and community-based services for people who meet both the functional standard and Health First Colorado financial rules, and who need long-term support comparable to a nursing facility. Dementia is not a separate waiver, and there is no published lower functional bar just because someone has a dementia diagnosis.

Is there a special Medicaid functional test only for dementia in Colorado?

No. Colorado does not publish a separate, lower functional threshold for dementia. People 65 and older must have a significant functional impairment. People 18 to 64 must be blind, physically disabled, or have an HIV or AIDS diagnosis. All applicants must need support at a nursing-facility-comparable level, as determined by a Case Management Agency.

What is the asset limit for the HCBS-EBD waiver?

Countable resource limits are $2,000 for a single applicant and $3,000 for a couple. Which resources count, how income is treated, and any spousal rules are confirmed during the Health First Colorado financial review. These limits can change, so applicants should verify the current amounts when they apply.

Who decides if someone in Denver qualifies, and how often is that reviewed?

A local Case Management Agency determines level of care and reviews it annually. The Colorado Department of Health Care Policy and Financing administers the waiver. Even after someone is enrolled, each waiver service still needs prior approval before Health First Colorado will pay for it.

Can our family hire its own caregiver under this waiver?

Yes, if CDASS is part of the approved plan. Consumer Directed Attendant Support Services lets families direct and hire their own attendant care rather than being assigned an agency. The EBD waiver also includes In Home Support Services and adult day health. Hiring under CDASS is still subject to eligibility, the care plan, and prior approval.

Do we have to wait until the waiver is approved to get help at home?

Waiver services are not payable until they have prior approval. Families may arrange private companion care, personal care, or memory care at home on their own while the Case Management Agency completes its assessment and while Health First Colorado reviews financial eligibility. Private arrangements are separate from Medicaid authorization.

Does a look-back period apply if we transferred assets?

A distinct look-back length is not published as a special EBD waiver figure. Standard Medicaid transfer-of-asset rules still apply. If money or property was given away or transferred before an application, that history can affect eligibility, so it should be discussed during the financial review.