What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through Medicaid Waivers, which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.
Consumer Directed Attendant Support Services (CDASS) is not a Medicaid program per se. Rather, it is a way to empower participants and their families to make home care more personalized and responsive. Disabled and elderly individuals must be participating in a program to receive long term care outside of a nursing home.
The CDASS Program is based on the “Cash and Counseling” model in which the individual receiving care is responsible for the direction of their care. This includes hiring, training, and managing his or her care attendant. This program model is also referred to as self-direction or participant-directed care. However, with CDASS, an authorized representative, who may be a trusted friend or family member, may fulfill these responsibilities for the eligible individual.
Family members, including the adult children, can be hired and receive payment for being caregivers.
Under Colorado’s CDASS program, participants are allocated the funds that would otherwise go towards paying a care provider. Participants are then responsible for hiring their own personal care providers. Family members, including adult children and spouses, can be hired and receive payment for being caregivers.
Medicaid tightly regulates the amount that caregivers are paid. According to Genworth’s Cost of Care Survey 2021, the average hourly rate for home care in Colorado is $33.50. Caregivers paid through Medicaid receive an hourly rate, which may be well below the state average. At the time of this writing, the minimum amount a caregiver can be paid via CDASS is equivalent to the state’s minimum wage. As of January 2023, this is $13.65 an hour ($17.29 in Denver). However, depending on the number hours a caregiver works, the pay could be significantly higher.
Despite the Cash and Counseling name, funds are not provided directly to program participants. Instead, Colorado makes use of a financial intermediary. At this time, participants can choose between Palco and Public Partnerships Colorado (PPL CO), who will make payments to the care providers approved by the program participant.
To be eligible for the CDASS program, seniors must be residents of Colorado who are receiving services under, or qualify for, Colorado’s Elderly, Blind and Disabled (EBD) waiver or another of Colorado’s Medicaid waivers. Unfortunately, only the EBD waiver is relevant to the elderly.
The EBD Waiver considers both the applicant’s functional ability and his/her ability to pay privately for care. Functionally, applicants must be qualified for a nursing home level of care. However, they must choose to live at home or in the community and elect to self-direct their care.
In 2023, an unmarried, divorced, or widowed applicant can have no more than $2,742 in gross monthly income, which is equal to $32,904 per year. Even if an applicant is married, only income in the applicant’s name is counted for his/her application. Said another way, the income of a non-applicant spouse does not impact the applicant spouse’s eligibility.
However, a non-applicant spouse can be allocated up to $3,715.50 (in 2023) of monthly income from his/her applicant spouse. This is called a monthly maintenance needs allowance. This spousal allowance not only helps to prevent spousal impoverishment, but it also can assist in lowering the applicant’s income to within the eligibility limit.
In 2023, the countable resource limit is $2,000 for a single applicant. If married, a non-applicant spouse is permitted to retain up to $148,620 in resources. This is called a community spouse resource allowance and is in addition to the $2,000 in assets the applicant spouse is able to retain.
Different from income rules, all assets of a married couple are considered jointly owned, even if only one spouse is applying for Medicaid. (Click here for additional information about joint assets and Medicaid). However, certain assets are exempt, meaning they are not counted towards the asset limit. For instance, the couples’ home is exempt, provided one of the spouses continues to live in it. If only the applicant spouse lives in the home, his/her equity interest must be under $688,000 (in 2023).
Please Note: To prevent families from giving away their assets to meet the Medicaid eligibility limit, past asset transfers as far as 5 years preceding one’s Medicaid application date are evaluated. This is called the Medicaid look back period.
Over the Financial Limits?
In Colorado, it is possible to still qualify for Medicaid when one is over the income and / or asset limit(s) through a process known as Medicaid planning. Income over the limit can be allocated into a Qualified Income Trust to enable the applicant to become eligible. Countable assets can be converted into non-countable assets, such as irrevocable funeral trusts or home equity. While not everyone can qualify, those who are near the limits and cannot afford their cost of care, might consider this approach. Find assistance applying for Medicaid.
Benefits and Services
Under the CDASS program, personal care / attendant care services, including assistance with any of the activities of daily living, such as bathing, eating, mobility, and dressing, are covered. Assistance with activities involving an applicant’s health, such as managing medication and providing wound care, as well as homemaker services, such as housekeeping, grocery shopping and meal preparation are also covered.
Family members and relatives can be hired to provide most of these services. In certain situations, Colorado even permits spouses to receive compensation.
How to Apply / Learn More
More information about this statewide program can be found on Colorado’s Department of Health Care Policy and Financing website. Individuals currently on Medicaid (Health First Colorado) should contact Single Entry Point (SEP). Click here to find your local office.
If an individual is not currently on Medicaid, he or she must apply for the Medicaid supported waiver services. Find your county contact information here. One can also apply online.