Page Reviewed / Updated - January 25, 2020
The Elderly, Blind and Disabled Medicaid waiver is designed to help the elderly who have physical impairments that could qualify them to receive nursing home care. Individuals elect to receive care services at home or in alternative care facilities, such as assisted living, instead of in a nursing home environment. In addition to choosing their care environment, under this program individuals have the option to "consumer direct" or self-direct their own personal care services via Consumer-Directed Attendant Support Services (CDASS). This means they can hire and manage some of their own care providers, including relatives with the exception of spouses. As an example, they can elect from whom they receive personal care, but not necessarily who provides them with non-medical transportation.
Services covered under this waiver are selected to enable participants to maintain their independence outside of nursing homes. As such, personal emergency response systems (PERS), adult day care, respite care, and home modifications are covered. A broad category of assistance referred to as In-Home Support Services (IHSS) is another available benefit under this waiver and also allows for consumer direction of care providers. IHSS includes help with home-related tasks, such as laundry, house cleaning, and personal care, such as bathing and eating.
This waiver's full, official name is Home and Community-Based Services waiver for Persons who are Elderly, Blind and Disabled (HCBS-EBD). It is administered by the Colorado Department of Health Care Policy & Financing.
To be eligible for this waiver, an applicant must be a resident of Colorado. This waiver also considers age, income, financial assets, and functional ability as eligibility criteria.
Age and Functional Ability - while open to persons 18 and older who are disabled, those 65 years of age and older need not be designated officially as having a "disability,". Rather, they must be assessed and found in need of nursing home level care. Persons over 18 living with HIV or AIDS can also automatically meet the functional criteria even if they are not over 65 or legally defined as having a disability by the Social Security Administration.
2020 Income Limits - Single applicants may not have a gross monthly income greater than $2,349 each month. This is equal to an annual income of $28,188.
If married, and the applicant’s spouse is not also seeking Medicaid assistance, some of the applicant’s income can be allocated to their spouse as a living allowance. This is called a Minimum Monthly Maintenance Needs Allowance (MMMNA) and allows an applicant spouse to transfer up to $2,113.75 / month (this figure will change July 2020) to his/her healthy spouse. However, if the non-applicant spouse has high shelter costs, an applicant spouse may be able to transfer as much as $3,216 / month (this figure will change January 2021) to his/her non-applicant spouse. This income allowance not only prevents non-applicant spouses from becoming impoverished, but also assists applicants in lowering their countable income.
Another option to lower countable income when an applicant is over the income limit is to allocate excess income into a Miller Income Trust. (Miller Income Trusts are also called Qualified Income Trusts). Money deposited in the trust does not count towards Medicaid’s income limit, and can only be used for very specific reasons, such as contributing towards the cost of long-term care.
Both spousal income allocation and Miller Trusts are complicated, and one should consider consulting with a professional Medicaid planner should they choose to take this route to qualify for Medicaid.
2020 Asset Limits - Single applicants may have up to $2,000 in countable assets, which includes bank accounts, investment accounts, and retirement accounts.
If the applicant is married, and his/her spouse is not applying, then the non-applicant spouse is permitted to retain up to a maximum of $128,640 of the couple’s joint assets. (Learn more about Medicaid and joint assets here). This is called the Community Spouse Resource Allowance. A home, up to $595,000 in equity value, is an exempt asset (meaning its value is not counted toward the asset limit).
Countable assets in excess of the limits may be converted to exempt assets, such as modifying a home for aging in place or paying off debt. An applicant may also convert a lump sum of cash into annuity income, which no longer will count as an asset. These techniques both will likely require expert guidance from a Medicaid planning professional. Interested individuals should find help in advance of applying. Incorrectly implementing a planning strategy can violate Medicaid’s 60-month look back period, resulting in a period of Medicaid ineligibility. Find assistance qualifying for Medicaid.
As the objective of the Elderly, Blind and Disabled Waiver is to prevent unnecessary nursing home placements, the benefits are selected to enable individuals to continue living in the community and to support their family members who provide caregiving assistance. Some services such as Personal Care and Homemaker Services can be participant directed, meaning the beneficiary can choose their own provider of services. A complete list of services follows.
This waiver is available statewide in all counties. It has been structured to aid approximately 29,000 state residents. However, because it is not considered an entitlement program, eligibility does not ensure availability of services. Qualified applicants may have to wait to start their benefits if there is an interest list.