Health First Colorado (Medicaid) Elderly, Blind, and Disabled (EBD) Waiver

Last updated: August 27, 2021

 

Overview of the Elderly, Blind and Disabled Waiver

The Colorado Elderly, Blind, and Disabled Waiver, abbreviated as EBD, provides home and community-based services (HCBS) for elderly, blind, and disabled residents who are at risk of nursing home admission. Intended to assist persons in remaining at home, a variety of long-term services and supports are available. The benefits a program participant receives is dependent on that individual’s unique needs and existing supports. An individual who lives independently with no informal caregiver might receive in-home personal care assistance, delivery of prepared meals, and electronic medication reminders. On the other hand, a person who does have an informal caregiver might benefit from adult day care, respite care, and home modifications for safety and accessibility.

The services offered under this program may be provided by licensed care workers or program participants have the option to self-direct their personal care, health maintenance, and homemaker services. This can be done via two self-directed care options: In-Home Support Services (IHSS) and Consumer-Directed Attendant Support Services (CDASS). Both options allow program participants to hire a relative, including an adult child or spouse, or friend to provide care.

Via IHSS, program participants are not considered the “employer” of the caregiver. Instead, program participants work with a licensed IHSS home care agency who assists them in managing their budget and takes on all employer responsibilities, such as verifying caregiver capability, background checks, setting the caregiver payrate, withholding taxes, and issuing paychecks. Via CDASS, program participants are considered the “employer”. They manage their own budget and decide their caregiver’s rate of pay. However, a financial management services agency handles the financial aspects of employment responsibilities such as background checks, tax withholding, caregiver payments. For both service delivery options, program participants who cannot self-direct their own care can have a representative do so on their behalf.

Services can be received in one’s home, the home of a loved one, or an alternative care facility (assisted living residence), which may include memory care. Memory care offers specialized care for persons with Alzheimer’s disease or a related dementia.

The Elderly, Blind, and Disabled Waiver is not an entitlement program, which means meeting eligibility requirements does not equate to immediate receipt of program benefits. The waiver has a limited number of participant enrollment slots, and when these slots are full, a waitlist for program participation forms.

Colorado’s Elderly, Blind, and Disabled (EBD) Waiver is a 1915(c) Home and Community Based Services (HCBS) Medicaid Waiver. Medicaid in Colorado is called Health First Colorado. In 2014, the benefits available via the Persons Living with AIDS (PLWA) Waiver merged with the EBD Waiver.

 What are 1915(c) HCBS Medicaid Waivers?
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for “Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a nursing home level of care and are at risk of institutionalization such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. This means that meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.

 

Benefits of the Elderly, Blind and Disabled Waiver

Follows is a list of long-term services and supports available via the Elderly, Blind, and Disabled Waiver. An individual care plan will determine which services and supports a program participant will receive.

– Adult Day Care / Adult Day Health Care – daytime supervision and care in a community group setting
– Alternative Care Facility / Assisted Living Services – i.e., personal care assistance, homemaker services, and medication management in an assisted living facility
– Home Delivered Meals
– Home Modifications – for safety and accessibility
– Homemaker Services – i.e., light housecleaning, preparing meals, laundry, shopping for essentials
– Life Skills Training
– Non-Medical Transportation
– Peer Mentorship
– Personal Care Assistance – i.e., bathing, dressing, walking, toileting, eating
– Personal Emergency Response Systems
– Specialized Medical Equipment / Supplies – may include electronic medication reminders
– Respite Care – short-term, in-home and out-of-home care to relieve a primary caregiver
– Transition Setup – coverage of onetime expenses (i.e., security deposit, utility set up fees, essential home furnishings) to assist one in moving from a nursing home back into the community

Persons eligible for the EBD Waiver are also eligible to receive other Medicaid / Health First Colorado services, such as physician visits, hospitalization, home health care, laboratory services, and durable medical equipment.

While services may be provided in an assisted living residences, the cost of room and board is not covered by the EBD Waiver.

 

Eligibility Requirements for Colorado’s Elderly, Blind and Disabled Waiver

The EBD Waiver is for Colorado residents who are elderly (65+) or younger (18-64) if physically disabled or if diagnosed with HIV or AIDS (18+) and at risk of nursing home placement. Disabled persons who enroll prior to turning 65 can continue to receive waiver services upon turning 65. Additional eligibility criteria for persons 65+ are as follows below.

 The American Council on Aging provides a quick and easy CO Medicaid eligibility test for seniors

 

Financial Criteria: Income, Assets & Home Ownership

Income
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR), which increases on an annual basis in January. In 2021, an applicant, regardless of marital status, can have a monthly income up to $2,382. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,382 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of his/her spouse. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a spousal income allowance, also called a monthly maintenance needs allowance.
There is a minimum income allowance, set at $2,177.50 / month (effective July 2021 – June 2022), which is intended to bring a non-applicant spouse’s monthly income up to this amount. There is also a maximum income allowance, which is $3,259.50 / month (effective January 2021 – December 2021), and is dependent on the non-applicant spouse’s shelter and utility costs. This monthly maintenance needs allowance is intended to ensure the non-applicant spouse does not become impoverished.

Assets
In 2021, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $3,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are limited, though the non-applicant spouse is allocated a larger portion of the assets to prevent spousal impoverishment. (Unlike with income, Medicaid considers the assets of a married couple to be jointly owned). In this case, the applicant spouse can retain up to $2,000 in assets and the non-applicant spouse can keep up to $130,380. This larger allocation of assets to the non-applicant spouse is called a community spouse resource allowance.

Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Medicaid has a look back rule and violating it results in a penalty period of Medicaid ineligibility.

 To determine if you might have assets over CO Medicaid’s limit, and if so, receive an estimate of the amount, use our spend down calculator.

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take their home. Fortunately, for eligibility purposes, Medicaid in CO considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has “intent” to return to the home and his / her home equity interest is no greater than $603,000. Home equity interest is the current value of the home minus any outstanding mortgage.
– A spouse lives in the home.
– The applicant has a dependent relative living in the home.

To learn more about the potential of Medicaid taking the home, click here.

 

Medical Criteria: Functional Need

An applicant must require a nursing facility level of care (NFLOC). For the EBD Waiver, a Level of Care (LOC) Determination Screening Instrument is utilized to determine one’s level of care need. To meet a NFLOC, an applicant must require assistance with a minimum of 2 out of 6 activities of daily living (ADLs). The 6 ADLs are toileting, bathing, dressing, transferring, mobility, and eating. Persons with cognitive (memory) deficits or behavioral issues (i.e., wandering), which are common in persons with Alzheimer’s Disease or a related dementia, are also taken into account. If there is a need for moderate supervision related to cognition and / or behavior, this may qualify one as requiring a nursing facility level of care. A diagnosis of dementia in and of itself does not mean one will meet the level of care need.

 For more information about long-term care Medicaid in Colorado, click here.

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for CO Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.

When persons have income over the limits, Miller Trusts, also called a qualified income trust can help. “Excess” income is deposited into the trust, no longer counting as income.

When persons have assets over the limits, trusts are an option. Irrevocable Funeral Trusts are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Medicaid asset protection trusts (MAPTs), which protect assets from being counted, can also be utilized, but must be created well in advance of the need for long-term care. This type of trust not only reduces one’s countable assets, but also protects them for family as inheritance. This is because they are protected from Medicaid’s estate recovery program. There are many other strategies available when the applicant has assets exceeding the limit.

Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid planners are educated in the planning strategies available in the state of Colorado to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Some of the strategies, such as MAPTS (mentioned above), violate Medicaid’s 60-month look back rule, and therefore, should only be implemented with careful planning. However, there are some workarounds, and Medicaid planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid planner.

 

How to Apply for Colorado’s Elderly, Blind and Disabled Waiver

Before You Apply

Prior to submitting an application for the Elderly, Blind, and Disabled Waiver, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid eligibility test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid eligibility test.

As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.

Since the Elderly, Blind, and Disabled Waiver is not an entitlement program, there may be a waitlist for program participation. This waiver is approved for a maximum of approximately 29,040 beneficiaries per year. In the case of a waitlist, an applicant’s access to a participant slot is based on the date in which one was determined program eligible.

 

Application Process

To apply for the Elderly, Blind, and Disabled Waiver, applicants need to be eligible for Medicaid / Health First Colorado. Persons not yet enrolled in Medicaid can apply online at Colorado PEAK, over the phone at 800-221-3943, by completing and submitting an Application for Health Insurance & Help Paying Costs, or in person at one’s county Department of Human Services office. Offices by county can be found here.

Persons already enrolled in Medicaid, should contact their local SEP (Single Entry Point) agency to apply for the EBD Waiver. Contact information for SEP agencies by county can be found here.

For additional information about the EBD Waiver, click here. Persons can also contact their local SEP agency or call their county Department of Human Services office. The Office of Community Living (OCL) administers the Elderly, Blind, and Disabled Waiver.

 

Approval Process & Timing

The Colorado Medicaid / Health First Colorado application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed even further. In most cases, it takes between 45 and 90 days for the Medicaid agency to review and approve or deny one’s application. Based on law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). However, despite the law, applications are sometimes delayed even further. Furthermore, as wait-lists may exist, approved applicants may spend many months waiting to receive benefits.

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