Colorado Medicaid Definition
In Colorado, Medicaid is called Health First Colorado and is administered by the Colorado Department of Health Care Policy & Financing.
Medicaid is a wide-ranging health care insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, it provides health coverage for diverse groups of Colorado residents, including pregnant women, parents with dependent children, adults with no dependent children, disabled individuals, and seniors. That said, this page is focused on Medicaid eligibility for Colorado elders, aged 65 and over, and specifically for long term care, whether that be at home, in a nursing home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Colorado seniors may be eligible. These programs have slightly different financial and medical (functional) eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the requirements vary with marital status and that Colorado offers multiple pathways towards Medicaid eligibility.
1) Institutional / Nursing Home Medicaid – this is an entitlement program, which means anyone who meets the requirements will receive assistance. Benefits are only provided in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – with these programs, the number of participants is limited. Therefore, wait lists may exist. Benefits are provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled (ABD) – this is an entitlement program, which means as long as eligibility requirements are met, one is able to receive assistance. Benefits are provided at home or adult day care.
The table below provides a quick reference to allow Colorado seniors to determine if they might be immediately eligible for long term care from a Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT, not meeting all the requirements below does not mean one is not eligible or cannot become eligible for Medicaid. More.
|2020 Colorado Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,349 / month**||$2,000||Nursing Home||$4,698 / month**||$3,000 (Couples who will stay in the same nursing home room have a higher asset limit of $4,000)||Nursing Home||$2,349 / month for applicant**||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,349 / month||$2,000||Nursing Home||$4,698 / month||$3,000||Nursing Home||$2,349 / month for applicant||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$783 / month||$2,000||None||$1,175 / month||$3,000||None||$1,175 / month||$3,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income (SSDI), Veteran’s benefits, railroad retirement annuities, Social Security Income (SSI), IRA withdrawals, and stock dividends.
When only one spouse of a married couple is applying for nursing home Medicaid or a HCBS Medicaid waiver, only the income of the applicant is counted towards Medicaid’s income limit. Said another way, the income of the non-applicant spouse is not considered. The way income is calculated for married couples with one spouse applying for regular Medicaid differs. In this case, the income of both spouses is calculated towards the applicant spouse’s eligibility. To learn more about how Medicaid counts income, click here.
For married couples, with non-applicant spouses’ (of nursing home Medicaid and HCBS waiver applicants) with insufficient income in which to live, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA). This is the minimum amount of monthly income to which the non-applicant spouse is entitled, and it allows applicant spouses to transfer a portion of their income to their non-applicant spouses. The MMMNA effectively lowers an applicant’s income while also preventing a non-applicant spouse from becoming impoverished. It is important to note that this rule is not relevant for couples with one spouse applying for regular Medicaid.
As of July 2020, the MMMNA is $2,155.00 / month, and will increase again in July 2021. Based on one’s shelter and utility costs, a non-applicant spouse may be entitled to as much as $3,216 / month. (This figure is accurate as of January 2020 and will increase again in January 2021).
**While there is an income limit specified above for nursing home Medicaid, the beneficiary is not able to keep monthly income up to this amount. Instead, all of a beneficiary’s monthly income, with the exception of a personal needs allowance of approximately $89.55 / month, and possibly a monthly maintenance needs allowance for a non-applicant spouse, must be paid to the nursing home.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are not counted. In other words, they are exempt from Medicaid’s asset limit. Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant lives in it or is intending to live in it in the future, and has an equity interest in the home no greater than $595,000 (in 2020). (Equity interest is the value of an applicant’s ownership of the home). If the applicant has a non-applicant spouse living in the home, it is exempt regardless of if the applicant lives there and the applicant’s equity interest in it.
For married couples, as of 2020, the community spouse, also referred to as the non-applicant spouse or the well spouse, can retain up to a maximum of $128,640 of the couple’s joint assets, as the chart indicates above. This is called the Community Spouse Resource Allowance (CSRA). As with the spousal income allowance, this asset allowance rule only applies to married couples with one spouse applying for institutional Medicaid or a Medicaid waiver. It does not apply to a married couple with one spouse applying for regular Medicaid.
It’s vital that one does not give away assets or sell them for less than fair market value in an attempt to meet Medicaid’s asset limit. This is because Colorado has a Medicaid Look-Back Period, which is a period of 60 months (5 years) that dates back from one’s Medicaid application date. During this time frame, Medicaid checks all past transfers to ensure no assets were given away or sold for less than they are worth. If one is found to be in violation of the look-back period, a period of Medicaid ineligibility will result.
Qualifying When Over the Limits
For Colorado elderly residents (65 and over), who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Qualified Income Trusts (QIT’s) – QIT’s, also referred to as Miller Trusts, are for Medicaid applicants who are over the income limit, but still cannot afford to pay for their long-term care. (For Colorado Medicaid purposes, a Miller Trust is often simply called an Income Trust.) This type of trust offers a way for individuals over the Medicaid income limit to still qualify for long-term care Medicaid, as money deposited into a QIT does not count towards Medicaid’s income limit. In basic terms, one’s excess income (over the Medicaid limit) is directly deposited into a trust, in which a trustee is named, giving that individual legal control of the money. (In Colorado, the Medicaid applicant may be the trustee, given a successor trustee is named). The money in the account can only be used for very specific purposes, such as contributing towards the cost of nursing home care, HCBS long term care, and medical expenses accrued by the Medicaid enrollee. The account must be irreversible, meaning once it has been established, it cannot be changed or canceled, and upon death of the Medicaid participant or in the event of Medicaid disenrollment, the remainder of the funds must be paid to the Colorado Department of Health Care.
Unfortunately, Income Only Trusts do not assist one in spending down extra assets to qualify for Medicaid. Said another way, if one meets the income requirement for Medicaid eligibility, but not the asset requirement, the above option cannot assist one in reducing their assets that are over the limit. However, one can “spend down” assets by spending excess assets on non-countable assets, such as home improvements (replacing a leaky roof, updating the heating/plumbing), home modifications (wheelchair ramps, roll-in showers, and stair lifts), vehicle modifications (wheelchair lifts, adaptive control devices, and floor modifications to allow one to drive from a wheelchair), prepaying funeral and burial expenses, and paying off debt.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Colorado Medicaid Programs
1. Elderly, Blind and Disabled (EBD) Waiver – Provides services to disabled individuals and seniors living at home and in assisted living facilities to promote independent living and prevent premature nursing home placements. Assistance may include adult day care, personal care assistance, personal emergency response systems, and more.
2. Consumer Directed Attendant Support Services (CDASS) Program – A program option in regards to how one receives his/her long-term care services. CDASS allows program participants to self-direct their own care, acting as the employer of their attendant care provider.
How to Apply for Colorado Medicaid
For additional information about Colorado’s Medicaid programs, or to apply, one should contact their county Department of Human Services’ office. Contact information is available here. Persons can also call the Colorado Department of Human Services at 1-800-221-3943. Another option is to apply online via the Health First Colorado website. Finally, one’s local Single Entry Point Agency can provide assistance with applying for Medicaid.
To learn more about Medicaid’s application process, click here.