How to Apply for Medicaid to Pay for Assisted Living in Colorado: A Step-by-Step Guide

Applying for Medicaid to pay for assisted living in Colorado means two applications running side by side. One is the financial application for Health First Colorado, Colorado's Medicaid program, which the county human services office where your parent lives decides. The other is a care assessment with a regional case management agency, which decides whether your parent needs the level of care the waiver covers and then enrolls them. Starting both at once, with the paperwork already gathered, is the single biggest thing that keeps it moving.

I'm Parul Darji, a registered nurse and the owner of Aspen Leaf Assisted Living Residence. All four of our homes, in Flagler, Stratton, and Limon, accept Medicaid, and I've helped many families through this process. Here are the steps in the order families take them. Nothing here decides whether anyone qualifies. That's the state's decision, made through the county and the case management agency, not by a care home or an article.

If you'd like to understand the program itself first, I've written about what the HCBS waiver covers and what it doesn't. This guide is the how-to.

Who can get Medicaid to pay for assisted living in Colorado?

Assisted living is paid for through the Elderly, Blind, and Disabled waiver, usually called the EBD waiver, and it has two kinds of requirements.

• Care needs. For someone 65 or older, the waiver requires a significant functional impairment, meaning a need for help at a level comparable to what a nursing home provides. That's what the case management agency's assessment measures.
• Finances. On the state's current figures, monthly income has to be under three times the federal SSI benefit, and countable resources have to be under the state's limit. The county can tell you the current limit for a single person or a couple.

Two things surprise families here. First, Medicare isn't Medicaid, and Medicare doesn't pay for assisted living. Second, families are wrong in both directions about whether they'll qualify. Income over the limit doesn't automatically end the conversation, and the limit applies to countable resources, so not everything a family owns counts. Check properly rather than guessing.

What should you gather before you apply?

The application asks about identity, income and other health coverage, and for long-term care the county also looks at savings and property. It helps to have these together before you start:

• Your parent's Social Security number and, if they have one, a driver's license or other ID
• Award letters for Social Security, pensions and any other income
• Recent statements for every bank account
• Retirement accounts, annuities and life insurance policies
• Deeds and vehicle titles
• Medicare and any other health insurance cards and policy numbers
• A current medication list, with their doctors' names and phone numbers
• A power of attorney or other papers showing who can act for your parent

In my experience, most delays come from missing documents, not from decisions. If something can't be found, say so early rather than holding the application back.

How do you file the Medicaid application?

There are four ways to apply for Health First Colorado, and the county where your parent lives processes the application whichever one you use:

• Online through Colorado PEAK, the state's benefits website.
• By phone at 1-800-221-3943 (State Relay 711), weekdays from 8 a.m. to 4 p.m.
• On paper, using the application on the state's forms page, mailed or dropped off.
• In person at the county human services office.

If your parent already lives near our homes, that's one of two offices. Flagler and Stratton are in Kit Carson County, whose human services office is at 252 South 14th Street in Burlington (719-346-7158). Limon is in Lincoln County, whose office is at 103 3rd Avenue in Hugo (719-743-2404). If your parent lives somewhere else, it's the office in their county, and the state keeps a directory of every county office.

How does the care assessment work, and who does it?

This is the part that confuses families most, because the county doesn't do it. The care side runs through a regional case management agency. For Kit Carson, Lincoln, and Cheyenne counties, that's the Northeastern Colorado Association of Local Governments, based in Fort Morgan (toll-free 1-888-696-7212). For anywhere else in Colorado, the state keeps a directory of case management agencies by county.

The agency handles intake for the waiver, assesses your parent's day-to-day needs, and, once your parent qualifies, builds the service plan. The assessment looks at how your parent gets around, bathing and dressing, medications, memory, and health history, and it's what decides whether they meet the level of care the waiver requires. If you're stuck on the Medicaid application, ask the agency for help with that too.

As a nurse, my advice for the assessment is simple. Describe an ordinary week honestly, including the hard days. People tend to downplay what they need help with, especially in front of a stranger, and an assessment can only measure what it hears. If you can, be there for it, and have the medication list and your parent's doctors' contacts on hand.

What happens after your parent is approved?

Once both sides are approved, your parent is enrolled in the EBD waiver, and a case manager works with your family on a service plan. For assisted living, that plan includes what the state calls Alternative Care Facility services, provided in an assisted living home that's certified to accept Medicaid. Not every home is, so ask before you get attached to one.

From then on, the costs split in two. The waiver pays for the care services, like round-the-clock oversight, medication administration and personal care. Your parent pays the full cost of room and board, usually from Social Security or other income, and may also pay a share of the cost of the care. That's why asking any home for one all-in monthly number matters so much.

Then comes the move itself, which I've written about in what moving in actually looks like.

What if income or savings are over the limit?

It doesn't always end the conversation, but this is where good advice earns its cost.

• Income over the limit. For people whose income is over the limit and who need long-term care, including through the waiver, Colorado requires an income trust, sometimes called a Miller trust. Income goes into the trust each month and is paid out under the state's rules. The state publishes the form, but it's a legal document, so it's worth having an elder law attorney or the county walk you through it.
• Savings over the limit. How savings come down matters, because Colorado reviews the 60 months before the application for money or property that was given away or sold for less than it was worth, and a transfer like that can mean a period without coverage.
• A spouse at home. If your parent is married and their spouse will stay at home, Colorado protects part of the couple's income and savings for that spouse. Ask the county how it applies to you.

The rule I'd underline is this one: don't move money or property to qualify without advice first. Talk to the county or an elder law attorney before, not after.

How long does it take, and what can you do in the meantime?

Longer than most families plan for, and longer again if documents have to be chased, so start before it's urgent. A family that begins while a parent is still managing at home has room to be thorough. A family starting from a hospital corridor on a Friday afternoon doesn't.

In the meantime, look at homes, and ask each one three questions before you tour. Do you accept Medicaid? Do you have room for someone on it right now? If we start out paying privately and later need Medicaid, can our parent stay? How tours and assessments work covers the rest of what to ask.

Where can you get help with the paperwork?

You don't have to do this alone. The county human services office and the case management agency both help people apply, and the state runs local application assistance sites too. If your parent is a veteran or a surviving spouse, look into VA Aid and Attendance as well, and ask the county how it fits with Medicaid.

You're also welcome to ask us. We can't decide anything, but we can help you figure out who to call and what to bring. Our homes are in Flagler, Stratton, and Limon, on 6th Street and Circle Lane, and you can schedule a visit any time. A tour takes about thirty minutes, and you don't need an approval to come.

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Parul Darji, RN — Owner & Administrator, Aspen Leaf Assisted Living Residence. Serving families in Flagler, Stratton, and Limon, Colorado.