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Human Services

Long Term Services and Supports

Health First Colorado, Colorado's Medicaid Program

Home and Community Based Services and Nursing/Assisted Living Facility Services

Health First Colorado, Colorado’s Medicaid Program, provides its members with base medical benefits. These benefits (sometimes referred to as State Plan Benefits) include Primary Care,Pharmacy, Dental Services, and many more. Some of these benefits have restrictions. You can find more about the benefits and their requirements here

Home and Community Based Services (HCBS) are additional benefits within Health First Colorado designed to allow individuals who are at risk for institutional placement to remain in the community.

If you have questions about the process of applying for long term care services, current application status, or what happens after approval with Douglas County, you can call the Douglas County Department of Human Services at 303-688-4825.

You can find information regarding plan benefits and coverages here or call 1-800-221-3943. State relay 711.

 

Frequently Asked Questions

How do I apply?

If you are already receiving Health First Colorado Medicaid, please contact the Douglas County Department of Human Services at (303) 688-4825 to request to be considered for Long Term Care services. You don’t need to complete a new application. The additional program requirements information below will apply.

If you are not already receiving Health First Colorado Medicaid, there are several ways to apply.

Electronically:

By phone:

  • Contact the Health First Colorado Member Contact Center at 1-800-221-3943. State relay 711. Phone applications can be completed Monday through Friday between 8:00am and 4:00pm.

Paper:

  • Print, complete and sign a paper application and;
      • Mail it to our office at 4400 Castleton Court, Castle Rock, CO 80109
      • Drop it off at our office Monday-Friday between 8:00am and 5:00pm or anytime using the secure drop box in front of our office
      • Fax it to 877-285-8988
      • Email it to [email protected]

Additional Program Requirements

If the applicant(s) is/are under the age of 65, not currently receiving Social Security Disability (SSDI) or Supplemental Security Income (SSI) and requesting Long Term Care services, a Medicaid Disability Application will also need to be completed. These are submitted to the Douglas County Department of Human Services, in addition to a Medicaid Application.

Once a request for Long Term Care Services is received, the County will send a referral to either Rocky Mountain Human Services or Developmental Pathways to complete a functional needs assessment. A case manager from one of these agencies will schedule a time to meet with the applicant to determine the level of care needed. The case manager will send a copy of their determination to the Douglas County Department of Human Services.  If you have questions regarding these agencies or their processes please contact Rocky Mountain Human Services at 1-844-790-7647 or Developmental Pathways at 303-858-2260.

It can take 90 days or longer to determine eligibility for Long Term Services and Supports depending on when all documentation necessary to determine eligibility is received by Douglas County.

What is a Functional Assessment?

The Long Term Care Assessment or Functional Assessment helps us understand how much help you need with Activities of Daily Living (ADLs) such as bathing, dressing, and others. Determining an individual’s functional needs is one component of
eligibility for HCBS waivers. The Long Term Care assessment is a foundational component of the service planning process that helps assist in the selection of Long Term Care services to meet an individual’s needs. Case Managers from Single Entry Point (SEPs) agencies and Community Centered Boards (CCBs) will meet with you in person to complete the assessment.

The CCB for Douglas County is Developmental Pathways. Their telephone number is (303) 858-2260.

The SEP for Douglas County is Rocky Mountain Human Services. Their number is 1-844-790-7647.

 

What are the income and resources limits?

Income Limit

  • The current income limit is $2,382 per month.
  • For those individuals who are not hospitalized, an income trust can be established if income exceeds $2,382 a month. There are limits for the income trust which are depending upon which county the applicant resides.
  • Only individual applicant income is considered in the eligibility determination. An applicant’s spouse’s income is not considered.

Resource Limit

  • The individual resource limit is $2,000.
  • The couple resource limit is $4,000, if both members of a marital couple are applying for long-term care benefits and they are sharing the same room in a nursing facility or if both are going to receive Home and Community-Based Services.
  • The couple resource limit is $3,000 if both members of a marital couple are applying for long-term care benefits are living in separate rooms in a nursing facility.
  • The couple resource limit is $137,400 (2022 limit), if one member of the couple is applying for long-term care services and the other spouse is not applying for Medicaid and is not institutionalized.

What documentation will be needed?

Other items that will be reviewed and verification requested may include:

  • Monthly Gross Income-please note that this is for the applicant and spouse. If a minor child is requesting long term care services, the parent’s income is not counted for the child once a waiver is approved.
  • Income Trust – more information about when an income trust is needed and how to complete it here.
  • Resources – including but not limited to checking, savings, retirement/investment accounts, properties, vehicles, Life Insurance, Burial Policies, annuities, trusts, etc.
  • If married, spouse’s income, resources, and expenses
  • Transfer of assets within the last five years
  • Sponsor income/resources if currently a Sponsored Non-Citizen
  • Medical Assistance Estate Recovery Packet

*This is not a complete list and other documentation may be needed to determine eligibility for waiver programs.

Why do I need to set up a trust?

Please visit the Colorado Department of Health Care Policy and Financing website for more information about required trusts for the Long Term Care programs.

What happens at redetermination?

The Health First Colorado Medicaid program requires that eligibility be reviewed periodically. A redetermination application will be mailed to the mailing address on file or you will be notified by PEAK that it is time for you to complete your application through their site.

You must complete, sign, and return the redetermination application by the date listed on the paperwork.

You can turn in your redetermination application by one of the following methods:

  • Mail it to our office at 4400 Castleton Court, Castle Rock, CO 80109
  • Drop it off at our office Monday-Friday between 8:00am and 5:00pm or anytime using the secure drop box in front of our office
  • Fax it to 877-285-8988
  • Email it to [email protected]
  • Through your PEAK account

Verification of current income, resources, or other items may be required at redetermination.

Rocky Mountain Human Services or Developmental Pathways will need to meet with the member to conduct a new functional needs assessment each year and will return a copy of their determination to the Douglas County Department of Human Services.

If a trust exists for the member, current account statements may be needed.

Additional information or documentation may be needed to complete the redetermination.

You will be mailed a notice or notified to check your PEAK account for the status of the redetermination once it has been completed.

Where can I get more information about the Home and Community Based Services waivers and their benefits?

A waiver is an extra set of Health First Colorado, Colorado’s Medicaid program, benefits that you could qualify for in certain cases. These benefits can help you remain in your home and community. Waivers have extra program rules and some programs may have waitlists.

Adult Waivers Children’s Waivers

Waiver Charts – side-by-side comparison of waiver benefits
Waiver Flow Charts – decision tree-type flow chart showing waiver options

Additional information can be found on the Colorado Department of Health Care Policy and Financing website.

How do I arrange Medicaid transportation?

If you don’t have a way to get to and from your covered health care services and appointments, you may be able to get a free ride. This service, called Non-Emergent Medical Transportation (NEMT), is not for emergencies. If you are having an emergency, call 911.

Set up a ride at least 2 days before your appointment. Call 1-855-489-4999 or State Relay 711.

Be ready to give:

  • Your name
  • Your Health First Colorado ID number
  • Other personal information, such as birth date
  • The date and time you need a ride
  • The address of your pick-up location
  • The name, address, and phone number of the health care provider you will see

You may bring a family member or caretaker to your appointment. When you call for a ride, let them know if you want to bring a family member or caretaker with you.

For more information, call IntelliRide at 1-855-489-4999. State Relay 711. Or, visit the Health First Colorado website or IntelliRide.

How do I find an assisted living facility or nursing facility that accepts Medicaid?

Please visit the Colorado Department of Health Care Policy and Financing website to find assisted living facilities or nursing facilities that accept Medicaid. You will need to reach out to the facility to ensure that they have an available bed at the time that you are looking.

The Denver Regional Council of Governments, DRCOG, is the Douglas County Area Agency on Aging. They may be able to provide some assistance in locating services, providers, and resources. Please visit their website or give them a call at (303) 480-6700. For callers outside of the Denver area, the number is 1-866-959-3017.

Additional Resources

Rocky Mountain Human Services

Rocky Mountain Human Services is the Single Entry Point (SEP) organization for Douglas County.
Main Phone: 1-844-790-RMHS (7647)

Rocky Mountain Human Services

Developmental Pathways

Developmental Pathways is the Community Centered Board (CCB) for Douglas County.
Main Phone: (303) 360-6600.

Developmental Pathways