Transition into Adulthood: Colorado Medicaid Waiver Comparison Guide

This guide is an overview of services provided in the Elderly, Blind and Disabled (EBD), the Supported Living Services (SLS) and the Developmental Disability (DD) Medicaid Waiver programs. All programs aim to provide Home and Community-Based Services (HCBS) for individuals experiencing a disability.

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EBD WAIVER

Elderly, Blind and Disabled

The EBD waiver provides assistance to individuals who are 65 and older and have a functional impairment and individuals who are 18 and older who are physically disabled or require long-term supports and services in order to remain in a community setting.

SLS WAIVER

Supported Living Services

The SLS waiver provides necessary services and supports for individuals (18 and older) with intellectual or developmental disabilities so they can remain in their homes and communities.

DD WAIVER

Developmental Disability

The DD waiver provides access to 24/7 supervision/supports through Residential Habilitation and Day Habilitation Services. Living arrangements can range from host home to group home settings and residential supports for individuals who live with and/or are provided services by members of their family.

Services Provided by Wavier Type

ServiceEBDSLSDD
Alternative Care Facility (ACE)
In Home Support Services (IHSS)
Community Transition Services
Adult Day Services or Day Habilitation
Personal Care
Homemaker Services
Respite Care
Home Modification
Non-Medical Transportation
Personal Emergency Response System
Medication Reminder
Consumer Directed Attendant Support Services (CDASS)
Professional Services (hippotherapy, massage, movement therapy, etc.)
Vehicle Modification
Assistive Technology
Mentorship
Supported Employment
Prevocational Services
Behavioral Services
Dental / Vision
Specialized Medical Equipment & Supplies
Residential Habilitation (Individual/Group)**

Case Management Agency

Access to each wavier is managed by a different Case Management Agency. That agency is the best resource for more specific information.

The EBD waiver is managed by the Single Entry Point (SEP) agency in your area. The SLS and DD waiver is managed by the Community Centered Boards (CCB) system.

For more information about Single Entry Point (SEP) Agencies and the Community Centered Boards (CCB) system go to: www.colorado.gov and search.

Services Defined

(All definitions gathered from Colorado Department of Health Care Policy & Financing)

ServiceWavier-Based Definition
Alternative Care Facility (ACE)EBD – An Assisted Living Residence to provide alternative care services and Protective Oversight to Health First Colorado (Colorado's Medicaid Program) clients. Alternative care services include, but are not limited to, personal care and homemaker services. Room and board shall not be a benefit of ACF services. Clients shall be responsible for room and board in an amount not to exceed the Department established rate.
In Home Support Services (IHSS)EBD – In-Home Support Services (IHSS) is a participant-directed service option that enables participants to direct who is providing their care, as well as the type of care to be provided. IHSS enables consumers to decide which services to use, which workers to hire, and what time of day they will come
Community Transition ServicesEBD – Community Transition Services (CTS) are activities essential to move a client from a skilled nursing facility and establish a community-based residence. Services are provided by a Transition Coordination Agency (TCA) and include at least two Independent Living Core Services
Adult Day Services or Day HabilitationEBD – Services furnished four or more hours per day in a community based setting, encompassing both health and social services needed to ensure the optimal functioning of the participant. SLS / DD – Day Habilitation Services and Supports include assistance with the acquisition, retention or improvement of self-help, socialization and adaptive skills that take place in a non-residential setting, separate from the client’s private residence or other residential living arrangement, except when services are necessary in the residence due to medical or safety needs. Day Habilitation Services and Supports encompass three (3) types of habilitative environments: 1) specialized habilitation services, 2) supported community connections, and 3) prevocational services.
Personal CareEBD – Services which provide assistance to a client in their own home in order to meet the client's physical, maintenance and supportive needs. This assistance may take the form of hands-on assistance (actually performing a task for the person) or cueing to prompt the participant to perform a task. Personal care services do not require the supervision of a nurse or physician's orders. SLS – Personal Care is assistance to enable a client to accomplish tasks that the client would complete without assistance if the client did not have a disability. This assistance may take the form of hands-on assistance by actually performing a task for the client or cueing to prompt the client to perform a task.
Homemaker ServicesEBD – Homemaker Services are general household activities provided in the home of an eligible client, provided by a Homemaker Provider Agency to maintain a healthy and safe home environment for a client. When the person ordinarily responsible for these activities is absent or unable to manage these tasks. Covered benefits shall be for the benefit of the client and not for the benefit of other persons living in the home. Services shall be applied only to the permanent living space of the client. SLS – Homemaker Services are provided in the client’s home and are allowed when the client’s disability creates a higher volume of household tasks or requires that household tasks are performed with greater frequency. There are two types of Homemaker Services: Basic Homemaker Services includes cleaning, completing laundry, completing basic household care or maintenance within the client’s primary residence only in the areas where the client frequents. Enhanced Homemaker Services include Basic Homemaker Services with the addition of either procedures for habilitation or procedures to perform extraordinary cleaning.
Respite CareEBD – Respite care services are provided to an eligible client on a short-term basis because of the absence or need for relief of those persons normally providing the care. Respite Care may be provided in a Class 1 nursing facility, an alternative care facility or by an employee of a certified personal care agency in the clients home. An individual client shall be authorized for no more than 30 days of respite in each calendar year. SLS – Respite Care means services provided to an eligible client who is unable to care for himself/herself on a short term basis because of the absence or the need for relief of those persons normally providing care. Respite Care is provided in the client’s residence and may be provided by different levels of providers depending upon the needs of the client.
Home ModificationHome Modifications are specific modifications, adaptations or improvements in a client's existing home setting which, based on the client's medical condition are necessary to ensure the health, welfare and safety of the client, and enable the client to function with greater independence in the home to prevent institutionalization of the client. EBD –There is a $10,000 lifetime maximum for the home modification benefit. SLS – The total cost of home accessibility adaptations, vehicle modifications, and assistive technology shall not exceed $10,000 over the five (5) year life of the HCBS Waiver except that on a case by case basis the Operating Agency may approve a higher amount.
Non-Medical TransportationEBD – Non-medical transportation services shall include, but not be limited to, transportation between the client's home and nonmedical services or resources such as adult day services, shopping, therapeutic swimming, dentist appointments, counseling sessions, and other services as required by the care plan to prevent institutionalization SLS/DD – Non-Medical Transportation enables clients to gain access to Day Habilitation Services and Supports, Prevocational Services and Supported Employment services.
Personal Emergency Response SystemEBD – Personal Emergency Response System, an electronic monitoring service, or the installation, purchase, or rental of devices which enable the client to remain safely in their own home by enabling them to secure help in the event of an emergency. SLS – Personal Emergency Response System (PERS) is an electronic device that enables clients to secure help in an emergency. The client may also wear a portable "help" button to allow for mobility. The system is connected to the client’s phone and programmed to a signal a response center once a "help" button is activated. The response center is staffed by trained professionals.
Medication ReminderEBD/SLS – Medication reminder services to help individuals take their medications in the correct dosages at the correct times to prevent adverse drug events.
Consumer Directed Attendant Support Services (CDASS)EBD – CDASS allows clients to manage their personal care, homemaker and health maintenance services. Clients can manage services including hiring, training, supervising and, if necessary, the firing of their attendants. CDASS allows participants to direct certain services provided only by nurses or certified nurse aides due to the exemption of the Nurse Practice Act. SLS – Coming Soon
Professional Services (hippotherapy, massage, movement therapy, etc.)SLS – Professional services are provided by licensed, certified, registered or accredited professionals and the intervention is related to an identified medical or behavioral need.
Vehicle ModificationSLS – Vehicle modifications are adaptations or alterations to an automobile or van that is the client’s primary means of transportation; to accommodate the special needs of the client; are necessary to enable the client to integrate more fully into the community; and to ensure the health and safety of the client.
Assistive TechnologySLS – Assistive Technology includes services, supports or devices that assist a client to increase maintain or improve functional capabilities. This may include assisting the client in the selection, acquisition, or use of an assistive technology device.
MentorshipSLS – Mentorship Services means services provided by peers to promote self-advocacy and encourage community living among clients by instructing and advising on issues and topics related to community living, describing real-world experiences as example and modeling successful community living and problem-solving.
Supported EmploymentSLS/DD – Integrated employment services (supported employment) provides individuals with considerable ongoing job related services and supports to obtain and maintain paid work in a regular community work setting.
Prevocational ServicesSLS/DD – Prevocational services are designed to assist individuals with developmental disabilities in acquiring and maintaining work habits and work-related skills. Prevocational services are intended to have a more generalized result as opposed to vocational training for a specific job.
Behavioral ServicesSLS/DD – Behavioral Services are services related to a client’s developmental disability which assist a client to acquire or maintain appropriate interactions with others.
Dental / VisionSLS/DD – Dental Services means dental services that are inclusive of diagnostic, preventive, periodontal and prosthodontic services, as well as basic restorative and oral surgery procedures to restore the client to functional dental health and not available through the Medicaid State Plan. Vision Services means services that include eye exams and diagnosis, glasses, contacts, and other medically necessary methods to improve specific vision system problems when not available through the Medicaid State Plan.
Specialized Medical Equipment & SuppliesSLS/DD – Specialized Medical Equipment and Supplies include: devices, controls, or appliances that are required due to the client’s disability and that enable the client to increase the client’s ability to perform activities of daily living or to safely remain in the home and community.
Residential Habilitation (Individual/Group)**DD Under Residential Habilitation Services and Supports (RHSS) the responsibility for the living environment rests with the service agency and encompass two types of living environments: Individual Residential Services and Supports (IRSS) and Group Residential Services and Supports (GRSS). The following activities are performed by staff and are designed to assist individuals to reside as interdependently as possible in the community: •Self-advocacy training may include training to assist in expressing personal preferences, self-representation, individual rights, and to make increasingly responsible choices. •Independent living training may include personal care, household services, child and infant care (for parents themselves who are developmentally disabled), and communication skills such as the telephone. •Cognitive services may include training involving money management and personal finances, planning and decision making. •Implementation of recommended follow-up counseling, behavioral or other therapeutic interventions by residential staff, under the direction of a professional, that are aimed at increasing the overall effective functioning of an individual. •Emergency assistance training includes developing responses in case of emergencies; prevention planning and training in the use of equipment or technologies used to access emergency response systems. •Community access services that explore community services available to all people, natural supports available to the individual, and develop methods to access additional services/supports/activities desired by the individual •Travel services may include providing, arranging, transporting, or accompanying a person with developmental Disabilities to services and supports identified in the Individualized Plan (plan of care). •Supervision services may include a person safeguarding an individual with developmental disabilities and/or utilizing technology for the same purpose. IRSS can be provided through the Family Care Giver Option. This allows an individual to stay in their home and have a family member or non-related person become a paid provider to implement services.