Thank you to everyone who joined our recent virtual town hall. During the session, Developmental Pathways (DP) shared updates from the State of Colorado, including potential service reductions, possible impacts, and what these changes may mean for people receiving services.
A recording of the town hall (excluding the Q&A portion) and the presentation slide deck are now available to view.
If you have questions about LTSS changes, please contact your case manager, visit HCPF’s Medicaid Sustainability and Colorado’s LTSS System page, or view our FAQ below.
LTSS System Changes FAQ
This FAQ provides general information about recent and upcoming changes to the Long-Term Services and Supports (LTSS) system. It summarizes common questions raised by supported individuals, families, and caregivers. Because situations vary, individuals and families should always reach out to their case manager for guidance specific to their circumstances.
If you need help finding your case manager’s contact information, please reach out to our Case Management Care Team at 303‑360‑6600, ext. 3, option 2, or email CMCareTeam@dpcolo.org.
This information was published on April 16, 2026 and may become outdated as the state continues to implement changes. Please visit the Medicaid Sustainability and Colorado’s LTSS System webpage for the most up-to-date information.
What is ARPA?
ARPA stands for the American Rescue Plan Act.
The Colorado Department of Health Care Policy and Financing (HCPF) is the state agency that manages Colorado’s Medicaid program (Health First Colorado), Child Health Plan Plus (CHP+), and other health care initiatives for low-income, aged, and disabled residents.
Case Management & Getting Help
Can my case manager explain how these changes affect me personally?
Yes, case managers can provide individual explanations of how system changes may impact you or your loved one’s services.
Waivers & Program
At what age does DP recommend parents place their child on the Developmental Disabilities (DD) Waiver waitlist?
There is no single recommended age, as each child’s situation and needs are different. However, the earliest a child can be placed on the DD waiver waitlist is age 14 and families are encouraged to connect with their case manager to discuss the timing that best fits their child’s circumstances and long-term support needs.
Are there changes to the Supported Living Services (SLS) Waiver?
There are no specific changes to the SLS waiver. However, if you receive Personal Care, Homemaker, or Health Maintenance Activities (HMA) under SLS, those services have moved to Community First Choice (CFC) and are now subject to CFC soft-cap limitations.
Do these changes affect the Children’s Extensive Support (CES) Waiver?
Changes specifically impacting services for the CES waiver are regarding Community Connector, including adjusted unit limits and age appropriateness.
Are children’s waivers still available?
Yes, children’s waivers and support services for children are still available.
Do the changes affect occupational therapy or other Medicaid-covered therapies?
As of April 16, 2026, the state budget currently impacts occupational therapy through a rate reduction, along with other Medicaid services. There are other changes in the budget that affect Pediatric Behavioral Therapy (PBT) and these providers will also be impacted by any additional across the board reductions.
Which equine-related services are being discontinued?
Equine services are being removed from Home and Community Based Services (HCBS), but currently, hippotherapy will remain in Medicaid State Plan or Health First Colorado. Please review the HCPF fact sheet for more information.
Community First Choice (CFC) Services
What services fall under Community First Choice (CFC)?
CFC includes services such as Personal Care, Homemaker, and Health Maintenance Activities (HMA). These services are outside individual waivers but are available across waivers.
What are the new annual or weekly limits for CFC services?
CFC services now have annual authorizations that function as weekly soft caps:
- Personal Care: 10,000 units annually (approximately 40 hours per week)
- Homemaker: 4,500 units annually (approximately 20 hours per week)
- Health Maintenance Activities (HMA): 19,000 units annually (approximately 80 hours per week)
What does “soft cap” mean?
A soft cap is a defined annual limit. If additional hours are medically necessary, your case manager can request an exception by following established procedures.
Caregiver Hours & Family Caregiving
Is there a cap on weekly caregiver hours?
Yes, the state is implementing a phased cap on paid weekly hours per caregiver:
July 1, 2026: Up to 84 hours per week per member
January 1, 2027: Up to 70 hours per week per member
July 1, 2027: Up to 56 hours per week per member
Are there exceptions to the caregiver hour caps?
Currently, we do not have additional information on what an exception protocol may look like and are waiting for more operational guidance from the state. Once more information is available, your case manager will share it with you.
Can more than one family member provide homemaker services?
Yes, Legally Responsible Persons (LRPs), such as parents of a minor or a spouse of an individual, are only authorized 5 hours per week of homemaker services per member. If a member has two LRPs providing services, each can provide 5 hours a week for a total of 10 hours per week per member. Other family members who are not LRPs can also provide homemaker services through service delivery options like Consumer Directed Attendant Support Services (CDASS).
Can a sibling provide homemaker services?
Yes, an adult sibling may provide homemaker services if all eligibility and program requirements are met.
Can someone serve as both an Authorized Representative (AR) and a paid family caregiver?
No. Under In-Home Support Services (IHSS) and Consumer-Directed Attendant Support Services (CDASS), if a member has an AR, that individual cannot also be a paid attendant or family caregiver. If you are serving as an AR for your family member, you are not eligible to be paid to provide attendant care.
Members and families who receive conflicting information are encouraged to confirm program-specific rules with their case manager.
How can case managers help if more care hours are needed than one caregiver can provide?
Case managers can assist by discussing alternative caregiver arrangements and reviewing options for meeting service needs within program rules. This includes providing lists of eligible provider agencies to individuals/families or completing a Request for Proposal (RFP) that includes an individual profile outlining what services are needed and sharing with eligible provider agencies to receive responses of availability. To browse and connect with local providers, please create an account on Wayfinder.
Are case managers authorizing caregiver service hours based on past approvals or the new guidelines?
Case managers authorize service hours based on the current guidelines and rules in effect as of April 1, 2026, not based on past total hours that may have previously been approved.
Income, Benefits, & Cost Participation
Does Social Security Disability (SSDI) count as income?
Yes, SSDI and earned income are both considered monthly income.
Guidance indicates that this depends on individual circumstances. Members and caregivers should review state guidance and consult their fiscal management service or provider agency. Please review the HCPF memo on Difficulty of Care and Community First Choice for more information.
PETI (Participant Engagement and Trust Income)
How is PETI paid, and to whom?
PETI is paid to the provider agency, not to the Case Management Agency.
Does PETI apply to all waivers?
PETI requirements vary by waiver and living arrangement. Questions about fairness or implementation should be directed to HCPF.
How is PETI divided between the member and the provider?
HCPF will be creating a DD waiver PETI tool for case managers to use in determining how much of an individual’s monthly income would be needed to be used to pay for residential services.
What happens if a PASA cannot collect PETI payments?
Decisions about continued service when PETI cannot be collected are made by the provider agency. All providers have requirements to provide adequate notice of termination of services for any reason.
Is Medicaid Buy-In an exception to PETI?
Yes, individuals who are enrolled in the Medicaid Buy-In Program would be exempt from PETI.
To be eligible for the Medicaid Buy-In, does an individual need to pay a monthly premium, or can someone who qualifies for the zero premium category still be considered enrolled?
Please review the information provided by HCPF on Medicaid Buy-In for more information.
When will the PETI assessment tool be available?
The DD waiver PETI assessment tool has not yet been finalized by HCPF. When it is finalized, it will be posted on this HCPF webpage.
Community Connector Services
What Community Connector activities are approved, and have there been any changes to the criteria for approved activities?
Services must occur in a variety of integrated local community settings that are available to the broader community and may include activities such as volunteer opportunities in which the member interacts with community members who are not paid supports (including activity staff) or family members. Providers should ensure selected activities meet these setting requirements prior to service delivery.
Activities must be inclusive, open to the public, and generally attended by members of the broader community. Members should connect with their case manager to discuss which specific activities qualify.
Activities that are solely recreational or entertainment-based, or that result in the member being passive or observational, shall not be authorized under this service. Providers shall not select or provide activities that do not meet these criteria.
Does practicing life skills like grocery shopping count as a Community Connector activity?
Activities must meet inclusion and setting requirements and be age-appropriate. Case managers can help determine whether a specific activity qualifies.
Why were our Community Connector hours reduced?
HCPF is instituting new limits on Community Connector services to make sure services remain available for all. If your child’s community communication engagement needs exceed those limits, there is an exception process available.
Host Home Services
Will host home funding be reduced?
At this time, host home funding reductions have not been included in sustainability changes. A previously proposed budget item affecting some Individual Residential Services and Supports (IRSS) setting has been paused. However, Host Home Providers (HHP) would be impacted by any across the board rate reduction that may occur.
Travel & Service Delivery
Can family caregivers and members travel out of state?
Travel may be permitted, but members must confirm with both their case manager and service provider. Waiver requirements, including in-person service rules, must still be met.
Renewals & Eligibility
How do I renew my LTSS benefits or Level of Care Certification?
Members must complete an annual Level of Care Certification. If you receive a notice from Medicaid, contact the office listed on the letter and then connect with your case manager.
Unmet Needs & Direct Services
Is there a limit on how many unmet needs requests can be made each year?
There is no strict limit on the number of requests. Funding thresholds apply, depending on the service and program. It is best to speak with your case manager who will submit the requests and provide guidance you if you are nearing any thresholds.
Community Advocacy
Where can I find community advocacy groups?
Please see our November 2025 DP Policy Pulse blog, where advocacy groups are highlighted in the resource list.
Still Have Questions?
Your case manager is the best starting point for individualized questions. They can also direct you to state resources or provider agencies as needed.