The Brain Injury (BI) Waiver is a Health First Colorado (Colorado Medicaid) waiver that adds long-term services and supports for people who have a qualifying brain injury and need extra help to remain at home or in the community. It is intended as an alternative to long-term hospital or nursing facility care, and waiver programs may have additional rules and possible waitlists.
Must be age 16 or older
Brain injury must have occurred before your 65th birthday
Must meet an approved level of care similar to what would be needed in a nursing facility or hospital
Diagnosis must fit within program-defined categories
Must meet financial eligibility requirements (income limits tied to SSI and resource limits)
Enrollment and service planning are coordinated through a local Case Management Agency (CMA)
BI Waiver services are added on top of standard Health First Colorado coverage and can include supports such as respite care, adult day services, behavioral management, home modifications, and supportive living services, based on the member’s assessment and approved service plan.
BI Waiver services are added on top of standard Health First Colorado coverage and may include supports that help members stay safe and stable at home, depending on assessed needs and the approved service plan. Members on the BI Waiver typically meet LOC requirements and can also access Community First Choice (CFC) benefits when eligible. Under CFC, members may be able to obtain IHSS, a person-centered service model that can allow the member to choose their caregiver, including certain relatives, when program rules are met.
In-Home Support Services (IHSS) is an option within Community First Choice (CFC) that gives members more control over how in-home support is delivered. In this model, the member helps guide day-to-day care, including choosing and overseeing attendants, while an IHSS-approved agency supports the service plan and coordination.
IHSS under CFC is used to deliver core in-home supports based on the member’s assessed needs and approved service plan. These commonly include:
Personal care support: hands-on assistance, supervision, or cueing for daily personal needs.
Homemaker support: help with essential household tasks tied to health and safety.
Health Maintenance Activities (HMA): routine health-related tasks that are allowed under Medicaid rules when the member cannot complete them independently.
Independent living core supports: the IHSS model includes required elements intended to support stable, safe services in the home.
What is approved depends on the assessment results and the authorized plan. Not every member receives every type of support.
IHSS is designed to offer more choice in who provides care. In many situations, members can select attendants who are relatives. Some circumstances may also allow a “legally responsible person” to provide certain services when permitted by program rules and specifically authorized in the service plan.
Even though IHSS is member-directed, an IHSS-approved agency plays a supporting role. This can include items such as backup coverage planning, access to nursing oversight when required by the model, and required program supports that help services run safely and consistently.
Confirm you have Health First Colorado with full benefits.
Connect with your local Case Management Agency (CMA). This is the starting point for CFC and IHSS planning.
Complete required assessments to determine:
Whether you meet the CFC level-of-care requirement, and
Whether you have an assessed need for personal care, homemaker, and/or approved health maintenance activities.
Work with your CMA to build an approved service plan that lists the supports you can receive and the amount authorized.
Choose an IHSS-approved agency and set up services (attendants, scheduling, oversight, and backup plans).
Services begin once the plan and provider setup are complete. Ongoing reviews happen at least annually, and sooner if there is a significant change in needs.
A waiver is not required to access CFC; meeting the level-of-care criteria is what matters. However, people enrolled in HCBS waivers generally already meet level-of-care requirements and may be able to use CFC and IHSS alongside their waiver services, depending on their plan and eligibility.
Personal Care is in-home support that helps a person complete daily personal routines safely. It is for individuals who need hands-on help, supervision, or reminders because of a disability, medical condition, or functional limitation.
Personal Care support is based on the individual’s needs and approved care plan, but commonly includes:
Bathing, grooming, oral care, and hygiene
Dressing and undressing
Toileting support and continence care
Eating support that is non-medical (help setting up meals, prompting, or physical assistance when allowed)
Mobility and transfers within the home (for example, moving from bed to chair) when authorized
Safety oversight, cueing, and reminders related to personal routines
Personal Care is typically authorized after an assessment and is provided according to an approved plan that outlines what support is allowed and how much. The amount of service depends on what is approved for the individual.
Personal Care is focused on the member’s needs, not general help for others in the household.
Covered tasks and service limits are determined by the approved plan.
Homemaker services provide help with essential household tasks that support a safe, healthy home environment for the individual receiving services. This service is intended for people who cannot complete certain home tasks due to disability or health-related limitations.
Homemaker support is based on the individual’s needs and approved plan, but commonly includes:
Light cleaning in areas used by the individual (kitchen and bathroom surfaces, sweeping, mopping, dusting)
Laundry related to the individual
Meal preparation related to the individual’s needs
Shopping and errands for the individual when authorized
Basic home tasks that reduce health and safety risks (for example, keeping walkways clear and maintaining basic sanitation)
Homemaker services are typically approved after an assessment and included in a service plan that specifies which tasks are allowed, how often, and any limits that apply.
Homemaker is for the benefit of the person receiving services and is tied to health and safety needs.
It is not intended as a full housekeeping service for the entire household.
In-Home Respite is short-term care that gives a break to the person who usually provides most of the day-to-day support (often a parent, spouse, or other unpaid caregiver). The goal is to help families maintain stability at home by providing temporary coverage when the primary caregiver needs relief or is unavailable.
Respite is authorized based on the member’s needs and the approved plan, but commonly includes:
Supervision and safety monitoring
Help with daily routines and basic personal needs during the respite shift
Support provided in the home or another approved setting, depending on what the plan allows
What tasks are covered, where respite can be provided, and how it is billed depends on the member’s authorized plan and the program rules connected to that plan.
The member/family works with their case manager to identify the need for caregiver relief.
Respite is added to the approved service plan with the authorized amount.
The family chooses an approved provider/agency, and respite is scheduled according to the plan.
Respite limits vary by program and service plan. The service plan will list the maximum amount allowed for the plan year.
In some cases, a case manager can request approval for respite above the standard cap when the situation supports it and required documentation is completed.
Respite is intended for caregiver relief. Your approved service plan will show exactly how much respite is authorized and any limits that apply.
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