The Children’s Extensive Supports (CES) Waiver is a Health First Colorado (Colorado Medicaid) waiver designed for children who need a high level of ongoing support due to an intellectual and/or developmental disability and related functional needs. The waiver adds services beyond standard Medicaid to help children remain supported at home and in the community.
A key requirement for CES is that a child must meet the Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) level of care. This is not assumed based on diagnosis alone. It is determined through a Functional Needs Assessment, which evaluates the child’s functional support needs and whether they meet ICF/IID criteria. ICF/IID services and the level-of-care framework are defined in the Code of Federal Regulations.
If approved, CES services are added on top of regular Health First Colorado benefits and are guided by an assessment and an approved service plan coordinated through their assigned case management agency.
ANIMO HomeCare is a Program Approved Service Agency (PASA), meaning we are authorized to provide direct, community-based services for individuals with intellectual or developmental disabilities who are approved for Medicaid waiver supports. When included in an approved CES service plan, ANIMO may provide PASA services such as:
Respite (caregiver relief)
Community Connector
Extraordinary Homemaker
When a child also qualifies for Community First Choice (CFC), ANIMO can support IHSS under CFC. IHSS is a flexible service model that may allow certain family members to become paid caregivers when program rules are met and the service is authorized in the care plan.
Community Connector is a Medicaid service that helps children increase inclusion in everyday community life. The focus is on building relationships, confidence, and “natural supports” by participating in typical activities in the community, with support tailored to the child’s needs and goals.
What is approved depends on the child’s assessment and service plan, but Community Connector commonly supports:
Participating in everyday community activities that encourage social connection and independence
Practicing skills during real-life activities, such as communication, routines, safety awareness, and participation skills
Strengthening natural supports, such as connections with community groups, programs, and people who can become part of long-term support
Community Connector is not meant to replace personal care or daily-living supports. It also is not intended to pay for activities that are purely recreational without a clear purpose tied to inclusion, skill-building, or community participation goals.
Confirm the child has Health First Colorado (Medicaid).
Work with the child’s Case Management Agency (CMA) to see whether Community Connector fits the child’s needs and waiver pathway.
Complete required assessments and service planning.
If approved, Community Connector is added to the authorized service plan with an approved amount of service.
Choose a Program Approved Service Agency (PASA) that provides Community Connector and begin services under the plan.
ANIMO HomeCare provides Community Connector as a PASA service when it is authorized in the child’s service plan.
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.
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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