Community First Choice Colorado: Self-Directed Medicaid Home Care

Your parent qualifies for Medicaid home care in Colorado, but the agency they've been assigned sends different aides every week. Your mom doesn't trust strangers in her house, and the last aide didn't know how to help her transfer from her wheelchair. You've heard there's a way for your parent to choose — and even hire — their own caregivers through Medicaid. There is, and it's called Community First Choice.

What Community First Choice Actually Is

Community First Choice (CFC) is a Medicaid State Plan benefit — not a waiver — that covers personal care and homemaker services for people who meet a nursing-facility level of care. Colorado began transitioning eligible EBD waiver participants to CFC during their annual Continued Stay Reviews between July 2025 and June 2026.

The practical difference between CFC and a standard EBD waiver placement: CFC is an entitlement. Because it's a State Plan benefit rather than a waiver, there is no waitlist. If your parent is clinically and financially eligible, they receive services. Period.

CFC covers attendant care (help with bathing, dressing, eating, mobility), homemaker services (meal prep, light housekeeping, laundry), and health maintenance activities that a nurse has delegated to a non-licensed caregiver.

CDASS: The Self-Direction Option

Within CFC, your parent can choose Consumer Directed Attendant Support Services (CDASS) for maximum control. Under CDASS, your parent receives a monthly budget based on their assessed care needs and becomes the employer of record for their caregivers.

This means your parent — or you, acting as their authorized representative — can:

• Hire anyone, including family members (except a spouse), as paid caregivers
• Set schedules that match your parent's actual routine, not an agency's availability
• Train caregivers on your parent's specific needs and preferences
• Fire caregivers who aren't a good fit without going through agency bureaucracy

The monthly budget covers wages, and a fiscal management service (FMS) handles payroll taxes, workers' compensation, and compliance so your family doesn't have to manage the employer paperwork directly.

Financial Eligibility

CFC and CDASS use the same financial thresholds as all Colorado Medicaid long-term care programs:

• Asset limit: $2,000 in countable resources for individuals
• Income cap: $2,982 per month gross income — Colorado is an income-cap state, so exceeding this by even $1 requires a Miller Trust
• Spousal protections: The healthy spouse keeps between $32,532 and $162,660 in assets, plus a monthly income floor of $2,705

Unlike nursing home Medicaid, where your parent keeps only $110.36 per month, HCBS participants (including CFC and CDASS) retain $2,199 of their monthly income for living expenses. This is a significant financial advantage of staying at home.

Your parent's home is exempt as long as they have an intent to return, a spouse lives there, or their equity is under $1,130,000. But watch for the beneficiary deed trap — under C.R.S. § 15-15-403, an active beneficiary deed on the home makes it a countable asset, potentially disqualifying your parent entirely.

How to Get Started

Step 1: Your parent must already be enrolled in Medicaid long-term care (or applying) and meet the nursing-facility level of care through the 100.2 functional assessment conducted by your regional Case Management Agency (CMA).

Step 2: During the assessment or annual review, tell your CMA case manager that your parent wants CFC with the CDASS self-direction option. The case manager will explain the responsibilities and help develop a person-centered service plan.

Step 3: Choose a fiscal management service. The FMS handles payroll, tax withholding, and insurance for the caregivers your parent hires.

Step 4: Recruit and hire caregivers. Many families start with a trusted neighbor, church member, or adult grandchild. The FMS processes background checks and manages onboarding.

Step 5: Track hours and spending against the monthly budget. If your parent's needs increase, request a reassessment from the CMA to adjust the allocation.

What the CFC Transition Means for Current EBD Waiver Participants

If your parent is already on the EBD waiver, the transition to CFC happens automatically during their annual Continued Stay Review. Personal care and homemaker services shift from the waiver to CFC. Other EBD services — adult day programs, home modifications, respite care, non-medical transportation — stay on the waiver.

The transition should be seamless in theory: same eligibility rules, same level of services, same financial thresholds. In practice, some families report temporary disruptions as caseworkers reassign service authorizations. If your parent's services are reduced or interrupted during the transition, request a written explanation from the CMA and file a grievance if the reduction isn't justified by a change in your parent's assessed needs.

Common Challenges With Self-Direction

CDASS gives families tremendous flexibility, but it also transfers real responsibilities:

Finding reliable caregivers. Unlike agency-directed care where the agency handles staffing, under CDASS you're responsible for recruiting. Start with people who already know your parent — neighbors, church friends, extended family. Post in community groups. The FMS can sometimes connect you with local caregiver networks.

Managing the budget. Your parent receives a fixed monthly allocation. If you hire one caregiver at $18/hour for 30 hours a week, that's roughly $2,160/month. If the budget is $2,000, you need to adjust hours or find a second caregiver at a lower rate for some shifts. The CMA reassesses the budget annually, but you can request an off-cycle reassessment if your parent's needs increase.

Handling emergencies. If your regular caregiver calls in sick, there's no agency backup pool. Families using CDASS should have at least two caregivers trained and available as backups.

Employer responsibilities. While the FMS handles payroll mechanics, you're still the employer for scheduling, performance, and termination decisions. Document everything — it protects both your family and the caregiver.

CFC vs. Agency-Directed Care: Which Is Right?

CFC with CDASS works best when your family has the capacity to manage caregivers — recruiting, scheduling, supervising. If your parent is cognitively intact and opinionated about who helps them (many are), self-direction gives them dignity and consistency.

Agency-directed care through the standard EBD waiver is better if no one in the family can take on the management role, or if your parent needs specialized clinical oversight that individual caregivers can't provide.

You can also split the difference: use agency-directed care for skilled services (like nursing visits or therapy) and CDASS for routine personal care and homemaking. Talk to your CMA case manager about structuring a hybrid plan.

Either way, the financial eligibility rules are identical. The Colorado Medicaid Long-Term Care & Asset Protection Guide covers both pathways — including the Miller Trust setup, spend-down strategies, and the exact CMA referral process — so you can make an informed choice about which model fits your parent's situation.

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