Nursing Facility Diversion in Colorado: Programs That Keep Seniors at Home

Colorado Would Rather Keep Your Parent at Home

Nursing home care in Colorado costs $9,000 to $12,000 per month, and the state Medicaid program pays for a significant share of it. HCPF has strong financial and policy incentives to keep seniors out of nursing facilities when community-based care is viable — and it has built several programs specifically for that purpose.

If your parent is on the verge of nursing home placement, or is already in a facility and wants to come home, these programs can change the trajectory.

At-Risk Diversion

At-Risk Diversion is the program that matters most for families trying to prevent a nursing home admission that feels inevitable.

When a community-dwelling senior is at imminent risk of nursing facility placement — due to a sudden decline in function, a caregiver crisis, or a hospital discharge with no safe home environment — their regional CMA can consider the case for At-Risk Diversion, a pathway that prioritizes HCBS resources so home-based care can be assembled before placement.

The pathway can prioritize personal care hours, respite, or home-safety resources, but the senior still needs to meet EBD waiver eligibility (nursing facility level of care, income under $2,982 per month, assets under $2,000), and services remain subject to program authorization.

To trigger at-risk diversion, the family or a hospital social worker contacts the regional CMA with documentation of the imminent placement risk. A signed PMIP from the physician is still required, but CMAs are expected to expedite the intake screening.

Transition Coordination Services (TCS)

Transition Coordination Services work in the opposite direction — helping seniors who are already in a nursing facility return to the community.

TCS is a formal benefit under the EBD waiver specifically designed for nursing home residents who want to move back home or into a community-based setting. A Transition Coordinator — assigned through the CMA — works with the resident, their family, and the facility discharge planners to develop a community reintegration plan.

The transition plan covers:

• Housing: Identifying accessible, affordable housing if the senior's previous home is no longer available. TCS can connect families with local housing resources.
• Home setup: Identifying one-time expenses needed to establish a community residence, subject to the current Transition Services rules and authorization. This is separate from the ongoing home modification benefit.
• Care coordination: The Transition Coordinator builds the person-centered support plan before the senior leaves the facility, ensuring personal care, homemaker services, meal delivery, and transportation are authorized and scheduled from day one.
• Follow-up: Ask the CMA what follow-up and problem-solving support will be available after discharge.

TCS enrollment requires that the nursing home resident be Medicaid-eligible and meet nursing facility level of care. The resident (or their legal guardian) must express a desire to return to the community — TCS is voluntary and resident-directed.

Funding and Transition Costs

Transition Coordination Services are intended to cover or coordinate one-time transition costs associated with moving back to the community, subject to eligibility and authorization. Ask the CMA which expenses are covered and how they interact with the ongoing waiver budget; do not commit to housing or setup costs before approval.

When Diversion Isn't the Right Answer

Not every nursing home admission should be diverted. Some seniors have care needs that genuinely exceed what can be safely delivered at home — severe behavioral symptoms of dementia that put them or their caregivers at physical risk, complex skilled nursing needs requiring 24-hour clinical monitoring, or a complete absence of any informal support network.

The EBD waiver's nursing facility level of care assessment exists precisely to evaluate this question. If the CMA case manager and the clinical team determine that the senior's safety cannot be maintained in a community setting even with maximum waiver support, institutional care may be the medically appropriate plan.

The right question isn't "can we avoid the nursing home?" but "can we deliver equivalent safety and care quality at home, using available resources?" When the answer is yes, Colorado's diversion and transition programs provide the infrastructure to make it happen.

The Colorado home care planning guide includes a crisis decision framework that helps families assess whether home-based care is viable for their parent's specific situation — and maps out the diversion or transition pathway step by step if it is.

See more Colorado guides →