Caring for an older parent or other elderly loved one poses many challenges involving available time, energy, and finances. Caregivers need all the help they can get. There are a number of government programs designed to assist in one way or another. One that is perhaps lesser known in Colorado is called Consumer-Directed Attendant Support Services (CDASS), under the Department of Health Care Policy and Financing (DHCPF). It is focused on assisting people who are enrolled in Colorado’s Medicaid program, known as Health First Colorado. 

All 50 states offer an option of what is called “self-directed” or — as Colorado labels it — “consumer-directed” Medicaid services. Through these programs states grant waivers that allow income-qualified individuals to manage their own long-term in-home care services. In some states, that can include hiring a family member to provide care. Benefits, coverage, eligibility, and rules differ from state to state.

Option to Manage Your Own Care Attendants in Colorado

In Colorado, DHCPF says it is committed to providing “service delivery options that empower Health First Colorado members and their families to direct and manage the long-term care services and supports they need to live at home.” To that end, CDASS lets you direct and manage the attendants who provide your personal care, homemaker, and health maintenance services, rather than working through an agency. “Through CDASS,” the Department says, “you are empowered to hire, train and manage attendants of your choice to best fit your unique needs or you may delegate these responsibilities to an Authorized Representative.”

These consumer-directed services are made available through a number of specific “waivers,” one of which is the Elderly, Blind and Disabled (EBD) waiver. DHCPF defines such waivers as “an extra set of Health First Colorado benefits that you could qualify for in certain cases . . . [that] can help you remain in your home and community.”

The Elderly, Blind and Disabled Waiver in Colorado

The EBD waiver provides assistance specifically to people ages 65 and older who have a functional impairment and who require long-term supports at a level typically provided in a nursing facility. (As the name implies, the waiver also assists anyone who is blind or people ages 18-64 who are physically disabled or have a diagnosis of HIV or AIDS.) To qualify a person must require such long-term supports in order to remain in a community setting. EBD services work with or in addition to the services that you already receive through Health First Colorado and other federal, state, and local public programs. If you receive services through the EBD waiver, you are also eligible for all Health First Colorado services except nursing facility and long-term hospital care.

DHCPF explains that if clients opt for consumer-directed support services, their choice of services include personal care, homemaker, and health maintenance activities. These are defined by DHCPF as follows:

Personal care — assistance with activities such as bathing, dressing or eating.

Homemaker activities — assistance with general household activities needed to maintain a healthy and safe living environment, such as housekeeping, meal preparation and laundry.

Health maintenance actives — routine and repetitive activities of daily living which require skilled assistance for health and normal bodily functioning, and which would be carried out by an individual with a disability if he or she were physically/cognitively able.

Management agencies are an option to help you

A client or their authorized representative may choose to self-direct these services or choose to have the same services delivered through an approved agency-based model.

DHCPF contracts with local, non-state entities called Case Management Agencies (CMAs) to enable people with long-term care needs to access appropriate supportive services. These agencies form a statewide network that provides case management and care coordination for EBD waiver clients. The Department contracts with 24 CMAs for the case management and utilization review of long-term care waivers. Case management functions include: intake/screening/referral, assessment of client needs, functional eligibility determination, service plan development, ongoing case management, and monitoring to assure participant protections and quality assurance.

“Clients assist the case manager to identify, through a person-centered service planning process, those services and supports needed to prevent placement in a nursing facility,” states DHCPF. In addition to these waiver services, clients also have access to all Medicaid state plan benefits.

A client and/or authorized representative may choose to direct these services or opt to have the same services delivered by a traditional Medicaid agency provider. Clients who choose to self-direct personal care/assistance and/or homemaker services will receive support for these services through a Financial Management Services (FMS) organization. The FMS will be responsible for providing appropriate and timely fiscal management services to individuals and or authorized representatives who choose to self-direct these services.

Who qualifies for Colorado’s Consumer-Directed Attendant Support Services?

To qualify for Colorado’s Consumer-Directed Attendant Support Services, you must be willing to receive services in your home or community as opposed to residing in a nursing facility. At the same time, however, in order to qualify you must require long-term support services at a level that is comparable to services typically provided in a nursing facility.

You must be 18 years or older; if under age 65, you must be blind or have a physical disability, or have a diagnosis of HIV or AIDS. If you are age 65 or older, you must have been determined to have a significant functional impairment. You must otherwise be in stable health and able to direct your own services or assign an Authorized Representative. You are able to use Health First Colorado dollars to pay the attendant of your choice rather than a home health agency or personal care agency. You manage your own Health First Colorado funds, giving you increased choice and control. This flexibility enables you to manage the services you need to live independently and to more fully participate in your community.

Financial qualification

Your income must be less than three times the current Federal Supplemental Security Income (SSI) limit per month. (See SSI website for current information.) For a single person, your countable resources must be less than $2,000; for a couple, less than $3,000.

How to apply Colorado’s Consumer-Directed Attendant Support Services

If you are already enrolled in Health First Colorado, contact your local Single Entry Point (SEP) or Community Centered Board (CCB), which specializes in determining eligibility, planning care, and providing referrals.

If you are NOT yet enrolled in Health First Colorado, Apply Now.

Learn more about Colorado’s Consumer-Directed Attendant Support Services at

You can find additional details at the following sites:

If you have more questions about this program, contact your local Single Entry Point Agency, Community Centered Board (CCB), the Member Contact Center, or Consumer Direct Colorado (CDCO).


Additional waivers

The Elderly, Blind and Disabled waiver may be the most relevant to readers of this article, but DHCPF does have additional CDASS waivers as follows:

Supported Living Services Waiver in Colorado

The Supported Living Services (SLS) waiver provides necessary services and supports for individuals with intellectual or developmental disabilities so they can remain in their homes and communities. The SLS waiver promotes individual choice and decision-making through the individualized planning process and the tailoring of services and supports to address prioritized, unmet needs. In addition, this waiver is designed to supplement existing natural supports and traditional community resources with targeted and cost-effective services and supports. The person receiving services is responsible for his or her living arrangements, which can include living with family or in their own home. Up to three persons receiving services can live together. Participants on this waiver do not require 24-hour supervision on a continuous basis for services and supports offered on this waiver. Click Supported Living Services waiver to learn more.

Community Mental Health Supports Waiver in Colorado

The Community Mental Health Supports waiver provides assistance to people with a mental illness who require long-term supports and services in order to remain in a community setting. It is for someone experiencing severe and persistent mental health needs that require assistance with one or more Activities of Daily Living (ADL). Generally this client has a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified within the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The disorder is episodic, recurrent, or has persistent features, but may vary in terms of severity and disabling effects, and has resulted in functional impairment that substantially interferes with or limits one or more major activities. Click Community Mental Health Supports waiver to learn more.

Complementary and Integrative Health Waiver in Colorado

The Complementary and Integrative Health waiver helps individuals living with a spinal cord injury, multiple sclerosis, a brain injury, spina bifida, muscular dystrophy, or cerebral palsy with the inability for independent ambulation. Eligible clients must be 18 years of age or older and have been determined to have an inability for independent ambulation resulting from the qualifying condition as identified by the case manager through the assessment process. The inability for independent ambulation means the individual does not walk and requires use of a wheelchair or scooter in all settings, whether or not they can operate the wheelchair or scooter safely on their own; OR the individual does walk but requires use of a walker or cane in all settings, whether or not they can use the walker or cane safely on their own; OR the individual does walk but requires “touch” or “stand-by” assistance to ambulate safely in all settings. This waiver provides acupuncture, chiropractic, and massage therapy in addition to other services. Click Complementary and Integrative Health waiver to learn more.

Brain Injury Waiver in Colorado

The Brain Injury waiver helps people with a brain injury who need extra support to live in their communities. Clients must be 16 years or older, have suffered a brain injury before their 65th birthday, and have a diagnosis that fits within certain categories. Click Brain Injury waiver to learn more.