To help pay for home health care, Colorado’s Medicaid Program, Health First Colorado, offers a home health benefit to help eligible members. A physician must deem home health services medically necessary to treat an injury, illness or disability, including mental health disorders. The duration of treatment and specific services needed must also be outlined. Care is covered intermittently, meaning Health First Colorado doesn’t cover 24-hour home health services. 

Who’s Eligible for Health First Colorado?

To qualify for home health care funding under Health First Colorado, members must:

  • Require home health services to treat or improve an illness, injury or disability, including mental illness
  • Be unable to perform medical tasks independently and not have access to a willing family member or caregiver able to perform the tasks
  • Require services that can’t effectively be treated in an outpatient clinic or reside in a home setting equipped to receive suitable care for their medical condition
  • Receive services meeting medically necessary criteria consistent with professional practices

The services must be ordered by a physician, provided by a state certified home health care agency that abides by Health First Colorado’s rules and approved by the Options for Long Term Care Agency (OLTC). After receiving the physician’s orders, OLTC has 10 days to conduct an in-person assessment to determine whether home health services will be approved. 

What Home Health Care Services Are Covered?

Two types of home health services are covered by Health First Colorado. Acute home health is for members with acute health care needs, such as post-surgical recovery or post-hospitalization for an illness or injury, requiring skilled home health services for up to 60 calendar days or until the issue is resolved. Prior authorization isn’t needed for services. Long-term home health is for members requiring ongoing home health services beyond the acute home health time frame. In this case, prior authorization is needed. 

Many covered services must be included in an individual’s care plan and can include skilled personal care or homemaking tasks. Skilled personal care tasks are administered by a certified home health care aide and may include:

  • Dressing
  • Bathing
  • Feeding
  • Exercise
  • Transfers
  • Medication assistance
  • Bladder and bowel care
  • Respiratory system care
  • Hair and skin care
  • Ambulation
  • Speech, occupational or physical therapy

Homemaking services typically include:

  • Meal preparation
  • Light housekeeping
  • Dishwashing
  • Bed making
  • Shopping
  • Laundry