Did you know that the month of November celebrates over 35 different National observations?! I didn’t either until I did a little bit of research and one thing I learned was that November recognizes the month as National Family Caregivers Month and Home Care and Hospice month! As we fast forward to January (yes, I started writing this in November…) I am finally through the holidays, through illnesses and the kiddos are back in school. Life is settling in and feeling back to our usual, hectic “normal”. It has been a while since I wrote anything, let alone, a educational post to try to guide you on your SN journey.
I plan to provide some education on being a paid caregiver and what that can look like, in addition to the states that offer this as an option.
The state of Colorado is one of 12 states that allow someone to be paid as a caregiver for a family member. All the information provided here will be specific to Colorado. If you have questions about other states, I’d be happy to do some research for you!
The first step in this process is to apply for Medicaid. Health First Colorado is the name for the states’ Medicaid program. You qualify for Medicaid either based on income or disability. You always have the right to appeal if you are denied. After you apply, it can take several weeks to a month or two to get an approval. If you are unable to qualify due to income (most often because it is too high) you would apply for the “Buy-In” program. This provides medical assistance to families who have a child under the age of 19, with a qualifying disability, who also make more than 300 times the Federal Poverty level (FPL).
Typically, a family will be connected with a case management company such as A Rise Above, PASCO or Wellspring. These case management companies will help you apply to Medicaid, and then apply for waiver services, depending on need. Waivers, through Medicaid, allow approval for the services under Medicaid to be accessed due to special circumstances- like a disability. If you are a follower of my blog, then you’ve maybe already been approved for a waiver, or are looking into doing so!
The waiver in Colorado that qualifies you to be a paid Caregiver is called the Children’s Home and Community-Based Services (referred to hereafter as the C-HCBS waiver). For knowledge, Colorado has 12 waivers total. Once you are approved for Medicaid, even if it is through the buy-in process, you’d then apply for a waiver. Once you are approved for a waiver (in this case, we are discussing the C-HCBS), you then have another company that will “hire” you as an employee. This would be a home health agency such as Aveanna, PASCO, or All for Kids. The state has a page linking all approved agencies here. Depending on what needs are necessary for your child will determine which role of CNA versus IHSS will fit you best. It is important to note that if becoming a CNA, many of the tasks you may do are actually considered “skilled” tasks, which actually means it would require a higher level of nursing care to perform. These could be things like g-tube changes or trach care. In the case of being a CNA, this would mean you’d still need to have a nurse come in for these tasks, or have them done by another clinician. IHSS does not have as “high” of a threshold for care. I’d say you need to chat with your case manager to discuss what is best. Both roles pay differently and you are qualified for different tasks depending, so this really is an area where questions are best answered by who you are working with.
Once you begin this process, both your case manager for the waiver and for Medicaid will be in contact with you. In our case, I have 60-day check-ins with the nurse who oversees IHSS care, and then we have yearly skills assessments as well. We also go through year qualifications/needs for Bowen to ensure everything I do for him remains necessary. There are also in-service trainings that come due once a year as well. Medicaid requires me to do monthly contact emails with our case manager also. So every month, by the end of the month, I send a detailed email about how Bowen is doing. This includes current status, review of therapies and medications, appointments and outcomes, illnesses, hospitalizations etc. Some months these can be quite time consuming. If you have consecutive months without contact, your Medicaid benefits can be suspended.
Now, Colorado is currently taking feedback from stakeholders, as they are looking at a case management re-design. I am still working to read up on this and understand it better. One page I follow on Facebook posts frequently about it. The Colorado Special Needs Resource page has some incredible admins who work very hard to keep their followers educated. It is a private page, so you will need to answer some questions before you have access. Their page also has a lot of resources and links once you join. I think I will tackle this information on the redesign in a future blog post, since it goes into a lot of detail regarding law changes.
To summarize, Colorado is one of 12 states who allow parents to become paid caregivers if their child meets certain disability requirements, per the state. In Colorado, you can be paid as a CNA or as an In-Home Support Services attendant, known as IHSS. The IHSS attendant is through the C-HCBS waiver. In Colorado, to qualify for any services through the state, you child will be to be approved through Medicaid which is known as Health First Colorado. Following approval, you will then establish yourself with a home health agency who hires you in the role of CNA or IHSS to administer care for your child.
Hopefully, this information is helpful. I know it feels confusing and it is! Which is why I try to do these posts every once in a while. Hopefully the read is worth your time and if no one has told you today, you’re doing a great job!
Somewhere In Between 