Navigating the Medicaid Transition Process for IDD Adults

Intellectual and Developmental Disability (IDD) is typically a lifelong condition which is usually identified at a very young age and qualifies the Individual for benefits through Medicaid. Families often become aware of these services through healthcare providers or schools. At age 18, the Individual is eligible to transfer to adult Medicaid benefits and services. This includes transition into residential programs such as the Host Home Provider (HHP) system, managed by a Program Approved Service Agency (PASA) like Evergreen Service Providers. IDD adults also have the option to reside with eligible family members, as prescribed by the Colorado Family Caregiver Act.

The Roles of Colorado Agencies

There is a process that Individuals with IDD and their families must navigate in order to select and transition into the residential situation that is the best fit for the Individual. In the state of Colorado this program falls within the Colorado Department of Public Health and Environment (CDPHE) which partners with its sister agency, the Colorado Department of Health Care Policy and Financing (HCPF) to provide oversight. The HCPF is the Medicaid payee and is responsible for ensuring that Individuals are receiving the services for which they are eligible and for which payment is being made.

Rather than delegating the tasks associated with this responsibility to sub-agencies of the CDPHE, the HCPF works with about twenty nonprofit Community Centered Boards (CCBs) which function as bridges between the State and the Individual receiving services. These nonprofit organizations have long-standing relationships with the state in fulfilling this role and are reviewed regularly by the CDPHE.

CCBs coordinate case management for Individuals (also considered Customers) and are the primary contact for agencies like Evergreen Service Providers. When the family of an adult with IDD (or the adult themselves, acting as their own legal guardian) makes the decision to place that Individual with a Host Home Provider, the case manager typically issues a Request for Proposal (RFP) to all agencies that partner with that CCB – typically those within its geographic region.

Host Home Provider Placement

Host Home Providers open their hearts and homes to these Individuals, make them a part of their families, and provide an environment in which they are respected, treated with dignity, and have the resources to thrive. The HHP receives training, obtains certain certifications, maintains documentation required by the state, and earns a stipend for providing the services and care the Individual receives.

Individuals and their families can request to work with a CCB outside their region if they want to be associated with a particular service provider. The RFP will specify the requirements of the Individual, including the need for support of physical conditions such as limited mobility or vision impairment, behavioral or emotional challenges, the preference for a home with or without children or pets, and proximity to work and day programs in which the Individual may be involved.

Once the RFP is issued, the process moves quickly. Agencies such as Evergreen Service Providers will present the RFP to HHPs who seem to be a fit for providing the support needed and meeting the living condition requests of the applicant. If the HHP agrees, the agency submits a response to the CCB. The case manager then chooses from among the respondents and schedules interviews for the Individual and their family with those agencies. Typically scheduled at the CCB office, Evergreen’s administrative team attends these meet-and-greet sessions and includes the HHP if the Individual and their family agree.

The family typically has one to three weeks to perform due diligence, consider their options, and choose which agency and host home is the best fit. Visits to the Host Homes are scheduled to allow the Individual to see the room they would occupy, perhaps eat a meal with the family and, if they choose, stay a night or two. Once the HHP choice is finalized, the Agency works quickly to move the Individual into their new environment.

At that point, the agency assumes the primary responsibility for ensuring that services are provided as agreed. The Individual is also supported by an Interdisciplinary Team, made up of representatives from all agencies and providers with which they are involved, which coordinates services to ensure that all needs of the Individual are met.

Working Directly with a PASA

There are exceptions to this process in that a family may occasionally directly approach an agency, such as Evergreen, because they want to work specifically with that service provider. And calls are occasionally received from families who have not been aware of the process or availability of benefits because the Individual has done well with the family to that point. If it is felt that it will be best for the Individual to remain with family, Evergreen will help them understand and explore Colorado’s Family Caregiver option and determine eligibility. If families choose this option, they receive the same training and fulfill the same requirements as Host Home Providers and receive the same pay and support from the agency with which they are associated.

These residential programs can be life-changing for IDD adults!  They provide the support and afford the opportunities for Individuals to be more independent, to grow personally, and to be a contributing member of their community.

Other Important Resources

  • Being part of this program enriches the lives of those providing care as well. If you think being a Host Home Provider might be for you, check out our HHP FAQs.
  • If you’d like to keep your IDD loved one with family, learn more about the Family Caregiver option. If your IDD family member is at least age 18 and you’d like to explore residential options, watch our short video to learn more about Medicaid waivers and the process.
  • For very detailed information about transitioning to adult services, you can view a replay of a workshop presented by Developmental Pathways or attend their upcoming virtual Transition Fair on May 7, 9:00 AM to 12:30 PM. Be sure to RSVP from the Transition Fair link.

Or contact Evergreen Service Providers for questions about any of these topics or services, or to discuss options for yourself or your IDD family member. We’ll walk with you every step of the way. It is with gratitude that we embrace the opportunity to be a part of this system that helps Individuals living with IDD to thrive.

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Evergreen Service Providers
5460 Ward Rd # 230
Arvada, CO 80002
PHONE: 303-431-0306

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Evergreen Service Providers is a small, non-profit, 501 (c)(3) agency. Based in Arvada, Colorado, we’ve been serving Individuals with intellectual and developmental disabilities since 1991.

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5460 Ward Rd # 230
Arvada, CO 80002
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