Nursing Homes in Colorado
Nursing homes play an important role in supporting America's aging population. They bridge the gap between assisted living and hospitals, caring for seniors who need more than just help with activities of daily living but don't require surgery. Nursing homes treat the mind and the body; about 48% of residents have physical ailments and 43% have social/emotional issues.
According to the 2020 Census, 15.1% of Colorado's 5.8 million residents are aged 65 and older. This is the age group taking up most of the 14,122 beds in Colorado's 220 nursing homes. Some residents require long-term care due to the ongoing nature of their conditions, while others receive short-term care to help them recover from an illness or surgery.
This guide reveals if Medicaid will pay for nursing home care in Colorado, what makes someone eligible for the program and how to apply. It also lists some useful and free resources for seniors and their families, discusses alternative ways to pay nursing home expenses and summarizes the rules and regulations governing Colorado's Medicaid.
Popular Cities in Colorado
Cost of Colorado Nursing Homes
The average cost of nursing homes in Colorado is $230 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in Colorado?
Health First Colorado, the state's Medicaid program, can pay up to 100% of nursing home care costs for applicants that satisfy its strict eligibility criteria. Almost 1.7 million Coloradans — nearly 30% of the population — are enrolled in Medicaid and CHIP, although not all are seniors. The benefits for Medicaid beneficiaries residing in nursing homes include 24/7 care from teams that combine the skills of registered nurses, licensed practical nurses and certified nursing assistants. Depending on the residents' conditions, they may also receive visits from physicians and physical, occupational or speech therapies from licensed therapists.
Some seniors have conditions that require skilled nursing care but don't yet justify moving to a nursing home. Medicaid can help these seniors via Colorado's Elderly, Blind and Disabled Waiver, which will pay skilled nursing fees and some other costs for care at home or in the community. However, as it's not an entitlement program, there may be a waiting list. Seniors who qualify for Medicaid and Medicare may be able to receive skilled nursing care at home from the Program of All-Inclusive Elderly Care (PACE), which combines the benefits of both programs to cover all aspects of care. However, the senior will have to reside in an area covered by a PACE provider.
Eligibility for Medicaid in Colorado
To be eligible, a single person (or one applicant from a two-person household) must have an annual income below $32,905 and assets below $2,001. Almost all income/assets must contribute to costs, except for a monthly personal needs allowance of $95.97 and enough to pay Medicare and other insurance premiums. The Spousal Impoverishment Act allows approved applicants to transfer some income to their spouse to cover everyday expenses and for the spouse to retain assets of $148,620. If both seniors in a two-person household apply, their combined annual income can't exceed $65,808, and their assets shouldn't be above $3,000 (if they reside in different rooms) or $4,000 (if they share a room).
| Income Limits* | Asset Limits | |
|---|---|---|
| Single Person | $32,904 | $2,000 |
| Two-Person Household | $65,808 | $3,000 (if in separate rooms)$4,000 (if in a shared room) |
*per year
Coloradans applying for Medicaid to cover nursing home costs must be deemed in need of skilled nursing care as defined by a Level of Care Screening Assessment. They must also be:
- A U.S. citizen or legal immigrant
- A Colorado resident
- Aged 65 and older
Applying for Medicaid in Colorado
There are several ways to apply for Medicaid in Colorado, each of which may suit seniors with different communication preferences.
- Online: Apply directly via the Health First Colorado website (the speediest option).
- Mail and In-person: Download, print and complete an application form and mail it, or drop it off at the nearest county office or application assistance site.
- Phone: Call the Colorado Department of Health Care Policy & Financing at (800) 221-3943.
Information You Will Need
To minimize delays, seniors and their families should prepare the following documentation:
- Proof of income for the previous 60 months (from the application date), such as bank statements
- Proof of assets, such as investment account statements
- Birth certificate
- Medicare card
- Social Security card (or green card, if born outside the United States)
- Car registration and insurance documents
- Insurance policy numbers for every household member
- Proof of pensions (including letters from the providers)
- Property deeds
- Proof of the sale or transfer of real property for the 60 months prior to the Medicaid application date
- VA discharge papers, if a veteran
- Any additional documents that may support the claim
Additional Medicaid Support & Resources in Colorado
Colorado seniors and their families can access numerous resources specializing in Medicaid that won't charge for their help. Those listed in the following table provide up-to-date information, as well as advice and direct support.
| Contact | Service | |
|---|---|---|
| Medicaid Planning Assistance | Online Only | This collaboration with the American Council on Aging provides substantial content for those who like to do research. It has information about Medicaid in general and how it applies to Colorado in particular. Visitors will also find useful tools, such as a Medicaid eligibility test and spend down calculator. |
| Benefits.gov | (303) 866-2993 | This site simplifies the process of finding local and state benefits. Its Benefit Finder questionnaire can help seniors quickly identify what they might qualify for based on their responses to a series of questions. This may include Medicaid and other federally funded benefits. |
| Colorado Coalition for the Homeless | (303) 293-2220 | This nonprofit aids seniors who are homeless or are at risk of homelessness. It can help them understand more about Medicaid and how to sign up for the program. Although some centers accept payment via insurance, no seniors are refused assistance if they can't pay. |
| Health First Colorado | (800) 221-3943 | As Health First Colorado is the state's Medicaid program, it's often the best source of information for older citizens and their families. Its advisors can communicate face-to-face with seniors at their local county office or application assistance site, or seniors can make a call. |
Can You Use Medicare to Pay for Nursing Home Care in Colorado?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers several specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support & Resources in Colorado
There are several agencies in Colorado that provide free information, advice and support to seniors who may qualify for Medicare, as well as existing beneficiaries. They can help seniors learn more about the different plans, apply for Medicare and receive support if an application has been denied.
| Contact | Service | |
|---|---|---|
| Colorado Department of Health — Office of Adult and Disability Services | (303) 866-5700 | The Office of Adult and Disability Services is often the first stop for families wanting information about Colorado's programs for older citizens. Its programs cover many areas of need, including legal advice (which can help seniors denied Medicare), nutritional education and protection from exploitation and abuse. |
| Medicare Savings Program | Contact the local county office | The program helps seniors on low incomes cover some or all of the costs of their Medicare premiums. It can sometimes cover co-pays and deductibles for Medicare Part A and Medicare Part B as well. There are four programs, each contributing various amounts based on the senior's specific circumstances. |
| Medicare.gov | (800) 633-4227 | Seniors can use Medicare's official site to find out more about the program and locate experts in Medicare operating locally. They can apply for benefits directly with their online accounts and enroll in Medicare plans. |
| BenefitsCheckUp | (800) 794-6559 | This is available in English and Spanish and can help seniors and their families find an array of local resources, including Medicare. Other resources may include income assistance, tax relief, pension assistance and affordable transportation programs. |
| Senior Health Care & Medicare Assistance (SHIP and SMP) | SHIP (888) 696-7213 or SMP (800) 503-5190 | Trained counselors from the State Health Insurance Assistance Program (SHIP) provide unbiased information, advice and help regarding all Medicare matters, including supplementary programs such as Medigap. The Senior Medicare Patrol educates seniors on how to spot Medicare fraud. Beneficiaries can also report suspected fraud to the SMP. |
Other Financial Assistance Options for Nursing Home Care in Colorado
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| How to Apply | How It Works | |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov. | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy. |
Nursing Home Laws and Regulations in Colorado
| Licensing Requirements | Colorado nursing homes and their administrators must be licensed. The homes must demonstrate they are financially stable and the staff is qualified for their roles. They must also prove the building complies with construction codes and regulations regarding fire safety and health and safety |
| Staffing Requirements | The medical director must be a physician whose responsibilities include liaising between internal and external medical providers. The director of nursing must be a registered nurse who supervises all nursing staff. Nursing supervisors must be either registered nurses or licensed practical nurses. |
| Staff Training Requirements | Registered nurses and licensed practical nurses must be qualified for their roles, and certified nursing assistants must complete at least 75 hours of training, which must be with a state-approved competency program. Nonmedical staff, such as housekeepers, must receive training appropriate to their roles. |
| Admission Restrictions | Nursing homes can only accept residents whose needs can be addressed by the facility. Only four residents can reside in one room, and the facility can refuse entry to people it believes may be a danger to others. |
| Care Planning Requirements | A licensed nurse must assess a resident's physical, mental and functional abilities within 24 hours of admission, with the results forming the basis of a care plan. The resident's care plan must be completed within 7 days by the nurse and social services staff. |
| Dietary and Nutritional Services Requirements | A dietitian or similarly qualified professional must oversee nutritional services. Seniors must receive at least three meals per day that comply with their nutritional and dietary requirements. There must be a diet manual so meal preparation staff are aware of each resident's dietary needs. |
| Specialized Rehabilitative Services | The facility must provide physical, occupational and speech therapists for residents referred by a physician. Records must be kept of all treatments, and therapists must communicate updates on resident care to the facility within 2 weeks of the first treatment and every 30 days thereafter. |
| Medication and Pharmaceutical Services | Medications must only be given as ordered by a physician and cannot be altered in any way to make them more palatable to the resident without prior approval. Only qualified staff can administer medications, and detailed records of each dose must be made and maintained. |
| Activities Requirements | Staff must assess a resident's activities needs within 7 days of admission and develop an activities plan within 21 days. The plan must be suitable for the resident's functional capacities and address various needs, such as physical, spiritual, social and intellectual. |
| Infection Control Requirements | There must be an infection control program, including staff training, an appropriate response to an outbreak and guidelines on reporting outbreaks to the Department of Public Health and Environment. |
| Medicaid Coverage | Medicaid will cover medical and nonmedical costs for eligible seniors residing in Colorado nursing homes approved for Medicaid. It will pay for a semiprivate room but not a private room. |
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