Many people with disabilities who live in long-term care facilities or other institutional settings would like to live in the community. Other people who have just been diagnosed with a disability or had a serious medical event and are in the hospital usually want to return to the community as soon as possible.

If you are in a situation like this and want to move from a hospital or institution to a home in the community, check out Transition Services and Transition Coordination. They can help you:

• Decide which community-based setting is possible and the right choice for you
• Coordinate your move out of an institution and into the community
• Connect with community-based supports, services, and training
• Sign up for waivers to get Home and Community Based Services (HCBS)
• Find your housing options and choose the best one for you

Who Qualifies?

Transition Services and Transition Coordination may help you if you:

• Have Health First Colorado (Medicaid) coverage
• Are 18 years old or older
• Qualify for one or more of Colorado’s six adult waiver programs
• Are moving from an institutional setting to a home and community-based setting, or have a change in life circumstance where you may need Home and Community Based Services (HCBS).

If you don’t have Health First Colorado (Medicaid) coverage, you can apply through Colorado PEAK, by contacting your local county human services department, or by calling 1-800-221-3943.

How can I get started with Transition Services and Transition Coordination?

To apply for Transition Services and Transition Coordination:

1. If you don’t have Health First Colorado (Medicaid) coverage, you need to apply through Colorado PEAK or by contacting your local county human services department. Note: If you have a job, you can earn up to $123,330 per year and still get coverage through the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In). Learn more in DB101’s Medicaid Adult Buy-In article.
2. Contact your Local Contact Agency for Options Counseling or get a referral to it. Referrals can be made by long-term care facility staff, family members, friends, or community members. The Options Counseling staff will guide you through the application process and help get you started with your Transition Services and Transition Coordination.
3. Apply for one of Colorado’s adult waiver programs:

   • Brain Injury Waiver (BI)

   • Community Mental Health Supports Waiver (CMHS)

   • Developmental Disabilities Waiver (DD)

   • Elderly, Blind and Disabled Waiver (EBD)

   • Spinal Cord Injury Waiver (SCI)

   • Supported Living Services Waiver (SLS)

Note: If you already get Health First Colorado (Medicaid) and have a Case Manager, you can ask them about Home and Community Based Services (HCBS) and they can help you apply.

Learn more about waiver programs in DB101’s HCBS Waivers article.

Cash benefits, health coverage, personal care attendants, adaptive transportation, and other programs and services can help you live successfully and independently in the community. This section introduces some of these and shows how they can help.

Cash Benefits

Money is a key for being able to live on your own in the community. Money pays for rent, food, and the other things you need. When you live in a long-term care facility, such as a nursing home, they usually take care of your budget. But when you live in the community, you need to manage your own money or get somebody who can help you manage it.

If you qualify, cash benefits are monthly payments from government programs that can help you pay for your needs. Social Security runs two of the two major cash benefits programs for people with disabilities:

• Supplemental Security Income (SSI) gives monthly payments to people with disabilities who have low income and low resources. You do not need to have worked in the past to get SSI. Learn more in DB101’s SSI article.
• Social Security Disability Insurance (SSDI) gives monthly payments to people with disabilities who qualify because they used to work. Learn more in DB101’s SSDI article.

Health Coverage

Health coverage is another key to living in the community. Here are a few ways you might qualify for coverage:

• If you get SSDI, you also get Medicare coverage after you’ve been getting SSDI for a couple of years. You may also qualify for Health First Colorado (Medicaid) depending on your disability, living situation, income, and resources. Learn more about Medicare in DB101’s How Health Benefits Work article.
• If you get SSI, you automatically get Health First Colorado (Medicaid). Learn more about Health First Colorado (Medicaid) in DB101’s How Health Benefits Work article.
• If you have a disability and work, you can earn up to $123,330 per year and still get coverage through the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In). Learn more in DB101’s Medicaid Adult Buy-In article.

Long-Term Services and Supports

Colorado has 10 waiver programs for people with disabilities who could be at risk of living in an institution due to their level of care. Six are for adults and four are for children. They offer extra Long-Term Services and Supports (LTSS) that go beyond the regular Health First Colorado (Medicaid) benefits, including things like assistive technology, mentoring, case management, non-medical transportation, mental health counseling, supported employment services, and homemaker services.

The six adult waivers are:

• Brain Injury Waiver (BI)
• Community Mental Health Supports Waiver (CMHS)
• Developmental Disabilities Waiver (DD)
• Elderly, Blind and Disabled Waiver (EBD)
• Spinal Cord Injury Waiver (SCI), and
• Supported Living Services Waiver (SLS).

Learn more about the adult waivers in DB101’s HCBS Waivers article.

The four children’s waivers are:

• Children with Life Limiting Illness Waiver (CLLI)
• Children’s Extensive Support Waiver (CES)
• Children’s Habilitation Residential Program Waiver (CHRP), and
• Children’s Home and Community-Based Services Waiver (CHCBS).

Learn more about the children’s waivers in DB101’s HCBS Waivers article.

Each waiver program offers a slightly different set of services and supports. Get more information in DB101’s HCBS Waivers article, including who qualifies, how to apply, and more details about the services each program includes.

Nonprofits and Community Organizations

Nonprofits and community organizations can give you advice and support to live independently in the community. Centers for Independent Living, The Arc, The Colorado Coalition for the Homeless, and Brothers Redevelopment are some of the organizations that can help.

Centers for Independent Living

Centers for Independent Living (CILs) offer advice, guidance, and services to help you live independently in the community. Their services can include:

• Independent living assistance, where staff gives you advice on what government services can help you live independently, how to apply, how to manage your personal life to stay independent, and how to connect with service providers in your area. You may also get access to free computers and internet so that you can connect to online services, websites and applications.
• Housing assistance to help you find the right kind of housing, including accessible housing, and to apply to rent or own the home. CILs can also help you apply for affordable housing programs, including Section 8 Housing Choice Vouchers that help you pay rent.
• American Sign Language (ASL) interpreting services, where CILs connect you with trained interpreters to help at events you attend or at work.
• Technology services to explore what types of assistive technology can help you live independently. Many CILs have “technology labs” where you can try different products and learn how to use them. You might also be able to rent or borrow technology, depending on your local CIL.
• Support groups and mentorship let you share your concerns and learn from other people with disabilities on how to stay as happy and healthy as possible.
• Youth support to help children with disabilities live in the community. This can help keep families together and support youth as they prepare to live independently as adults.
• Transition services to provide advice and guidance with moving out of an institution or long-term care facility and into the community.

Find your local Center for Independent Living.

The Arc of Colorado

The Arc of Colorado offers services, supports, and activities that help people with developmental disabilities (DD) live in the community. To get help, contact a local Arc chapter.

Arc chapters offer things like:

• Self-advocacy training for your general life or a specific problem that comes up (such as housing or job discrimination).
• Regular group meetings for peer support, fun activities, and more ideas for successful community living.
• Trainings for organizations and the broader community so the public can better understand the lives of people with intellectual and developmental disabilities.

The Arc of Colorado has more resources, including videos and links to other helpful organizations, in their Self-Advocacy section. They also have resources for families that have a member with an intellectual or developmental disability.

Brothers Redevelopment

Brothers Redevelopment offers affordable, safe, and accessible housing for people who have low income and have disabilities or are elderly.

Brothers operates apartments, which you can explore and apply for through their Affordable Housing section.

Brothers also can help you if you are living in your own place in the community and need modifications to your home, such as installing a ramp or roll-in shower. They have a full list of home modifications and repairs, which both make your home more accessible and help with regular home maintenance. Brothers can help with repairs can like plumbing, painting, and door repairs. Many of the modifications and repairs are completed at no cost to you or at a big discount.

Find a Brothers Redevelopment office near you.

Colorado Coalition for the Homeless

The Colorado Coalition for the Homeless has several services to support health, independent living, and well-being:

• Housing support: The Coalition manages housing properties and works with landlords in the community. Most residents also get services like counseling, life skills training, financial literacy, and help finding work. These extra services can help you have a better life in the community.
• Healthcare: The Coalition runs five health centers that offer medical and behavioral healthcare, substance use treatment, dental, vision, and pharmacy services. The services are for adults and children who are experiencing or are at risk of homelessness.
• Other services: For people who are experiencing or are at risk of homelessness, the Coalition offers many of the types of services that CILs and the Arc offer, including things like help finding and keeping work, legal referrals and advocacy, veterans programs, and help with benefits applications.

Contact the Colorado Coalition for the Homeless or call 1-303-293-2217.

Paid work means more money to pay for the things you need and want, so you can live better. To help you get work, Colorado has programs that can help you find, land, and keep a job. State employment programs can also help you grow into your work and career. And if you start work and your income and resources go up, there is a special Health First Colorado (Medicaid) program that lets you work and keep your health coverage.

Getting into the Workforce

Division of Vocational Rehabilitation (DVR)

The Division of Vocational Rehabilitation (DVR) helps people with disabilities train for, find and secure employment. Their services include:

• Vocational counseling and training
• Job search, application, and interviewing skills
• On-the-job coaching
• Keeping a job
• Job accommodations
• Medical or psychological testing
• Assistive technology evaluations
• Equipment or therapies to improve physical or cognitive functioning
• Individual, group, or other types of mental health counseling
• Home and vehicle modifications for employment-related purposes, and
• Financial needs assessments.

Most of these services are free or the cost is based on how much you can afford. Anybody who has a disability that is a substantial barrier to employment may qualify for DVR services. Find your local DVR office.

Learn more about DVR in DB101’s Finding the Right Job for You article.

Colorado Workforce Centers

For career counseling and guidance, you can visit a Colorado Workforce Center near you. Workforce Centers provide free services including:

• Job listings
• Computer and internet access
• Career counseling and training for jobseekers

They can also help you use Connecting Colorado to search for jobs through a job database, post your resume, and apply for specific jobs.

Workforce Centers have staff that can help you, or you can explore services on your own. Find a Workforce Center near you.

Learn more about Workforce Centers in DB101’s Finding the Right Job for You article.

Keeping Your Health Benefits While You Work

Many people with disabilities choose not to work because they think they will lose health benefits, especially Health First Colorado (Medicaid). However, you can earn and save money and still keep Health First Colorado (Medicaid) through the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In).

The Medicaid Adult Buy-In lets you keep your Health First Colorado (Medicaid) benefits while working. The income limit for the Medicaid Adult Buy-In is much higher, there’s no resource limit, and you can get the same coverage as regular Health First Colorado (Medicaid). (Sometimes, the Medicaid Adult Buy-In is called WAwD for short.)

To qualify for the Medicaid Adult Buy-In, you must:

• Be 16 years old or older
• Live in Colorado
• Be a U.S. citizen or a qualified immigrant
• Be working
• Have a disability that meets Social Security’s medical standards.
  • Note: For the Medicaid Adult Buy-In, SSA’s disability rules related to income do not apply.
  • Note: If you aren’t sure if your disability qualifies, you can apply and the state will check.
• Have countable income at or below $5,096 per month for individuals.
  • The Medicaid Adult Buy-In counts your money the same way as SSI does: almost all of your unearned income is counted, but less than half of your earned income is counted. That means you could earn as much as $10,278 per month ($123,330 per year!) and still qualify.
  • Only your income is counted, not the income of other household members.

If you have Medicaid Adult Buy-In coverage, you may have to pay a monthly premium of up to $200 each month (the higher your income, the higher your premium).

Learn more about the Medicaid Adult Buy-In in DB101’s How Health Benefits Work article.

Valerie’s Story

Valerie was diagnosed with severe rheumatoid arthritis at the age of 23. Within a year she lost the ability to walk, and shortly after that Valerie entered a nursing home. A nursing home can be a difficult place for a young person. While Valerie got excellent care and made friends with the nurses and social workers there, she felt limited by where she lived and didn’t get to see her friends and family much. Valerie couldn’t eat what she wanted unless she ordered food from the outside and she had to wake up early every morning for her medications.

Transition Services

Valerie decided to see how she could move from the nursing home back to the community. A social worker at the nursing home told her to look into Transition Services, which could help her find a home and get the long-term services and supports she would need to stay in the community. Transition Services could also help her sign up for a waiver program so she could get Home and Community-Based Services (HCBS).

Valerie’s social worker told her that she would likely be able to get Transition Services. Valerie was already enrolled in Health First Colorado (Medicaid), which was the first step. She was also over 18 years old and residing in a nursing home, which counted as a “qualified institution.”

Valerie asked if she qualified for one of the waiver programs. The social worker recommended that she apply for the Elderly, Blind, & Disabled Waiver (EBD) because it best fit her situation and type of disability. The social worker connected Valerie with her closest Single Entry Point Agency, where she was able to apply for the EBD Waiver. Staff at the Single Entry Point asked Valerie a series of questions and started signing her up for the waiver program. Soon, they were also helping her look for housing.

Long-Term Services and Supports (LTSS)

Valerie found a nice home with the help of the Single Entry Point Agency staff. The EBD Waiver includes Home Accessibility Modifications, so she installed a ramp and door opener to her new place. She is now happy in her new home and is working with a social worker to make the best use of her waiver and the services it gives her.

She is also excited about the Long-Term Services and Supports (LTSS) that will help her keep living in the community. She gets medical benefits through Health First Colorado (Medicaid) and qualifies for more than a dozen services through the EBD Waiver. Those services include personal care attendants, non-medical transportation, peer mentorship, and life skills training. Valerie has a Case Manager who helps make sure she has the services and supports she needs to remain independent and healthy. The life skills training is especially useful, since this is her first time living on her own while using a wheelchair and daily personal assistance.

Valerie has a team of personal care attendants to help her with daily activities, like dressing, bathing, cooking, and cleaning. Valerie also has a doctor and nurse who visit her on a regular basis. Valerie gets help with transportation to and from her rheumatologist, who is the only doctor she must travel to see. She is also able to use non-medical transportation for shopping and her weekly support group. More importantly, Valerie sees her friends and family more often, and that makes her happier.

Division of Vocational Rehabilitation (DVR)

Now that she is settled in her own home, Valerie is thinking about getting a job. Work would give her more income, a renewed sense of purpose, and the ability to meet new people and make new friends. Valerie plans to visit her local Division of Vocational Rehabilitation (DVR) office, which provides services such as vocational counseling, training, and help finding and applying for jobs. Valerie also feels comfortable knowing that the non-medical transportation can help her get to and from work. Valerie was worried that earning money could make her lose Health First Colorado (Medicaid), until her social worker told her that she could earn more money using the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In) and keep both her EBD Waiver and Health First Colorado (Medicaid) coverage.

Valerie’s life has changed a lot since she decided to move out of the nursing home. Instead of limitations, Valerie sees her life as full of possibilities and potential.