Example

Eric’s Story

Eric is 45 years old and was diagnosed with multiple sclerosis (MS) 15 years ago. He’s been living on his own for most of his adult life and has always valued his independence. A few years after he was diagnosed, Eric went from working full-time to part-time and signed up for Health First Colorado (Medicaid) for healthcare and other needs. His MS has progressed over the years and he is having a harder time with cooking, cleaning, and other daily tasks. The nursing services he gets under Health First Colorado (Medicaid) just aren’t keeping up with his needs. He’s starting to think that he could use extra services but isn’t sure where to look.

A few friends told Eric he should think about moving into a nursing facility, but Eric values his independence and wants to keep living at home. He decided to call his Health First Colorado (Medicaid) social worker and ask if there is a way for him to get the services he needs at home. His social worker told him about waiver programs, which give extra benefits and services to qualifying people with disabilities. She said that waiver programs are designed to help people live in the community rather than an institution. She then gave Eric the website for Colorado’s Home and Community Based Services Waivers. “There are six waivers for adults,” she explained. “You can browse the page and see what’s best for you.”

“Thanks so much!” Eric said, and soon he started looking through the website.

Choosing the Right Waiver

Eric checked out each of the six adult waivers. Five of them didn’t seem to fit his MS diagnosis: there was one for people with brain injuries, one for people with mental health conditions, one for people with spinal cord injuries, and two for people with developmental disabilities. But then he saw the Elderly, Blind & Disabled Waiver (EBD), which would work for a wider range of disabilities.

Eric looked at the information page for the EBD waiver and he thought it might support his needs. He fit the eligibility group since he was between the ages of 18 and 64 and had a physical disability. Multiple sclerosis affected Eric’s strength, mobility, pain, and fatigue: it would clearly count as a physical disability. He already had coverage through the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In), and could get the waiver through that program.

One thing on the website stood out to Eric: it said that for him to qualify, he must need long-term support services at a level like those provided in a nursing facility. He probably would not have qualified a couple of years ago, but now he did, because his MS had progressed. It was time to sign up for the waiver.

The benefits and services in the EBD waiver would be a huge help for Eric. He would keep his existing Health First Colorado (Medicaid) benefits and get a bunch of extra benefits and services, like adult day services, home delivered meals, home modifications, non-medical transportation, In-Home Support Services, and respite care services. Eric was confident that those benefits would allow him to keep living at home and in the community.

Applying for the Waiver

Eric was ready to apply for the EBD waiver. He looked at the bottom of the EBD waiver website, which said to enroll in Health First Colorado (Medicaid) and then contact a Single Entry Point (SEP) agency to start the application. Because Eric was already enrolled in Health First Colorado (Medicaid), he visited the Single Entry Point Agency locater and found the address, phone number, and website for his local office.

He called the Single Entry Point office and asked about applying for the EBD waiver. The staff was friendly and told him about the waiver, the services it provides, and how he could qualify. Then, they scheduled an evaluation with the Case Manager for Home and Community Based Services. The next day Eric was referred to an Intake Case Manager named Eve. She scheduled a visit within 10 days, which is the usual timeframe for a Case Manager to evaluate a client.

Late the next week, Eve came to Eric’s home for an initial assessment, called a “home visit.” Eve and Eric discussed his Activities of Daily Living to determine Eric’s needs for each area. They discussed bathing, dressing, mobility, transferring, eating, supervision, memory, cognition, and supervision behavior. It’s clear in their conversation that Eric’s level of need is equal to that provided in a nursing home. Eve tells Eric that he will qualify for the EBD waiver, and Eric is ecstatic that he will have the supports to keep him living in his home.

Eve tells Eric that she will process his application. She warns him that it could take up to 45 days, but that she’ll try to speed it up since Eric is at risk of needing to go to a nursing home. They make a plan that outlines which waiver services Eric will need. Eric is really looking forward to the adult day services and non-medical transportation, which will help him keep in touch with his community.

Eric doesn’t plan to be shy about using the new benefits and services to stay independent. He knows that taking care of his health and personal needs is the best way to keep living at home. The EBD waiver will make that possible. It’s a perfect fit.