Considering home health care for yourself or a loved one can be a big decision. You want the best possible care, but navigating eligibility requirements can feel overwhelming. This blog post will answer the question: who qualifies for home health care services in Colorado, specifically focusing on the criteria and resources available in our state.

Understanding Home Health Care Eligibility in Colorado

“Home care allows seniors to remain in their homes while having regular company and professional care. Aside from enjoying the comfort of familiar surroundings, seniors can benefit from several other aspects of home care” [Source: A Place for Mom]. These services can be essential for individuals who need assistance with daily living activities or managing a chronic illness. But who qualifies for home health care services in Colorado?

Here’s a breakdown of the key factors:

• Medical Necessity: You must have a documented medical need for skilled nursing care, physical therapy, occupational therapy, or speech-language pathology services. This need is typically determined by your doctor.
• Homebound Status: You must be unable to leave your home without significant difficulty due to your illness or injury. This could be because you require assistance with mobility, transportation, or experience significant pain when leaving home.
• Doctor’s Orders: A licensed physician must create a plan of care (POC) outlining the specific services you need and how often you need them.
• Colorado Specific Considerations: Colorado’s Health First Colorado program offers both Acute Home Health services for short-term needs and Long-Term Home Health (LTHH) services for ongoing care. Patients enrolled in Health First Colorado Managed Care programs may require prior authorization for acute home health services.

For more answers about Home Health Care eligibility, including any state-specific regulations, requirements, or programs that may influence who qualifies, check out the Colorado Department of Health Care Policy & Financing Home Health Care FAQ page.

Resources & Support for Determining Eligibility

If you’re unsure whether you qualify for home health care services in Colorado, there are several resources available to help you navigate the process. Your primary care physician is an excellent starting point. Discuss your needs and limitations with them. They can assess your medical condition and determine if home health care is the right option for you. Having a documented medical need for skilled care is a key factor in eligibility.

Another valuable resource is a reputable home health care agency. Find one on Medicare.gov and reach out to them to inquire about eligibility requirements and the specific services they offer. Look for agencies certified by the state of Colorado to ensure they meet quality standards.

If you are enrolled in the state’s Medicaid program, Health First Colorado offers resources specifically tailored to your situation. Visit their website for detailed information on home health services and eligibility criteria specific to the program. This can be helpful in understanding any additional requirements or considerations within the program. It’s also important to note that 

Medicare doesn’t pay for [Source: Medicare.Gov]:

• 24-hour-a-day care at your home
• Home meal delivery
• Homemaker services (like shopping and cleaning) unrelated to your care plan
• Custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need

By exploring these resources, you can gain a better understanding of eligibility requirements and make informed decisions about home health care for yourself or your loved one. Contact us at Colorado Visiting Nurses Association if you have any more questions.

Taking the Next Step

Once you have a better understanding of who qualifies for home health care services in Colorado, you can start exploring your options. Talk to your doctor, research reputable home health care agencies, and explore any applicable state programs.

Making informed decisions about home health care can ensure you or your loved one receives the care and support needed to live comfortably and safely at home. As Colorado’s leading home health care agency, our services at Colorado Visiting Nurse Association provide quality and compassionate home health care that promotes independence and dignity. Learn more about our continuum of care options here.