Health First Colorado’s Home Health Benefit

Colorado provides a Medicaid benefit known as Home Health First. Through Health First Colorado (the state’s Medicaid program) there are certain terms, regulations, and benefits of which members should be aware. This week, we’ll talk about how the Home Health First benefit for Colorado’s home health care patients, the types of coverage, and eligible types of caregiver services which can be provided.

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Home Health Program Colorado Requirements

According to the Colorado Department of Health Care Policy & Financing, there are two types of home health care services in Colorado which are covered by Medicaid. These are acute home health and long-term home health. The former refers to a service in which a person has a small need — usually due to some type of surgery — and they can receive care with Medicaid for up to 60 days or until their condition is manageable on their own. Long-term home health, then, is provided for patients whose conditions cannot be resolved within a 60 day period and need ongoing treatment. The Home Health Benefit covered under Health First Colorado can be given to members who require home health services for any number of illnesses, disabilities, or physical or mental disabilities. Member with the benefit cannot provide the necessary health services for themselves and have no immediate familial caregivers who can do so, and the services cannot be ones which could adequately be given at an outpatient treatment center. Any person or persons receiving the Home Health First benefit must also be receiving a care plan outlined by a licensed doctor. A doctor must also review patient reports regularly to ensure proper care.

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Eligible Caregivers for Home Health First

There are a few different types of home health services which can receive the Home Health First benefit. Skilled nursing is covered, and this type requires a registered nurse or licensed nurse practitioner to provide treatment. A CNA, or certified nurse aide, can also be covered by the benefit. Any physical, occupational, or speech therapy which cannot, due to the condition of the patient or other unforeseen circumstances, be done on an outpatient basis can also be covered by Home Health First. All of these are dependent on what treatments are necessary. A patient who only needs medication administered may only need a CNA, while a patient with more complicated treatments may require a registered nurse. There is a special Pediatric Assessment Tool which was developed in 2013 to assess the needs of home health services for children.

Always talk to a professional when considering home health services under Health First Colorado. Contact the state for questions regarding eligibility and they should provide the proper documentation and services to get coverage squared away.