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Learn how Community First Choice, IHSS, traditional agency care, and Colorado Medicaid waivers help eligible residents receive care at home—and how a trusted family member may be able to get paid for providing that care.
This guide explains how Colorado Medicaid home care works, what Community First Choice covers, how IHSS and Traditional Agency delivery compare, which waivers may apply, who qualifies, and how FreedomCare helps families set up care at home.
If you’re caring for a loved one in Colorado and wondering whether Medicaid can help cover the cost of care at home, you’re not alone. Between Community First Choice, IHSS, HCBS waivers, and traditional home care agencies, the options can feel overwhelming before you even get started.
Most families simply want to know whether their loved one can remain safely at home—and whether a family member who is already providing that care can get paid.
FreedomCare is a licensed Home Care Agency in Colorado, certified by the Colorado Department of Public Health and Environment and enrolled with Colorado Medicaid. We help families understand their options under Community First Choice and guide them through every step of setting up care.
Colorado's Medicaid program is called Health First Colorado. It funds home care for eligible residents through Community First Choice (CFC), a statewide program that launched July 1, 2025. Under CFC, eligible members can receive Personal Care, Homemaker services, and Health Maintenance Activities at home instead of in a nursing facility.
CFC is now part of the State Plan — which means if you meet the eligibility criteria, you are guaranteed access. You don't have to wait for a waiver slot to open up.
Within CFC, there are three ways care can be delivered: through IHSS (participant-directed, with agency support), through CDASS (participant-directed, with a Financial Management Service vendor), or through a Traditional Agency. FreedomCare provides services through IHSS and Traditional Agency delivery. We do not provide CDASS.
Most families who come to FreedomCare will use one of these two models. Which one fits depends on what services are needed and how much involvement the family wants in managing care day-to-day. We'll walk you through both.
The Bottom Line: CFC is Colorado's main Medicaid home care benefit. FreedomCare provides care through IHSS and Traditional Agency delivery, not CDASS.
Community First Choice covers three core services for eligible Medicaid members:
Hands-on help with bathing, dressing, grooming, eating, toileting, and mobility.
Routine household tasks like meal preparation, light housekeeping, laundry, shopping, and help with banking or money management.
Skilled tasks that would typically require a licensed professional, such as medication administration, wound care, catheter care, and respiratory management.
There's an important distinction worth understanding here. Personal Care and Homemaker services can be delivered through either IHSS or Traditional Agency models. Health Maintenance Activities are only available through IHSS. If your loved one needs skilled care tasks — and you want a family member to provide them without a nursing license — IHSS is the pathway that makes that possible.
Under IHSS, Colorado waives the Nurse Practice Act for Health Maintenance Activities. That means a trained family caregiver can legally perform tasks like administering medication or managing wound care without holding a CNA, LPN, or RN license. FreedomCare provides the required training and clinical oversight.
The Bottom Line: CFC covers Personal Care, Homemaker services, and Health Maintenance Activities. HMA is available only through IHSS.
In-Home Support Services (IHSS) is the participant-directed delivery model under CFC. It's the model FreedomCare recommends for families who want to choose their own caregiver — including a trusted family member — while having an agency handle the employment and administrative side.
Under IHSS, the care recipient is at the center of their care. They select their attendant, direct how services are delivered, and supervise day-to-day care. FreedomCare, as the licensed IHSS agency, handles everything else — background checks, required training, care plan development, payroll, and ongoing compliance.
Caregivers are employed by FreedomCare as W-2 employees. They submit their hours and FreedomCare manages payroll, tax withholding, and all employer-side responsibilities. There's no financial administration burden on the family.
Under IHSS, a care recipient can choose almost any trusted family member, friend, or caregiver as their attendant — adult children, siblings, grandchildren, nieces, nephews, relatives, friends, or neighbors. The caregiver must be at least 16 years of age and demonstrate competency in caring for the Member to the satisfaction of the Member or Authorized Representative, pass a Colorado Bureau of Investigation background check, and complete required training through FreedomCare before providing paid care.
Spouses and parents of minor children are classified as Legally Responsible Persons (LRPs) under Colorado Medicaid. Legally Responsible Persons (LRPs) may be eligible to provide certain paid caregiving services under Colorado Medicaid, though limitations apply to homemaker service hours.
The Bottom Line: IHSS lets the care recipient choose and direct a trusted caregiver while FreedomCare handles employment, payroll, training, and compliance.
Under Traditional Agency service delivery, FreedomCare manages the care arrangement as a conventional home care agency. This model covers Personal Care and Homemaker services.
The care recipient can often request a specific caregiver — including a trusted family member — depending on agency policy and program rules. FreedomCare handles scheduling, hiring, training, backup coverage, and all employment compliance. This is a good fit for families who want professional oversight without managing care logistics themselves.
Health Maintenance Activities are not available through Traditional Agency delivery. If skilled care tasks are part of the picture, IHSS is the right model.
The Bottom Line: Traditional Agency delivery is the more hands-off option. FreedomCare manages the care arrangement, but HMA is not included.
One of the most common questions we hear is: what's the difference between these three models? Here's a straightforward comparison.
The Bottom Line: FreedomCare offers IHSS and Traditional Agency delivery. CDASS is a separate model for families who want full employer control.
| Feature | IHSS (FreedomCare) | Traditional Agency (FreedomCare) | CDASS (not FreedomCare) |
|---|---|---|---|
| Family member as paid caregiver? | Yes | Possible — depends on policy | Yes (excl. LRPs) |
| Spouse eligible as caregiver? | Yes | Generally no (LRP rules) | Generally no (LRP rules) |
| Health Maintenance Activities covered? | Yes — Nurse Practice Act waived | No | Yes — Nurse Practice Act waived |
| Who directs care? | Care recipient | FreedomCare agency | Care recipient (direct employer) |
| Who manages payroll? | FreedomCare | FreedomCare | FMS Vendor (Palco or PPL) |
| Administrative burden on family? | Low — agency handles employer tasks | Very low — agency manages everything | Higher — family acts as direct employer |
| Best for | Families who want to choose their caregiver, including for skilled tasks | Families who prefer agency-managed care | Families who want full employer control |
CDASS is a separate provider type that uses Financial Management Service vendors rather than home care agencies. FreedomCare is not a CDASS provider. If CDASS is the right fit for your situation, your Case Manager can connect you with an approved FMS vendor.
In addition to CFC, Colorado operates several Home and Community-Based Services (HCBS) waivers under 1915(c) federal authority. These waivers serve specific populations and have their own eligibility criteria — separate from CFC.
It's important to understand that waivers don't replace CFC. They run alongside it. Since July 1, 2025, Personal Care, Homemaker, and Health Maintenance services have been transitioning from individual waivers into CFC. Waivers continue to fund services that CFC doesn't cover — things like adult day programs, respite care, supported employment, and home modifications. Most members can receive both CFC and waiver services at the same time, as long as the same service isn't billed twice.
If you're on a waiver and unsure how this affects your current services, FreedomCare can help you understand what to expect at your next Continued Stay Review.
The Bottom Line: CFC covers core home care services, while waivers continue to provide additional supports for specific populations.
| Waiver | Who It Serves | CFC Services Available? | Family Caregiver Pay? | Waitlist? |
|---|---|---|---|---|
| Elderly, Blind & Disabled (EBD) | Age 65+; or 18–64 with physical disability or HIV/AIDS | Yes | Yes | No |
| Brain Injury (BI) | Age 16+, acquired brain injury | Yes | Yes | No |
| Complementary & Integrative Health (CIH) | Age 18+, qualifying physical disability | Yes | Yes | No |
| Community Mental Health Supports (CMHS) | Age 18+, severe persistent mental health needs | Yes | Yes | No |
| Supported Living Services (SLS) | Age 18+, intellectual/developmental disability | Yes | Yes | Yes |
| Developmental Disabilities (DD) | Age 18+, I/DD requiring 24-hour support | Limited | Limited | Yes |
| Children's Extensive Support (CES) | Birth to 18, intellectual/developmental disability | Yes | Yes | Yes |
| Children with Complex Health Needs (CwCHN) | Birth to 18, medically complex | Limited | Limited | Varies |
Qualifying for CFC services requires meeting two sets of criteria: financial eligibility for Health First Colorado, and functional eligibility based on level of care. Both have to be met.
To qualify for CFC services, your loved one must meet an institutional level of care. That means their daily living needs are significant enough that, without support at home, they would be at risk of needing a nursing home or other facility. A county Case Management Agency conducts a formal assessment to make this determination.
The assessment looks at the person's ability to manage Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). It determines which services are authorized, how many hours per week, and which delivery options apply.
The Bottom Line: The member must meet both Medicaid financial rules and an institutional level-of-care standard before services can be authorized.
When the state evaluates whether someone qualifies for home care, they're looking at whether that person needs hands-on physical help with basic daily tasks — not just reminders or supervision. The same principle applies in Colorado as in most Medicaid programs: the need has to be for direct assistance.
Bathing and personal hygiene
Dressing and grooming
Eating
Mobility and transfers (moving in and out of bed or a chair, getting around the home)
Toileting and continence management
Meal preparation
Light housekeeping and laundry
Medication management
Shopping and errands
Banking and money management
Medication administration
Wound care
Catheter and bowel care
Respiratory care and management
Other skilled medical tasks authorized by a physician
HMA is only available through IHSS, where the Nurse Practice Act is waived. Family caregivers can be trained and paid to perform these tasks without a nursing license. FreedomCare provides the required training and clinical oversight to make this work.
Common reasons people don't qualify: needing help only with housekeeping, needing medication reminders but not physical assistance, or having needs that are occasional rather than consistent. FreedomCare helps families understand what the assessment is looking for upfront so there are no surprises.
The Bottom Line: Colorado looks for consistent, hands-on assistance needs. HMA is available only through IHSS.
Whether you're exploring IHSS, Traditional Agency care, or trying to understand how a waiver affects your options, FreedomCare walks you through the process from the start. Here's what enrollment typically looks like:
The Bottom Line: Enrollment typically includes Medicaid eligibility, a functional assessment, a care plan, caregiver onboarding, and a Start of Care.
FreedomCare helps families understand each step and what to expect.
Contact FreedomCare to talk through your loved one's care needs and current Medicaid status. We help you figure out which delivery model makes sense and what the next steps are.
If your loved one isn't already enrolled in Health First Colorado, we'll help you understand what the application involves. You can apply online at Colorado PEAK (coloradopeak.gov) or by calling 1-800-221-3943.
Connect with your local Case Management Agency — also called a Single Entry Point agency. They conduct the functional assessment that determines eligibility and authorized service hours. FreedomCare helps you understand what to expect from this process.
Once hours are authorized, your Case Manager develops a care plan. A FreedomCare nurse meets with you and your caregiver to finalize the plan and submit it back for approval. The paperwork doesn't fall on you.
FreedomCare enrolls your caregiver — background check, training, and employment paperwork. We walk your family member through each requirement so there are no surprises.
Care begins. FreedomCare schedules your Start of Care call, services officially start, and your caregiver gets paid reliably on time. We're available for as long as your family needs support.
You don't have to figure this out alone. Call FreedomCare at any point in the process — we'll meet you wherever you are.
If your loved one currently receives IHSS or home care through a waiver like EBD or CIH, their Personal Care, Homemaker, and Health Maintenance services are transitioning to CFC at each Continued Stay Review, on a rolling basis through June 2026. Your Case Manager handles the timing. Care doesn't stop during the transition.
At FreedomCare, we believe every family deserves a clear, honest picture of their home care options. We know how confusing Colorado's Medicaid landscape can feel — especially when you're already stretched thin caring for someone you love.
FreedomCare is a licensed Home Care Agency serving families across Adams, Arapahoe, Boulder, Broomfield, Clear Creek, Denver, Douglas, El Paso, Elbert, Gilpin, Jefferson, Larimer, Lincoln, Logan, Morgan, Pueblo, and Weld counties.
The Bottom Line: FreedomCare explains every option clearly and supports eligible families through IHSS or Traditional Agency delivery from enrollment through ongoing care.
We explain all Colorado CFC home care options — IHSS, Traditional Agency, and CDASS — in plain language, without jargon.
We're honest about what each model involves and which one is likely the right fit for your family's situation.
We never over-promise eligibility or make guarantees about program approval.
We handle caregiver enrollment, care plan development, payroll, and ongoing support from start to finish.
We stay with your family for as long as you need us — reassessments, care plan changes, questions along the way.
FreedomCare does not determine Medicaid eligibility — that is the role of county Case Management Agencies. What we do is make the path from eligibility to paid care as clear and smooth as possible.
Speak with FreedomCare Colorado today and get clear answers about IHSS, Traditional Agency delivery, CFC, waivers, caregiver rules, and next steps.
The Bottom Line: These FAQs cover family caregiver pay, IHSS, Traditional Agency delivery, CFC, spouse rules, ADLs, CDASS, and waivers.
Yes, in many cases. Through IHSS under Community First Choice, eligible care recipients can choose a family member — adult child, sibling, grandchild, or other relative — as their paid caregiver. The family member must pass a background check and complete required training through FreedomCare.
Both are offered by FreedomCare. Under IHSS, the care recipient chooses their own attendant and directs their care — FreedomCare handles all employer responsibilities and payroll. IHSS also covers Health Maintenance Activities. Under Traditional Agency, FreedomCare manages the care arrangement, covers Personal Care and Homemaker services, and the family has less day-to-day involvement. HMA is not available through Traditional Agency.
CFC is Colorado's statewide Medicaid home care program, launched July 1, 2025. It covers Personal Care, Homemaker, and Health Maintenance Activities for eligible Medicaid members who need long-term care support. Because it's part of the State Plan, it's an entitlement — there's no waitlist. Members on HCBS waivers are transitioning to CFC at their next Continued Stay Review, on a rolling basis through June 2026.
Spouses and parents of minor children are classified as Legally Responsible Persons (LRPs) under Colorado Medicaid. Legally Responsible Persons (LRPs) may be eligible to provide certain paid caregiving services under Colorado Medicaid, though limitations apply to homemaker service hours.
No. Under IHSS, the Nurse Practice Act is waived for Health Maintenance Activities. That means a trained family caregiver can administer medications, perform wound care, or manage respiratory equipment without holding a CNA, LPN, or RN license. FreedomCare provides the required training and clinical oversight.
Colorado looks at whether your loved one needs direct, hands-on help with daily tasks — bathing, dressing, eating, toileting, mobility, and transfers. Needing only reminders, housekeeping help, or occasional supervision usually doesn't meet the threshold on its own. Health Maintenance Activities like medication administration or wound care are also assessed when applicable.
CDASS (Consumer Directed Attendant Support Services) is a participant-directed model where the care recipient acts as the direct employer and uses a Financial Management Service vendor for payroll. FreedomCare is not a CDASS provider. If CDASS turns out to be the right fit, your Case Manager can connect you with an approved FMS vendor like Palco or Public Partnerships.
FreedomCare primarily serves members on the Elderly, Blind and Disabled (EBD) and Complementary and Integrative Health (CIH) waivers, as they access CFC services through IHSS or Traditional Agency delivery. We can help you understand how CFC and your current waiver work together.
The Bottom Line: Use these official resources to apply for Medicaid, confirm CFC and IHSS rules, review waiver programs, and find local support.
Apply for Colorado Medicaid or check your eligibility online.
healthfirstcolorado.com/apply-nowOfficial Colorado resource explaining CFC services, eligibility, and delivery models.
hcpf.colorado.gov/community-first-choice-optionOfficial resource explaining IHSS, what it covers, and how to get started.
hcpf.colorado.gov/in-home-support-servicesOverview of Colorado's waiver programs and their relationship to Community First Choice.
hcpf.colorado.gov/hcbs-waiversApply for Medicaid, check your application status, and manage benefits online.
colorado.gov/PEAKLocate your local county office for Medicaid support and benefit applications.
cdhs.colorado.gov/contact-your-countyInformation on state-funded programs including Home Care Allowance for eligible adults.
cdhs.colorado.gov/adult-financial-programsFederal resource explaining how HCBS waivers support long-term care in home and community settings.
medicaid.gov/medicaid/home-community-based-servicesThe Bottom Line: Colorado Medicaid rules can change, and FreedomCare does not determine eligibility or guarantee approval.
This content is for general informational purposes only and should not be relied upon as legal, medical, financial, or professional advice. Colorado Medicaid programs, including CFC, IHSS, CDASS, Traditional Agency services, and HCBS waivers, are subject to changing state and federal rules, eligibility standards, and administrative requirements. FreedomCare does not guarantee eligibility or program approval. Verify current requirements with the Colorado Department of Health Care Policy & Financing (HCPF) or your local Case Management Agency before applying for benefits or making care-related decisions.
We’ll help you find the right program for your family.
Why Families Choose FreedomCare
We help families across Colorado every day.
We’ll help you find the right program for your family.
Why Families Choose FreedomCare
We help families across Colorado every day.
FreedomCare helps Colorado families navigate Medicaid home care, understand their options, and start receiving care from someone they trust.
