How Colorado pays for disability services

Waiver inventory

Excluded: Elderly Blind and Disabled (0006), Complementary and Integrative Health (0961), Brain Injury (0288), Community Mental Health Supports (0268), Children with Complex Health Needs (0450, medically fragile, absorbed CHCBS on July 1, 2025). Source for the full waiver list: Medicaid.gov CO waiver factsheet. Full waiver documents are at HCPF HCBS Waivers; the DD waiver document is at drive.google.com

State-only funded programs

All four are 100% General Fund with no federal match, administered by HCPF's Office of Community Living, Division of Intellectual and Developmental Disabilities. FY2025-26 initial appropriations from SB 25-206, the Long Bill:

Sources: HCPF FY2026-27 Schedule 3, HCPF FY2026-27 Line Item Descriptions. FSSP served 5,832 people in FY2024-25, up 144% from 2,383 in FY2013-14 (IDD Strategic Plan).

County / regional / local funding

• Denver County mill levy for people with IDD. In 2003 Denver voters approved a one mill property tax levy dedicated to Denver residents with intellectual and developmental disabilities. Denver Human Services runs it as the I/DD Equitable Access to Services (IDDEAS) Program and contracts with Rocky Mountain Human Services (RMHS) to administer the majority of the funds. Money pays for three categories that Medicaid will not cover: essential supports (clothing and food, caregiver training, respite, housing stability, home modifications, adaptive equipment, speech, physical, and ABA therapies), quality of life experiences (recreation, creative skill building, family therapy), and community connections (day programs, cultural opportunities, clubs, camps). Residents can request funds directly or through their case manager. Annual dollar amount not published on the program page. RMHS Mill Levy
• Community Centered Boards (20 statewide). Colorado's IDD system has been organized since 1963 around locally accountable nonprofit CCBs with defined geographic areas. They historically handled eligibility determination, needs assessment, service planning, service arrangement and delivery, and funding allocation. HCPF still contracts with 20 CCBs for state-only program case management ($5,238,505 in FY2025-26). Alliance Colorado, IDD System, HCPF Line Item Descriptions
• 15 Case Management Agencies (CMAs). Under HB 21-1187, Colorado met federal conflict-free case management requirements by July 1, 2024, replacing the CCB entry-point role for Medicaid waivers with 15 selected CMAs covering defined service areas statewide. CMAs serve all 10 Medicaid waiver populations, not just IDD. Colorado appropriated $149,895,987 in FY2025-26 for Case Management for People with Disabilities, paid to CMAs as a per member per month targeted case management payment plus payments for required monitoring visits. IDD Strategic Plan, Schedule 3
• Denver County rate differential. Colorado's HCBS fee schedules carry a distinct Denver County rate set (modifier HX) that pays above the outside-Denver rate for nearly every service, functioning as a geographic cost adjustment written into the state fee schedule. Example: GRSS Level 1 is $207.73 per day outside Denver and $209.74 in Denver, effective July 1, 2026.
• Other counties: not verified. I did not find a retrievable primary source confirming mill levy programs in Boulder, El Paso, Jefferson, Larimer, Adams, or Weld counties.

Funding scale

• Total IDD-specific spending, FY2025-26 initial appropriation: approximately $1,479,533,845 all funds, comprising Division of IDD Medicaid Programs $1,397,650,813, state-only programs $22,122,685, and DHS Regional Centers for People with Developmental Disabilities $59,760,345. This excludes CFC personal care and homemaker services used by IDD waiver members, which sit in a different line. HCPF FY2026-27 Schedule 3
• Medicaid IDD waiver appropriations, FY2025-26 (total funds / General Fund / federal funds):
• Adult Comprehensive Services (HCBS-DD): $943,198,318 / $469,997,259 / $471,599,159
• Adult Supported Living Services (HCBS-SLS): $125,347,265 / $47,026,926 / $63,974,238 (plus $14,346,101 cash funds)
• Children's Extensive Support Services (HCBS-CES): $147,638,446 / $72,523,503 / $75,114,943
• Children's Habilitation Residential Program (HCBS-CHRP): $31,570,797 / $15,784,057 / $15,785,398
• Case Management for People with Disabilities: $149,895,987 / $70,613,942 / $74,287,442
• Division total: $1,397,650,813 / $675,945,687 / $700,761,180 (plus $20,943,946 cash funds)
• DD waiver actual expenditures: $894,095,505 in FY2024-25, up 112% from $422,166,719 in FY2018-19. HCPF forecasts another 20% growth by FY2027-28 and expenditures above $1 billion by FY2026-27 absent policy action. Jan 2026 legislative presentation
• State versus federal share: roughly 50/50 on the Medicaid lines, and 100% state on the $22.1 million of state-only programs.
• FMAP: 50.00% for FY2026 and FY2027, the statutory floor. Colorado's move to Community First Choice matters here because 1915(k) carries a statutorily enhanced federal match above a state's regular FMAP. CRS R43847, KFF FMAP
• Spending per participant, FY2024-25: DD waiver $8,943 per member per month, up 41% from $6,325 in FY2018-19. HCPF's own summary slide reports annual per-participant cost as DD $107,309, CHRP $87,210, CES $40,838, SLS $26,798, CIH $75,887. Note that HCPF labels that slide "Per Member per Month," which is inconsistent with the $8,943 monthly figure it gives for the DD waiver elsewhere in the same deck; the slide values are annual.
• People served: 21,949 members with IDD served across all waivers in FY2024-25. Total Colorado LTSS served in FY2024-25: 62,876 in HCBS waivers, 12,903 in facility-based programs, 6,179 in state-funded-only programs, 5,872 in PACE, 5,464 in long-term home health and private duty nursing.
• Waiting lists as of September 1, 2025: HCBS-DD "As Soon As Available" 2,749; HCBS-DD Safety Net 3,530; HCBS-DD Date-Specific 1,854; FSSP 1,085; State SLS 47. HCPF reports 90% of people on the ASAA list are already receiving some Medicaid or state-funded service, and that 667 people declined an offered slot, the leading reason being satisfaction with their current services. IDD Strategic Plan, Jan 2026 presentation
• Cost to end the DD waiting list: $272,000,000 total to end it by 2031 and ongoing (Jan 2026 estimate), or $293.9 million in ongoing General Fund over seven fiscal years FY2025-26 through FY2031-32 with federal match doubling the total (Nov 2025 estimate). Colorado has already invested more than $287,000,000 in ending the waitlist since FY2014-15.
• Average wait: not published as a statistic. Colorado manages three separate DD lists (ASAA, Safety Net, Date-Specific) rather than a single queue.

Residential funding detail

What is funded, on the HCBS-DD waiver only. SLS and CES do not fund residential; CHRP funds children's residential.

• Group Residential Services and Supports (GRSS), procedure code T2016 with modifier U3: settings of 4 to 8 people. Paid a per diem at seven acuity levels.
• Individual Residential Services and Supports (IRSS): settings of 1 to 3 people, including individualized settings. Same code, different modifier set. Paid a per diem at seven levels.
• IRSS Host Home (modifier TT or TU): shared living in a contracted family home, 1 to 2 people. Paid a per diem at seven levels, at rates below the non-host-home IRSS levels at the low end.
• In-home supports for people living with family members are covered under the DD waiver.
• Level 7 rates on every residential category are marked "NR" on the fee schedule, meaning not rated. Colorado is standardizing a negotiated rate tool* for Residential Habilitation Level 7 as one of its FY2026-27 sustainability actions.
• CHRP funds children's residential habilitation: self-advocacy training, independent living training, cognitive and communication services, counseling and therapeutic services, personal care, emergency assistance training, community connection training, travel, supervision, and respite.
• Regional Centers (state-operated ICF/IID under the Department of Human Services): $59,760,345 in FY2025-26.

Payment structure. Residential is a daily per diem with seven acuity levels, plus a Denver County geographic differential applied through the HX modifier. Day habilitation, employment, behavioral, and professional services are billed in 15-minute units with level tiers. Respite is billed in 15-minute units, converting to a daily rate once services exceed 40 units (10 hours) in a 24-hour period.

Room and board. This is changing right now. Effective August 1, 2026, DD residential services transition to Post-Eligibility Treatment of Income (PETI). Under PETI the member's own income (SSI, SSDI, earnings) is applied to the cost of care, with a protected allowance, and the state pays the remainder. Providers must bill using the approved PETI worksheet and the rate authorized on the Prior Authorization, and the HX Denver differential does not apply to PETI-billed residential. HCPF also lists "Align Member Cost of Care Contribution (DD PETI)" among its FY2026-27 Medicaid sustainability actions, describing it as aimed at alignment rather than at utilization, rates, or eligibility. Room and board is therefore not separately state-funded; it is funded from the member's own income under PETI, with Medicaid covering the service component. Source: endnote to the DD, SLS, CES rate schedule effective July 1, 2026 and the Jan 2026 legislative presentation.

Rate structure link: hcpf.colorado.gov

Comparable service rates

Outside Denver County unless noted. Rates effective July 1, 2026 are shown alongside the April 1, 2026 rates they replaced, because Colorado reduced rates by roughly 2% on July 1, 2026.

Behavioral services on the DD waiver, effective July 1, 2026: Behavioral Line Staff $7.79 per 15 minutes, capped at 960 units per plan year; Behavioral Consultation and Behavioral Counseling $27.49 per 15 minutes; Group Counseling $9.28. Professional services: Massage Therapy $20.56 per 15 minutes; Movement Therapy Bachelors $17.15, Masters $25.12. Non-medical transportation is paid per trip by mileage band, $13.76 to $34.62 in Denver.

Official rate schedule links

• Provider rates and fee schedules index: hcpf.colorado.gov
• DD, SLS, CES rate schedules effective July 1, 2026 through June 30, 2027: hcpf.colorado.gov
• CwCHN, CHRP rate schedules effective July 1, 2026: hcpf.colorado.gov
• Community First Choice fee schedule effective July 1, 2026: hcpf.colorado.gov
• DD, SLS, CES rate schedules effective April 1, 2026: hcpf.colorado.gov
• DD, SLS, CES rate schedules effective January 1, 2026: hcpf.colorado.gov
• DD, SLS, CES rate schedules effective October 1, 2025: hcpf.colorado.gov
• DD, SLS, CES rate schedules effective July 1, 2025: hcpf.colorado.gov
• Health First Colorado fee schedule (state plan services), January 1, 2026: hcpf.colorado.gov
• HCPF FY2026-27 budget request, Schedule 3 (line item by year): hcpf.colorado.gov
• HCPF FY2026-27 line item descriptions: hcpf.colorado.gov
• HCPF FY2026-27 Schedule 10, summary of change requests: hcpf.colorado.gov

Notable features and flags

• July 1, 2024: Colorado completed case management redesign under HB 21-1187, achieving conflict-free case management with 15 Case Management Agencies replacing the CCB entry-point monopoly. The 20 Community Centered Boards retain only the state-only program case management contract, worth $5,238,505 in FY2025-26.
• July 1, 2025 and July 1, 2026: Community First Choice launched and expanded. Remote Supports moved into CFC on July 1, 2025, permitting off-site supervision and support. The first full CFC fee schedule took effect July 1, 2026, moving personal care, homemaker, health maintenance, IHSS, CDASS, home-delivered meals, and PERS out of the individual waivers into the 1915(k) state plan benefit.
• July 1, 2026: Colorado cut HCBS rates. Nearly every DD, SLS, and CES rate fell about 2% from the April 1, 2026 level, including a 1.6% rate increase rollback. Additional targeted cuts: Community Connector rate reduced 15%, then aligned with Supported Community Connections for a further 23% reduction; IRSS rates aligned; Residential Habilitation Level 7 moved to a standardized negotiated rate tool; nursing facility minimum wage supplement eliminated.
• August 1, 2026: DD residential services transition to Post-Eligibility Treatment of Income. Providers must bill on the approved PETI worksheet at the rate authorized on the Prior Authorization, and the Denver HX modifier no longer applies to residential.
• Jan 2026 proposals to slow DD waiver growth: HCPF proposed reducing DD waiver "churn" enrollments by 50%, keeping people on the waitlist while continuing services under their existing waiver, saving $6.5 million total funds in FY2026-27 and $43.7 million in FY2027-28; and ending automatic youth-to-adult DD waiver transitions for people aging out of CES or CHRP, saving $15.3 million and $18.7 million respectively. Emergency enrollment, transfers from institutions, and child welfare authorizations are not affected. FY2026-27 change requests R-15 (OCL Payment Methodology Adjustments, minus $26,582,980) and R-17 (OCL Benefit Adjustments, minus $5,229,310) carry these, against R-05 (Office of Community Living Cost and Caseload, plus $136,855,181).
• Workforce: direct support professional wages rose from $14.59 per hour in 2018 to $19.01 in 2023, supported by a state minimum wage requirement for DSPs starting at $15.00 in 2021 and reaching $17.00 in 2024. Total workforce investment reported at $454.6 million. HCPF attributes 42.7% of cost growth to rate increases, 45.9% to utilization, and only 11.4% to enrollment and eligibility.
• Waitlist trajectory: Colorado has invested more than $287 million since FY2014-15 to reduce the DD waiver waitlist and estimates $272 million more to eliminate it by 2031. The FY2026-27 sustainability package moves in the opposite direction by slowing enrollment.

Confidence

Solid: the waiver inventory and authorities, every FY2025-26 appropriation figure (read directly from HCPF Schedule 3), the state-only program list and descriptions (read directly from the line item descriptions document), all rate figures in the comparable-rates table (read directly from the July 2026 DD/SLS/CES and CFC fee schedule PDFs), the September 1, 2025 waiting list counts, the FY2024-25 DD waiver expenditure and PMPM figures, the case management redesign date, the CFC transition dates, and the August 1, 2026 PETI transition. Estimated: the $1.48 billion total IDD figure is my sum of three separately appropriated lines and Colorado does not publish it as a single number; it excludes CFC spending attributable to IDD waiver members, which is not broken out. Also, HCPF's own FY2024-25 enrollment counts differ slightly between the November 2025 IDD Strategic Plan and the January 2026 legislative presentation, so I gave both. Could not find: a published Targeted Case Management PMPM rate for Case Management Agencies (it is not in the HCBS fee schedules or the Health First Colorado fee schedule); the annual dollar value of the Denver mill levy program; primary-source confirmation of mill levy programs in any Colorado county other than Denver; regional center (state ICF/IID) census; and an average waiting time, which Colorado does not report because it operates three parallel DD lists rather than one queue.