Colorado Medicaid CFC: Community First Choice Explained

Community First Choice (CFC) is a Colorado Medicaid benefit that pays for hands-on help at home. It covers personal care, homemaker tasks, and health maintenance work for people who would otherwise need care in a facility. The state's Medicaid agency, the Department of Health Care Policy and Financing (HCPF), turned it on in July 2025.

You describe your child, and the person on the other end is kind about it. Then comes the line you've heard many times, about the waitlist that might run a year or longer. If you've stopped expecting good news from that phone call, that's normal.

Community First Choice doesn't work that way, though, because it isn't a waiver at all. It lives in Colorado's Medicaid state plan, so the question is whether your child meets the rules. There's no funded slot to wait for.

What is CFC in Colorado?

Community First Choice is attendant care. It pays for someone to help your child bathe, dress, eat, and get through the parts of a day a same-age kid handles alone. Colorado runs it through a federal Medicaid option known by its rule number, 1915(k). That option lets a state put attendant services straight into its Medicaid state plan, instead of inside its own waiver.

Attendant care used to live inside separate waivers, which run on a set number of funded slots. Fixed slots are where waitlists come from, so moving these services into the state plan removes the slot limit. States that take this option also get a six percentage point rise in federal matching funds for these services, and that money helped Colorado pay for the expansion.

ABA therapy alongside your CFC supports.

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What services does CFC cover?

Personal care, homemaker, and health maintenance activities

Personal care covers hands-on help with bathing, dressing, grooming, and eating. Homemaker covers light house cleaning, meal preparation, shopping, and money management tied to your child's care. The third category, health maintenance activities, is the skilled work parents often end up doing themselves, like giving medication or respiratory care.

Beyond those three, the program also pays for home delivered meals, medication reminders, and personal emergency response systems. Remote supports are on the list too, and so are transition setup costs for a member moving out of a facility. Homemaker and personal care each carry a task called acquisition, maintenance, and enhancement of skills. It funds teaching your child to do more of a routine alone, instead of having it done for them.

Supports that moved out of waivers

In July 2025, those same services left the waivers and became CFC services. Families on a waiver didn't lose access on day one, though, because Colorado built a transition year. They kept getting those services through their waiver until their next Continued Stay Review. That's the annual meeting where your case manager rechecks who qualifies and rewrites the service plan. The transition year ended on June 30, 2026, so the moved services now come through CFC instead of the waiver.

What doesn't CFC cover?

CFC pays for attendant care and doesn't cover clinical treatment. That rules out ABA therapy, speech therapy, occupational therapy, and skilled nursing. CFC also doesn't cover the waiver-only supports that stayed put. Those include respite, specialized medical equipment, home modifications, and vehicle adaptations, which remain CES waiver services for families who hold that waiver.

And some of what your family needs won't be paid for by any Medicaid program at all. If you need help with those gaps, you can start with our roundup of Colorado autism resources.

Who qualifies for CFC in Colorado?

Health First Colorado is the state's Medicaid program, and your child needs full benefits under it first. Only then can this benefit start paying for care. For a child who isn't on a waiver, it comes down to household income. Once a child is on it, what Health First Colorado covers is broad.

Children ages 18 and under never owe copays. And behavioral health services carry no copay at any age. If your household income looks too high, there's still a disability path in.

The term institutional level of care can worry parents. It's a finding from the assessment, and your child keeps living at home. It means your child's needs are big enough that, without help at home, the care would have to happen in a facility. The rule names four settings: a nursing home, a hospital, an intermediate care facility for people with intellectual disabilities, or an inpatient mental health facility.

Colorado sorts that out with a standard check. This program was built for people who meet that bar and choose care at home. The forms have to show facility-level need because this benefit stands in for facility care, and your child stays home the whole time.

Can children get CFC in Colorado?

Age isn't a factor in the rules. That surprises parents who think this is a program for older adults. Your child qualifies the same way anyone does, with full Health First Colorado benefits and an assessed institutional level of care. The last piece is choosing to get that care at home.

Children do run into an extra standard called extraordinary care. After all, parents are expected to bathe, feed, and watch a young child anyway. So the state counts only the care that goes past what a family normally gives a same-age child who doesn't have a disability or chronic illness. That care also has to be key to keeping your child healthy and out of an institution.

Case managers draw that line with age-appropriate task standards from the state's direct care services calculator. Those same assessment worksheets are used for children and youth as for adults. So the talk is about the gap between your child's needs and a typical same-age kid's.

Children's Extensive Support (CES) is Colorado's waiver for children with developmental disabilities who live at home and need frequent hands-on help. If your child is already on a waiver and uses at least one waiver service a month, they meet the institutional level of care test. That removes the step most families find hardest.

Your transition followed your renewal schedule, so families didn't all switch on the same date. At your Continued Stay Review between July 1, 2025 and June 30, 2026, your case manager enrolled your child for the moved services. The rest stays on the waiver.

Families on the Children with Complex Health Needs (CwCHN) waiver moved on the same clock. That waiver merged two older children's waivers. Its in-home support for health maintenance activities now comes through CFC, too. And if your child has no waiver at all, you don't have to get one first, since new members can be assessed directly.

How is CFC different from a Medicaid waiver?

A waiver is a capped program with a set number of funded slots. And Colorado says plainly on its own waiver pages that some of those programs may have waitlists. A state plan benefit has no enrollment cap, so your child's assessment decides whether they can get it. If you've spent a year watching Colorado waiver waitlists, you'll notice this difference most.

Your child can hold a waiver and this benefit at the same time, and can draw respite from one and personal care from the other. But no single service gets paid for twice. And Colorado puts out a duplication chart for just that question. Your Case Management Agency (CMA) applies it when the service plan gets written. That's the local group that handles assessment, planning, and enrollment where you live.

How are CFC services delivered?

The three ways to run it differ mainly in who does the hiring, the scheduling, and the forms. Which one you pick decides how much of the work falls on you.

Agency-based care

A home care agency employs the attendant, handles hiring and payroll, and sends someone to your home. You give up some control over who shows up and when. The agency also takes care of the forms. That's a big help for a family juggling therapy schedules and school meetings. Personal care and homemaker services come this way too.

In-Home Support Services: self-direction with a safety net

In-Home Support Services (IHSS) sits in the middle. You pick the person and direct the work across the three attendant categories. The agency behind you stays employer of record and handles payroll, training support, and tax forms.

Consumer Directed Attendant Support Services: managing your own budget

Consumer Directed Attendant Support Services, or CDASS, hands you the most control and the most work. You get a service budget, then hire, train, schedule, and if it comes to it dismiss your own attendants. Meanwhile, a state-approved payroll vendor handles the payments. Since July 2025, new members reach this option through CFC instead of a waiver. Families using it under a waiver switch over at their Continued Stay Review.

Can a parent be their child's attendant?

Yes. Colorado lets parents and other legally responsible people serve as attendants under the two self-directed options. Those services can't duplicate something your child already gets, and you have to follow the state's hour rules. Both limits are spelled out in the state's legally responsible caregiver guidance.

If you become your child's attendant, you're their employee as well as their parent. Plenty of families decide against that. Others find it fills hours that nobody else could cover. If you want to know more about employer setup, hour rules, pay, taxes, or choosing between the two options, you can read our IHSS Colorado guide.

Colorado coverage questions, answered at intake.

Alpaca Health verifies your child's Health First Colorado benefits before the first session, so therapy and attendant care can run side by side.

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How to apply for CFC in Colorado

1. If your child already has Health First Colorado: Contact your Case Management Agency and ask for a CFC assessment, since there's no separate application to file and no waiver enrollment required first.
2. If your child is already on a waiver: Ask your case manager whether the moved services switched to CFC at your last Continued Stay Review. If they haven't, your case manager can walk you through the timing and next steps.
3. If your family is new to Medicaid: Apply for Health First Colorado first, because this benefit can't start until that coverage is in place, and the state's eligibility check is a good first stop.
4. Find the agency that serves you: Colorado's case management directory lists one agency per region, and since the 2024 redesign, that single agency covers your area regardless of your child's age, disability, or waiver.

While you wait for an assessment date, write down the exact tasks you handle for your child that a same-age kid manages alone. That list is what the assessment is about. If you want to know what else your family can stack on top of attendant care, you can read up on autism support in Colorado.

Colorado switched this benefit on in July 2025, and the rules are still being revised. Its own program answers have been updated again and again through 2026, with changes to what a family caregiver can do. So confirm any detail with your Case Management Agency before you build a schedule around it.

Using CFC alongside your child's ABA therapy

These two supports never touch the same billing code, so your child can use both in the same week. ABA therapy is covered under Colorado's Pediatric Behavioral Therapies benefit, its own part of Health First Colorado. That benefit sits under a federal rule called Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). EPSDT means state Medicaid programs have to cover medically necessary treatment for children.

That makes behavioral therapy open to any child on Health First Colorado when it's medically necessary. And no autism diagnosis is required. If you want to know how approval works, you can read our guide to Colorado Medicaid ABA coverage.

Even though the billing stays separate, it helps when the two people talk to each other. An attendant who knows your child's ABA goals, for instance, can reinforce them during the ordinary parts of the day. And a Board Certified Behavior Analyst (BCBA) who hears what the attendant sees at bath time gets better data than any clinic session. If you're still picking a provider, read up on choosing an ABA provider before you call anyone. That search doesn't have to wait for your CFC assessment to finish.

How Alpaca Health helps Colorado families

Alpaca Health matches Colorado families with local, independent BCBAs and takes on the hard parts. Those include insurance checks, the back and forth with the state's review vendor, and the prior authorization request (your plan's written yes before treatment starts). ABA therapy runs on Colorado's Pediatric Behavioral Therapies benefit, so it's approved apart from anything your Case Management Agency sets up. So starting one doesn't hold up the other. If your child is waiting on ABA therapy while the CFC paperwork moves, get matched with a BCBA.

FAQs about CFC in Colorado

Is there a waitlist for CFC in Colorado?

No. The benefit is built into Colorado's Medicaid state plan, so there's no enrollment cap and no slot to wait for. You can see it in the state's own pages, where the waiver pages warn that some programs may have waitlists and the CFC page lists who qualifies with no cap. Your timing depends on how fast your Case Management Agency completes the level of care assessment.

Do we lose waiver services if my child enrolls in CFC?

Enrolling in CFC doesn't cost your child their waiver, because CFC is its own benefit. Your child can hold both, as long as the same service isn't billed twice. The moved services change programs, though. Waiver-based access to the three attendant services was set to end on June 30, 2026. Those services now arrive through CFC, while waiver-only supports like respite and specialized equipment stay put.

Does Colorado Medicaid CFC cover ABA therapy?

CFC doesn't cover ABA therapy. It pays for attendant care, while ABA therapy is covered under Colorado's separate Pediatric Behavioral Therapies benefit. That benefit needs prior authorization, and each approval lasts up to six months before your provider asks again. Your child can get both at once, since the two never bill for the same thing. Find an ABA provider if you're starting or switching.

Can my child get CFC if our income is too high for Medicaid?

Possibly, though the benefit needs full Health First Colorado coverage first. But Colorado has a buy-in path for kids with disabilities. Its own behavioral therapy guidance points families over the income line toward that children's buy-in program. That path has its own rules, and if you want to know more, you can read our Colorado Medicaid buy-in guide. So ask your Case Management Agency to screen you instead of assuming you're over the line.