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Page Updated: November 6, 2023
Service Questions Provider Questions Other Questions
Frequently asked questions (FAQ) for Benefits Planning in the following Home and Community Based Services waivers:
- Developmental Disabilities (DD) waiver
- Supported Living Services (SLS) waiver
Service Questions
What is Benefits Planning?
- Benefits Planning helps members understand how they can work while also maintaining the benefits that they need. Certified Benefits Planners help the member and their support network develop a better understanding of the potential impact that employment-related income may have on the member’s public benefits.
Public benefits include, but are not limited to:- Social Security
- Health First Colorado (Colorado Medicaid)
- Medicare
- Food/nutrition programs
- Housing assistance
- Other federal, state, and local benefits.
Who are Benefits Planners?
- Benefits Planners hold one of the following credentials:
- Community Work Incentives Coordinator (CWIC)
- Community Partner Work Incentive Counselor (CPWIC)
- Credentialed Work Incentives Practitioner (WIP-C)
- Certified Benefits Planners are also expected to sustain a working knowledge of Health First Colorado Home and Community-Based Services (HCBS) Waivers.
Why use Benefits Planning?
- Some members may be worried that they could lose their services and cash benefits (e.g. Social Security) if they enter the workforce. This is where Benefits Planning can help! Benefits Planning is designed to help members make informed choices regarding finding employment or seeking career advancement. This service helps provide members with accurate, individualized, and accessible information about how they can work and earn an income while maintaining the benefits they need.
What is involved in Benefits Planning?
- The service will be customized to the member and their specific needs. This will likely result in a report called a Benefits Summary and Analysis (BS&A). One of the first steps will be verifying benefits and discussing the member’s goals/questions. The Benefits Planner may also identify any work incentives through Social Security that may be applicable to the member and then develop a work incentive plan for the member/team.
Benefits Planning may also be utilized to:- Assist with evaluating job offers or promotional opportunities by outlining the impact that changes may have on public benefits, such as Social Security, Medicaid, Medicare, housing/rental assistance, food/nutrition programs, etc.
- Provide information about programs or other resources that may support the member while pursuing employment, including Medicaid Buy-In options.
- Coordinate with members/teams with referrals to promote accessing services/resources that will advance the member’s desired employment goals, including referrals to the Division of Vocational Rehabilitation (DVR).
- Offer suggestions to members/teams regarding how to create and maintain a recordkeeping structure and reporting strategy related to benefits eligibility and requirements.
- A Benefits Planner may help the member/team on a temporary basis with the collection and submission of income statements and/or documentation related to the Social Security Administration (SSA), Medicaid, or other benefits managing organizations.
- Assist with evaluating job offers or promotional opportunities by outlining the impact that changes may have on public benefits, such as Social Security, Medicaid, Medicare, housing/rental assistance, food/nutrition programs, etc.
Is Benefits Planning the same as Benefits Counseling?
- Yes. Depending on the funding source, this service may go by different names, however, the concept and intention are the same. For example, the Division of Vocational Rehabilitation (DVR) covers Benefits Counseling, which is comparable to Health First Colorado’s Home and Community-Based Services (HCBS) Waiver Benefits Planning service. The certification required by DVR and HCBS Waivers for Benefits Counseling/Benefits Planning are the same.
Who is Benefits Planning for?
- Benefits Planning is available to any Health First Colorado member enrolled in the Home and Community-Based Services (HCBS) Developmental Disabilities (DD) or Supported Living Services (SLS) Waivers, or State SLS Program, regardless of employment history. This includes:
- Members who have never worked.
- Members who have previously attempted community employment.
- Members who are currently employed, or who have become unemployed.
- Members who are participating in Day Habilitation services, attending school, or who are not engaging in those activities.
How does Benefits Planning intersect with the Division of Vocational Rehabilitation (DVR)?
- It will depend on where the member is on their employment journey:
- If a member is not currently seeking employment but wants to gain an understanding of how work income may impact their life, that member can access Benefits Planning through the Waiver and does not specifically need to go through DVR first.
- After discussing outcomes/options with the Benefits Planner, if that member wishes to pursue employment, the Benefits Planner may be able to assist with submitting a referral to DVR.
- After discussing outcomes/options with the Benefits Planner, if that member wishes to pursue employment, the Benefits Planner may be able to assist with submitting a referral to DVR.
- If a member has an open case with DVR, they should access Benefits Counseling (funded through DVR) rather than the Waiver.
- If the member has been actively working with DVR or has recently applied to DVR, then the Case Manager should explore DVR’s ability to cover Benefits Counseling.
- If the member has been actively working with DVR or has recently applied to DVR, then the Case Manager should explore DVR’s ability to cover Benefits Counseling.
- If a member is working and does not have an open case with DVR, then Benefits Planning can be accessed through the Waiver. Typically, this will be related to the member facing a change in employment status, e.g. considering more hours, change in wage, promotion, etc.
- If the member is considering changing jobs or taking on a second job, the Benefits Planner can inform the member of possible benefit/financial impacts. If the member wants support related to job seeking/job development, then a referral to DVR may be made. The Benefits Planner may assist with making this referral, or the member could request assistance from others.
- If a member is not currently seeking employment but wants to gain an understanding of how work income may impact their life, that member can access Benefits Planning through the Waiver and does not specifically need to go through DVR first.
What are the authorization limitations regarding Benefits Planning?
- Similar to other HCBS services, Benefits Planning services must be prior authorized in the Service Plan. One unit is equal to 15 minutes of service. There is a limit of 40 units per Service Plan year.
For the HCBS-SLS Waiver, Benefits Planning does not count toward a member’s Service Plan Authorization Limit (SPAL). However, all services in the Service Plan, including Benefits Planning, would need to remain within the overall SLS service limit (Total Plan Spending).
Provider Questions
Where/how can Benefits Planning be delivered?
- Benefits Planning may be delivered in the member’s home, the community, the Benefit Planner’s office, or a location of the member’s choice. Benefits Planning may also be delivered virtually when telehealth-related requirements are met. Benefits Planners will coordinate schedules with the member and those the member wishes to participate to determine when and how to meet.
Does the provider have to be a Program Approved Service Agency (PASA) to deliver Benefits Planning?
- No. Benefits Planning providers do not have to be a PASA. To be authorized or reimbursed for Benefits Planning through the Waivers, entities must be an approved HCBS Medicaid provider with a Benefits Planning Specialty. These entities can be agencies or individuals.
For more information about provider enrollment, view the Benefits Planning Provider Enrollment Instructions on the Supported Employment Resources page.
Is Colorado residency required to provide Benefits Planning through the Waivers?
- Entities that enroll under the Benefits Planning Specialty, must be in Colorado. Entities can be individuals or agencies. This service does not allow for out-of-state (OOS) service locations to enroll. That said, if a Colorado-based agency enrolls as a provider and has a staff member who lives out of state, that would be permissible. It is an expectation that providers delivering Benefits Planning must obtain and sustain a working knowledge of Health First Colorado Waivers as well as federal, state, and local benefits.
What is the reimbursement rate for Benefits Planning through the Waiver?
- Benefits Planning is reimbursed in 15-minute increments (1 unit = 15 minutes). Rate and procedure codes are on the Provider Rates and Fee Schedule page.
Other Questions
Why does Benefits Planning exist?
- Colorado is an “Employment First” state. This means that we believe that everyone should have the opportunity to find employment in the general workforce. In fact, employment in the community is the first and preferred option for individuals with disabilities receiving assistance from publicly funded systems. In June of 2021, the state legislature passed Senate Bill 21-039 which called for the elimination of sub-minimum wage practices in Colorado. Additionally, this bill identified the need for ongoing benefits counseling to assist adults with intellectual and developmental disabilities (IDD) in earning higher incomes while retaining necessary supports. The creation of Benefits Planning is one component of many the state implemented to help adults with IDD pursue competitive integrated employment.
Are there other ways to access Benefits Planning/Counseling?
- This service and its equivalent may be available to people who are not enrolled on the DD/SLS Waivers. Colorado’s Association for People Supporting Employment First (APSE) has a Benefits Counseling Guide that can help identify options.
For more information, check out the CO APSE Benefits Counseling webpage.
Authorization and Documentation
- Case Managers need to determine if there is another funding source for Benefits Planning/Counseling that is readily available for the member prior to adding the service to the member’s Service Plan.
- Case Managers should determine if the member has an open case with DVR.
- If it is determined that the member does not have access to DVR’s Benefits Counseling or other comparable services, then Benefits Planning may be authorized through the Waiver.
- Case Managers are responsible for summarizing efforts made to determine whether another source (such as DVR) was available. The summary should be captured in the Case Management record (Log Notes/Activity Log).
- Similar to other services, Case Managers can assist members in connecting with qualified providers. The member can choose which provider to use.
What if I have additional questions about Benefits Planning that are not covered in this Frequently Asked Questions list?
- The Supported Employment Unit within Health Care Policy and Financing’s Office of Community Living can address further questions or individual case situations.
Email questions to: HCPF_Supported.Employment@state.co.us