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Children with Complex Health Needs Waiver (CwCHN)

A waiver is an extra set of Health First Colorado (Colorado's Medicaid program) benefits that children could qualify for in certain cases. These benefits can help children remain in their home and community. Waivers have extra program rules and some programs may have waitlists.

The Children with Complex Health Needs Waiver (CwCHN) provides Health First Colorado benefits in the home or community for children with complex health needs and/or life-limiting illnesses, and who are at risk for institutionalization in a hospital or nursing facility. The CwCHN Waiver allows families to continue to seek curative treatment while their child is receiving palliative or hospice care.

  • Services offered with this waiver supplement the services that children already receive through regular Health First Colorado benefits and other federal, state, and local public programs, as well as the support that children get from their community.
  • Children who receive services through the CwCHN waiver are also eligible for all Health First Colorado covered services including services through Community First Choice (CFC).

CwCHN waiver services include:

View the full text of the CwCHN waiver and Waiver Lifecycle

Background - Why a new waiver program?

The CwCHN waiver merged the Children’s Home and Community Based Services (CHCBS) waiver and the Children with Life-Limiting Illness (CLLI) waiver under a new name, the Children with Complex Health Needs (CwCHN) Waiver. The Department of Health Care Policy and Financing (HCPF) merged these two children’s waivers to ensure medically complex children have continued access to waiver and Health First Colorado services while also expanding benefits and streamlining services for children.

The implementation of CFC on July 1, 2025 moved the In Home Support Services - Health Maintenance Activities (IHSS-HMA) service from the CHCBS waiver into CFC. This left only one service on the CHCBS waiver, the Wellness Education Benefit (WEB), jeopardizing the state’s federal authority to operate the waiver on an ongoing basis. Without federal authority to operate the waiver, Members enrolled in the CHCBS waiver would have been at risk of losing access to their waiver services and, in some cases, Health First Colorado eligibility. Therefore, HCPF merged the CHCBS waiver with  the CLLI waiver and retitled it as the CwCHN waiver, ensuring members have continued access to care.

The services on the new CwCHN waiver are the same as the current CLLI waiver. Eligibility has been expanded to capture both the CHCBS and CLLI waiver populations. Members who currently receive In-Home Support Services - Health Maintenance Activities (IHSS-HMA) through the CHCBS waiver will receive that benefit through CFC.

The waiver merger does not change service definitions, unit limitations, service codes/modifiers, or the way Case Managers authorize services.

Implementation - How will children access or enroll onto this new waiver?

Current CHCBS Members

Between July 1, 2025 and June 30, 2026, all existing CHCBS members will transition to the CwCHN waiver and CFC at the time of their Continued Stay Review (CSR). Case Managers are responsible for enrolling current CHCBS members into CFC and the CwCHN waiver, explaining the new service options that may be available, and going through the service planning process.

Current CLLI members

Current CLLI members were automatically transitioned to the CwCHN waiver on July 1, 2025. At the time of CSR, current CLLI members will be able to enroll in CFC if they so choose.

New Members

New members need to reach out to their local Case Management Agency after July 1, 2025 to begin the eligibility and assessment process. Visit the Case Management Agency Directory page to find contact information for the agency in your area. Members will be assessed for CFC and waiver services at the same time.

For more information, please review these additional resources:

Who Qualifies?

The Children with Complex Health Needs Waiver has expanded eligibility criteria to include the Children’s Home and Community-Based Services (CHCBS) and Children with Life Limiting Illness (CLLI) waivers.

Children must meet the following financial and program criteria to access services under this program. To use waiver benefits, children must also be willing to receive services in their home or community.

Level of Care

  • Children must meet level of care (LOC) for a nursing facility or hospital
    • Meeting level of care means that an individual has a risk of going into a nursing facility or hospital if they cannot receive services in the home or community
  • Children must meet the Social Security Administration (SSA) definition of disability.

Eligibility Group

  • Children must be under 19 years of age
  • Children must require care that would typically be provided in either a skilled nursing facility and/or a hospital. The child may or may not have a life-limiting illness, as certified by a physician
  • Meet the Federal Social Security Administration (SSA) disability definition and/or is a Supplemental Security Income (SSI) recipient
  • To learn more details about the waiver eligibility requirements, please talk to your case manager

Financial

  • The child’s income must be less than three times the current Federal Supplemental Security Income (SSI) limit per month (See SSI website for current information) and their countable resources must be less than $2,000.
  • Parental income is not considered for the child’s eligibility.

Benefits and Services

The CwCHN waiver includes all former CLLI waiver services, plus the Wellness Education Benefit.

CwCHN Waiver Timeline

  • July 1, 2025 - The CHCBS waiver merged with the CLLI waiver and was renamed the Children with Complex Health Needs Waiver (CwCHN). Eligibility criteria was expanded and all CLLI waiver benefits became available on the merged waiver.
     
  • July 1, 2025 - Current CLLI waiver members were automatically transitioned to the CwCHN waiver. No action required.
     
  • July 1, 2025 through June 30, 2026 - Current CHCBS members will transition from CHCBS to CwCHN at the time of their Continued Stay Review. All waiver members will be able to enroll into CFC at that time as well.
     
  • Summer 2026 - The CHCBS waiver will conclude as all members will have been transitioned to the CwCHN waiver.

How to Apply

If you are already enrolled in Health First Colorado, contact your local Case Management Agency to start the waiver application process.

If you are NOT yet enrolled in Health First Colorado, you can apply now.

If you have more questions about this program please contact your local Case Management Agency or the Member Contact Center.

Learn More

Visit the CFC Resources webpage for more information on CFC, the CwCHN waiver, and the WEB. 

If you would like to get involved and stay up to date on information regarding the CwCHN waiver, please join the CFC Council meetings held monthly

Additionally, if you have any questions regarding these upcoming changes, please do not hesitate to reach out to the CFC inbox at hcpf_cfc@state.co.us 

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