Care at home instead of a nursing home

Who can join

• You are 55 or older.
• Your state says you need the level of care a nursing home gives.
• You live in the area a PACE program serves. PACE is only in some places.
• When you join, you can live safely at home or in the community with PACE’s help.
• You do not have to have Medicare or Medicaid to join. You may have either, both, or neither.

Source: 42 CFR 460.150 (b), (c) and (d), who can join PACE (eCFR). Read 2026-10-27.

Good to know before you join

• If you have Medicaid, you do not pay a monthly premium for PACE. (Medicare.gov, PACE)
• The PACE program becomes your only care provider. It promises you the services, not a certain doctor. (42 CFR 460.152(a)(1)(ii))
• If PACE turns you down because it is not safe for you to live at home, it must tell you why in writing and point you to other services. (42 CFR 460.152(b))

Sources: Medicare.gov, PACE · 42 CFR 460.152, how you join (eCFR). Read 2026-10-27.

• To get one, you must need the level of care that would otherwise mean living in an institution.
• A state can aim a waiver at a group, for example by age or by a health condition. So the programs differ from state to state.
• Each state chooses the most people its waiver will serve. So a program can be full: ask whether there is a waiting list, and ask to be put on it.

Source: Medicaid.gov, Home and Community-Based Services 1915(c). Read 2026-10-27. Asking about a waiting list is our advice, not a rule.

Medicaid for a child cared for at home (often called the TEFRA or Katie Beckett option)

• A state may cover children 18 or younger who meet Social Security’s disability rules and would be eligible for Medicaid if they were in a medical institution, while they get that level of care at home.
• The child needs the level of care a hospital, nursing facility or intermediate care facility gives; it is right to give that care at home; and Medicaid’s cost at home is no higher than in an institution.
• It is a choice each state makes. Ask your state Medicaid agency whether it offers this, and how it counts the parents’ income for it.

Source: 42 CFR 435.225 (eCFR). Read 2026-10-27.

In Colorado: the Children with Complex Health Needs waiver

• For children under 19 who need nursing-facility or hospital level of care and meet Social Security’s disability definition. It now also covers the former Children’s Home and Community-Based Services (CHCBS) and Children with Life Limiting Illness waivers.
• Parental income is not considered. The child’s own income must be under three times the federal SSI amount each month, and the child’s countable resources under $2,000.
• Waivers can have waiting lists. Already on Health First Colorado: ask your local Case Management Agency to start. Not yet: apply for Health First Colorado first. Member Contact Center: 1-800-221-3943.

Source: Colorado HCPF, Children with Complex Health Needs Waiver (CwCHN). Read 2026-10-27.

SSI for a child

• A child under 18 counts as disabled for SSI when a medically determinable impairment causes marked and severe functional limits, and has lasted or is expected to last at least 12 months, or to cause death.
• If the child lives with you, Social Security counts part of the parents’ income toward the child (it calls this deeming). That stops once a parent and the child no longer live in the same household.
• The SSI amounts and income limits: check with Social Security. Its pages could not be read today, so this page does not show them.

Sources: 20 CFR 416.906 and 20 CFR 416.1165 (eCFR). Read 2026-10-27. Apply with Social Security.