Colorado Medicaid · Family Guide · Updated June 2026
The 56-hour Caregiver Cap Exception Process
If one caregiver currently provides most of a member's weekly hours, this change affects you. The honest truth is a member's approved service hours aren't being cut, there's a real exceptions process and only your agency can file it.
Authorized Hours Stay Approved
Care Continues While Exception is Pending
Once an exception is submitted, the caregiver can keep working over the limit.
Your Agency Files the Exception
Families can't submit this. Provider agencies and CDASS employers do. Which is exactly why your choice of agency matters.
WHAT CHANGED
One caregiver, one member, 56 hours a week
Starting July 1, 2026, Colorado's Department of Health Care Policy & Financing (HCPF) limits how many hours a single caregiver can be paid to provide to one member each week. It applies across Personal Care, Homemaker, Health Maintenance Activities (HMA), Long-Term Home Health aide and nursing whether delivered agency-based, through IHSS, or through CDASS. The existing 16-hours-per-day limit stays in place.
The 56-hour limit phases in over a year, starting with the highest-hour situations first:
84
hours/week
JULY 1 - DECEMBER 31, 2026
CURRENT PHASE
70
hours/week
JAN 1 - JUNE 30, 2027
56
hours/week
JULY 1, 2027 - ONWARD
The part that matters most to families
A member will not lose authorized service hours or budget because of this rule. If approved hours run above a single caregiver's limit, those extra hours need to come from an additional caregiver, unless an exception is granted.
EXCEPTION RESPONSIBILITY
You don't file this request. Your agency does.
Under the rule, the provider agency or CDASS employer is the only party that can submit a Weekly Caregiver Limit Exception Request to HCPF. A member or a family caregiver cannot send it in on their own.
For members on Community First Choice (CFC), the agency also has to coordinate with the member's Case Manager, who completes a required attestation. The Case Manager does not approve or deny anything, HCPF makes every determination, but their attestation has to be in before HCPF will even review the request.
So the agency you work with isn't a formality. They're the one gathering the documentation, hitting the submission window, coordinating the case manager, and answering HCPF's follow-up questions. A request filed well, and on time, is a different outcome than one that's late, thin, or never sent.
STEP ONE: DO YOU QUALIFY?
The four exception criteria
An exception is only approved if the member meets at least one of these criteria, and the request is backed by documentation. These come straight from the rule (Section 8.7419.2.a).
1. Extraordinary clinical acuity
Extraordinary clinical acuity, which means the Member has a complex diagnosis which results in medical fragility, creates severe risk of hospitalization or death, requires strict limitation of close contact that cannot be reasonably mitigated by personal protective equipment, and is supported by clinical documentation.
§ 8.7419.2.a.i
2. Workforce access barriers
The member lives in a rural or frontier area, needs specialized skills, or requires an uncommon language and recruitment has genuinely failed (at least two documented attempts over 30+ days, or two failed retention efforts).
§ 8.7419.2.a.ii
3. Transition or stabilization
A hospital discharge within the past 30 days, a stabilization period following a crisis, or the window while the agency recruits and trains new staff after losing a caregiver.
§ 8.7419.2.a.iii
4. End-of-life circumstances
Continuity with a primary caregiver is clinically appropriate for a member with a terminal illness (prognosis of nine months or less), or a life-limiting illness for a member under 19 and supported by clinical documentation.
§ 8.7419.2.a.iv
If the situation doesn't meet a criterion, we're not going to sugarcoat it.
For a single parent or a spouse who is the paid caregiver, a cap on weekly hours can cut into the income your household runs on and that's a real loss. So here's the honest picture and what we do with it. The member keeps every authorized service hour; those don't disappear, they're shared across more than one caregiver. And the limit is per member, not a ceiling on you. A caregiver can still be paid up to the weekly limit for each person they serve. Our job is to push for your exception first, and when one truly isn't available, to sit down with you and your Case Manager and build a plan that keeps the member's care steady. Sorting that out is the part we carry, not you.
THE PROCESS, START TO FINISH
How an exception request moves
Eight stages, color-coded by who's responsible at each point, your agency, the case manager, and HCPF.
Identify Who's Over the Limit
The agency reviews schedules and authorized hours to find caregivers providing more than the applicable weekly cap for a member.
Check the exception criteria
Does the member meet one of the four criteria? If not, the agency coordinates with you and the case manager on alternative staffing. If yes, it moves forward.
Gather documentation & notify the case manager
The agency assembles the member-specific records the rule requires and lets the case manager know a request is coming.
Submit to HCPF in the right phase window
The agency completes and submits the Exception Request through HCPF's tool during the applicable submission period. The request goes into pending status, and HCPF and the case manager are notified.
Pending = care continues. Once the request is submitted, the caregiver is not required to follow the weekly limit until HCPF approves or denies it. A member's care doesn't stop while everyone waits. § 8.7419.2.c.v
Review & attestation (CFC members)
For members with case management, the case manager reviews and submits an attestation within 7 calendar days. HCPF will not review the request until that attestation is in.
Review & possible follow-up
HCPF gives an initial response within 14 calendar days. If it needs more information, it sends a Request for Information and your agency has 7 calendar days to respond, or HCPF decides on what it already has.
Final determination
HCPF approves, partially approves, or denies the request — case by case, based on the documentation and the member's assessed needs.
Decision is shared and acted upon
The determination goes to the agency, the FMS contractor, and the case manager; your agency informs the caregiver.
- Approved: valid through the Prior Authorization (PAR) end date.
- Denied: come into compliance within 7 calendar days; a new request is only possible with a change in circumstance and new documentation.
TIMING MATTERS
Submission windows for members already over the limit
If a member is currently over the cap, the request has to be submitted in that member's phase window. Miss it, and HCPF warns that funds for over-limit hours before a request was filed can be recouped — even if the exception is later approved.
| Phase | Who it covers | Submit during | HCPF review |
|---|---|---|---|
| Phase 1 | More than 84 hours/week from a single caregiver | July 1 – 31, 2026 | Through Aug 31, 2026 |
| Phase 2 | More than 70 hours/week, no approved exception | Nov 1 – 30, 2026 | Through Dec 31, 2026 |
| Phase 3 | More than 56 hours/week, no approved exception | May 1 – 31, 2027 | Through Jun 30, 2027 |
Newly over the limit? If a member crosses the cap because of a recertification, a change in condition, a new enrollment, or a new caregiving situation, the request is submitted when the need is identified — it doesn't wait for a phase window. Whenever possible, the rule asks agencies to file at least 30 days before the service start date.
WHAT GOES INTO THE EXCEPTION REQUEST
The documentation checklist
Your agency assembles all of this but knowing what's needed helps you hand over the right records quickly. Tap each item as you and your agency pull it together.
WHERE WE COME IN
You handle the care, we handle the request.
Because only the agency can file an exception and because a strong, on-time request is paramount — this is work we take on for the families we serve. It's part of how we advocate, not an add-on.
Flag when a caregiver is approaching the weekly limit, before it becomes a problem
Prepare and submit the request inside the correct window
Respond to HCPF's follow-up questions on deadline
Help you gather the right documentation for the criteria that fit
Coordinate with your case manager so the attestation isn't the bottleneck
Keep you in the loop in plain language, start to finish
The honest part: no agency can promise approval — HCPF decides every case on the documentation and the member's assessed needs. What an agency controls is whether the request is complete, well-documented, coordinated, and filed on time. That's the part we own.
or call/text us at (303) 800-7081
Frequently Asked Questions
Who can submit a Weekly Caregiver Limit Exception Request?
Only the provider agency or the CDASS employer can submit it to HCPF. A member or family caregiver can't file it directly. For Community First Choice members, the agency also coordinates with the case manager, who completes an attestation — but HCPF makes the final decision.
Will the cap reduce my family member's approved service hours?
No. The cap limits how many hours a single caregiver can be paid for per member each week. It doesn't reduce the member's authorized services or budget. Hours above the cap are covered by an additional caregiver, unless an exception is approved.
Can our caregiver keep working while the request is reviewed?
Yes. Once the request is submitted it's in pending status, and the caregiver isn't required to follow the weekly limit until 7 calendar days after HCPF approves or denies it. Care continues during the review.
How long does a decision take?
HCPF gives an initial response within 14 calendar days. If it asks for more information, the agency has 7 calendar days to respond or HCPF decides on what it already has.
How long does an approval last?
An approved exception is valid through the member's Prior Authorization (PAR) end date and must be renewed for the next PAR period. If it's approved within 60 days before a PAR ends, it carries through to the following PAR end date.
What if the request is denied?
Everyone involved must come into compliance within 7 calendar days of the decision. A new request can only be filed if there's a genuine change in circumstance or condition, plus new documentation that supports the exception criteria.
WHERE THIS COMES FROM
Official sources & citations
Everything on this page is drawn from Colorado HCPF's published rule and guidance. For the binding language, go to the source:.
- Emergency Rule — Doc B, MSB 26-05-05-B (10 CCR 2505-10 Section 8.7419, Home and Community-Based Services Weekly Caregiver Limits)
- Operational Memo HCPF OM 26-043 — Implement a Weekly Cap of 56 Hours Per Caregiver Per Member for Select LTSS
- Cap on Weekly Caregiving Hours — Fact Sheet (June 2026)
- Weekly Caregiver Limit Exception Request — Process Workflow (June 2026)
- Exception Submission Checklist for Providers (June 2026)
- Case Manager Attestation Form — Reference Guide (June 2026)
- HCPF Long-Term Services and Supports Training (look under "Weekly Caregiver Limit")
- Annual Caregiver Education Resource
- Provider Agency Caregiver Compliance Attestation Form,
- Exception Request Form link (pending)
- Provider Exception Request Form Reference
This page is educational and reflects HCPF's emergency rule and guidance as of June 2026; the rule and forms may be updated. It is general information, not legal advice, and it doesn't guarantee any outcome. HCPF reviews and decides every exception request on a case-by-case basis. Always confirm current requirements and timelines with official HCPF sources or your case manager.
