Colorado Medicaid · Policy Update · August 2026
On Friday, August 14, 2026, the Medical Services Board finally adopted the Weekly Caregiver Limit rule. It's been in emergency effect since July 1; this vote makes it permanent, effective October 15, 2026. Along the way, HCPF listened to stakeholders and rewrote several pieces of the exception process.
Good news for families leaning on one caregiver. New documentation for agencies to track. Zero change to what a member is authorized to receive.
Here's what moved, and what it means for your Weekly Caregiver Limit Exception Request.
Emergencies now get 21 days, not 7
A caregiver gets sick. Resigns without notice. A family emergency pulls them away with no warning. When that happens, an agency can lean on a temporary Emergency Situation allowance while it works the problem, no exception request required. That window just tripled, from 7 calendar days to 21.
Three extra weeks to recruit, screen, and train a replacement before the exception process even enters the picture. It won't help a member who's been over the cap for months; that's a workforce access barrier or transition exception, a different track entirely. But for a genuine, unplanned gap, it takes real pressure off the agency and the member.
A denial no longer means instant compliance
A denied request meant 7 calendar days to full compliance, no exceptions, no gradual ramp. HCPF heard, correctly, that 7 days isn't enough time to post a job, interview, run a background check, and get someone trained on a specific member's care plan. The finalized rule replaces that single deadline with two milestones:
- Within 14 calendar days of the denial, the agency has to show it's started, a background check running, a new hire in process, documented proof on request.
- Within 30 calendar days, the agency has to be fully compliant.
Hire someone sooner than 30 days, and compliance kicks in the moment they start. Either way, this is real room the old rule never gave, and it's worth updating anywhere you've told a family what happens after a denial.
Clearer language on clinical acuity and end-of-life
A complex diagnosis, on its own, kept getting read as automatic grounds for an exception. That wasn't our interpretation but we are grateful for additional clarity.
For Extraordinary Clinical Acuity, documentation now has to connect the dots explicitly: the member's condition must require precautions, infection control, safety limits, that make continuity with one caregiver clinically necessary and can't reasonably be handled through PPE or another workaround. A diagnosis alone won't carry a request anymore; the why has to be on paper.
End-of-Life picked up nearly identical wording, tying the exception to the specific precautions a condition requires rather than to a diagnosis label by itself. If you're filing under this criteria soon, include the diagnosis documentation anyway; it's still asked for.
One less form
HCPF removed the planned Caregiver Compliance Attestation Form entirely. Providers now share an annual informational resource with caregivers instead; no signature required, no form to chase down and file. Less paper for your caregivers, one less thing for your agency to track and store.
The Case Manager attestation for CFC exception requests is a separate requirement, and it's still very much in place. Don't confuse the two; they serve different parts of the process.
Who's actually on the hook for backup coverage
Alongside the rule, HCPF issued Operational Memo 26-058, effective August 13. It doesn't create new rules; it pulls existing staffing and contingency-planning requirements into one place.
An agency that accepts a member for services is responsible for staffing that member, full stop, whether the caregiver is an employee, a contractor, or an approved family member. If that caregiver becomes unavailable, the agency has to activate its own contingency plan and find alternate coverage; that responsibility doesn't shift just because the caregiver happens to be family. An agency cannot make unpaid help from a member's family its routine or primary backup plan. Voluntary help is fine when a family member offers it. It can't be the system the agency is counting on.
What hasn't changed
The core structure is intact. The cap still phases in at 84 hours a week through Dec 31, 2026, then 70 hours from Jan 1 to June 30, 2027, then 56 hours from July 1, 2027 on. A member's authorized hours and budget stay untouched by any of this; the cap limits what one caregiver can be paid for per member, not what the member receives. A pending exception request still means the caregiver keeps working over the limit while HCPF decides. Nobody stops care to wait on a determination.
Phase 2 matters most right now. If a caregiver is providing more than 70 hours a week without an approved exception, that request has to go in during the November 1–30, 2026 submission window.
What HCPF is reviewing
HCPF also clarified something that trips a lot of people up: reviewers aren't evaluating whether a member's condition is serious. They're evaluating whether this specific request, one caregiver, that many hours, is appropriate for that condition. Answer that question directly and you're most of the way there. A full medical chart isn't required, and HCPF has stated this explicitly; send only the information tied to the exception itself.
HCPF also published a new Exception Request Tips resource on its Long-Term Services and Supports Training page, built specifically to cut down on the back-and-forth Requests for Information that slow a case down. Worth a read before your agency files for the November window.
None of this changes who can file. It's still the provider agency or the CDASS employer, never the family, never the member. If a caregiver on your case is approaching the cap, or you're not sure how the new denial timeline or emergency window applies to your situation, talk to us or read the full breakdown on our 56-hour caregiver cap exception process page.
This post is educational and reflects HCPF's finalized rule and guidance as of August 2026. It is general information, not legal advice, and doesn't guarantee any outcome. Always confirm current requirements with official HCPF sources or your case manager.
0 Comments