For years, spouses in Colorado faced a rigid “40-hour rule” that limited how much Personal Care they could provide. Under the new Community First Choice (CFC) benefit, that specific spousal restriction is gone—but it has been replaced by a new system called Annual Service Limitations (or “Soft Caps“).
According to HCPF Operational Memo 25-076 (Effective Dec 22, 2025), the state has standardized how many hours any member can receive without a special exception.
Here is the honest truth about what you can be paid for in 2026.
The “40-Hour Rule” is Gone. The “Soft Cap” is In.
In the past, the limitation was on the spouse. Now, the limitation is on the service itself.
- Personal Care Soft Cap: ~6.5 Hours Per Day
- The Rule: The state has set a soft cap of 10,000 units per year for Personal Care. This averages out to roughly 6.5 hours per day (or about 45.5 hours per week).
- The Win: This is actually higher than the old 40-hour spousal cap. If your spouse provides all this care, they can now be paid for up to ~45 hours/week without needing a special exception.
Skilled Care (HMA) Limits
- HMA Soft Cap: ~13 Hours Per Day
- The Rule: For Health Maintenance Activities (skilled tasks like bowel programs, wound care, or ventilator support), the new soft cap is 19,000 units per year (approx. 13 hours/day).
- Impact: Spouses can still perform these skilled tasks if they demonstrate competency.
The “Protective Oversight” Warning
This is the biggest change for families.
- The New Limit: Protective Oversight (supervision for safety) is now strictly capped at 7 hours per week (1,460 units/year).
- The Truth: Requests exceeding 7 hours/week now require a State Review. Case managers can no longer authorize high hours of “watching” or “monitoring” without documenting a specific disability-related safety risk.
Can I Get More Hours? (The Exception Process)
Yes. These are “Soft Caps,” not hard limits. If your medical needs exceed these amounts, your Case Manager can submit an Exception Request.
To get an exception approved, you must prove:
- Extraordinary Care: The need exceeds what is typical for someone of your age (especially for children).
- Medical Necessity: There is a documented medical, cognitive, or behavioral condition requiring higher oversight.
- No Duplication: The service isn’t being covered by another program.
How We Help
Navigating “Soft Caps” and “Exception Requests” is complicated. As your agency, we help you understand these guidelines so you can advocate effectively with your Case Manager. We ensure your care plan is sustainable, compliant, and maximizes the support your family is entitled to.
Source Reference: Colorado Department of Health Care Policy & Financing, Operational Memo 25-076: Direct Care Services Calculator and Age-Appropriate Task Standards, December 16, 2025.
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