At a Glance is a Department of Health Care Policy & Financing (HCPF) publication that provides information on major initiatives, policy changes and program updates. Feel free to share At a Glance with your colleagues. Find previous editions of At a Glance on our website. Thank you for your interest!

State and Federal Medicaid Budget Pressures

Colorado’s Joint Budget Committee (JBC) has been making very difficult balancing decisions to address a budget gap of more than $1 billion. The Long Bill, which is the mechanism that funds all state programs for the next fiscal year 2025-2026, allocates $18.2 billion total funds and $5.5 billion General Fund for the Department of Health Care Policy & Financing (HCPF). It includes a 1.6% across-the-board Medicaid provider rate increase, as well as budget balancing proposals, such as: decrease of 1.5% HCPF personnel services; $250k Office of eHealth Innovation General Fund reduction; reduction to the Non-Emergency Medical Transportation (NEMT) rate from $6.41/mile to $3.00/mile; prepayment claims review funding to reduce improper payment; delay Medicaid reimbursement for services provided by a Community Health Worker by six months (SB 23-002 originally scheduled to start July 2025); limit behavioral health peer services to certain provider types most appropriate to provide that care; true-up funding for the SB21-009 Reproductive Health Program; rule change to aspheric lenses for prescriptions and enforce requirement of one pair of eyeglasses every two years; revert 988 Suicide and Crisis Lifeline funding; and restructure the nursing home fees and disability insurance premiums financing model.

The JBC scaled back, but approved, our budget requests focusing on increasing support for county administration to improve efficiencies and customer service in connecting Coloradans to our safety net programs; ensuring Colorado supports an equitable system resulting in high-quality, coordinated Medicaid services through the Accountable Care Collaborative Phase III; and funding for the state's All Payer Claims Database. More information about our budget can be found on our website. 

Our continued collaboration on better controlling Medicaid cost trends must continue as we begin the process of addressing the fiscal year 2026-2027 budget. HCPF’s Medicaid Sustainability Framework is designed to help us navigate Medicaid’s multi-year, fiscal challenge while fostering partnership and collaboration to achieve the shared goal of mitigating draconian cuts.

Medicaid covers 72 million people nationwide, including about 1.2 million Coloradans. Concerns about federal Medicaid cuts are on everyone’s mind. HCPF has new and updated fact sheets on potential impacts of federal proposals provided below.

• New! Video message from me explaining to Medicaid members the potential impacts of federal cuts and what we’re doing to protect Medicaid coverage here in Colorado
• New! Congressional District specific fact sheets provide district specific Medicaid enrollment and economic impact information
• New! Work Requirements fact sheet explains the potential impact of work requirements proposed as part of federal budget reconciliation
• Updated with new data! CO Medicaid Insights and Potential Federal Medicaid Reduction Impact Estimates provides insights on the most commonly discussed federal Medicaid reduction proposals as well as impacts on Colorado
• Updates with new data coming soon! County specific fact sheets provides county specific Medicaid enrollment and economic impact information
• Medical Assistance Coverage fact sheet provides Colorado specific information on Medicaid eligibility and benefits as well as financing mechanisms

Depending on what Congress ultimately passes, the impact to Colorado’s budget may climb well above $1 billion General Fund. To put that figure in perspective, every $1-1.5 billion in lost federal revenue represents a 20-30% needed increase in the state General Fund to replace it. HCPF’s projected fiscal year 2025-26 General Fund budget is $5.5 billion, meaning a $1 billion federal cut would represent about a 20% impact. Unique to Colorado is the combination of state constitutional provisions impacting our balanced budget requirement as well as revenue limitations propelled by Colorado’s Taxpayer Bill of Rights (TABOR) limit. As such, reductions to federal Medicaid funding may disproportionately impact Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+) benefits, coverage, eligibility requirements and/or provider reimbursements. 

Thank you and our many partners for all you do to care for and support our Health First Colorado and CHP+ members. We appreciate your ongoing engagement as we navigate both federal and state fiscal challenges.

Pharmacy Benefit Management System (PBMS) Transitioning Fall 2025: 

HCPF is transitioning some components of its PBMS from Prime Therapeutics (formerly

Magellan) to MedImpact in Fall 2025.

What to know about this transition:

• The Opioid Risk module is not changing and will continue to be managed by OpiSafe.
• MedImpact will implement and manage four new PBMS modules:
• The core PBMS
• Rebate
• Preferred Drug List
• Real-Time Benefit Tool
• Contact information for the PBMS, including the call center phone number, fax number and mailing address for paper claims will change. HCPF will provide this information closer to the transition date.
• The Bank Identification Number/Processor Control Number (BIN/PCN) for the

pharmacy claim submission will remain the same. Pharmacies will submit their claims as usual.

Why is the PBMS vendor changing?

Prime Therapeutic’s contract expires Fall 2025, and HCPF is required by state and federal regulations to solicit competitive bid packages from vendors on a regular basis. Through a competitive bid process, HCPF selected MedImpact to implement four of the five PBMS modules.

The Provider Services Call Center Will Transition May 1: 

As a reminder, the Provider Services Call Center will transition from Gainwell to OptumInsight (Optum). On May 1, 2025, Optum will officially take over management of the Provider Services Call Center.

Help HCPF spread the news

HCPF is committed to informing providers about this change and developed a toolkit so

external partners can assist us with sharing the news with providers. The toolkit includes talking points, an email blurb, and informational PowerPoint slides.

Important details to know

• The Provider Services Call Center phone number will change. The new phone

number will be updated on the Provider Contacts webpage.

• If providers call the current Provider Services Call Center phone number after May 1, they will hear a message with the correct phone number.

• Optum is only taking over management of the Provider Services Call Center. Gainwell will continue as the vendor for the Colorado interChange and the Provider Web Portal.

• This vendor change will only apply to the Provider Services Call Center. For a

complete list of assistance resources, visit the Provider Contacts webpage.

Visit the Colorado Medicaid Enterprise Solutions (CMES) Transition webpage for more information. 

Comprehensive Care for Colorado Webinar:

Join HCPF for an informational webinar on Comprehensive Care for Colorado, the Medicaid 1115 demonstration waiver that includes several benefits including health-related social needs (HRSN) such as housing and nutrition as well as services for substance use disorders and for those who are leaving incarceration from a state facility. Comprehensive Care for Colorado will also allow longer stays when medically necessary in some cases for people experiencing behavioral health needs. HCPF staff will provide brief updates about all of the waiver’s topics and will also answer questions from attendees. 

The presentation and slides will be in both English and Spanish. 

After the webinar, the recording and slides will be posted on the HRSN webpage where you can find additional information about the health-related social needs work at HCPF.

Webinar date and time: Thursday, May 29, 10 to 11:15 a.m. 

Registration and location: The webinar will be virtual via Zoom. Register in advance for the webinar. After registering, you will receive a confirmation email containing information about joining the webinar.

Webinar Accommodation and Language Access: Auxiliary aids and services for individuals with disabilities and language services for individuals whose primary language is not English may be provided upon request. Please notify HCPF_Stakeholders@state.co.us at least one week prior to the webinar to make arrangements. 

Accesibilidad y Acceso Lingüístico del Seminario Web: Las ayudas y servicios auxiliares para individuos con discapacidades y servicios de idiomas para individuos cuyo idioma principal no sea inglés pueden estar disponibles por solicitud. Comuníquese con HCPF_Stakeholders@state.co.us al menos una semana antes del seminario web para hacer los arreglos necesarios.

If you have general questions about health-related social needs, please email hcpf_hrsn@state.co.us.

Telehealth Remote Monitoring Grant:

Senate Bill 24-168 created the Telehealth Remote Monitoring Grant Program which will award up to $500,000 to eligible rural outpatient health care facilities via five (5) $100,000 grants. Grant funds are to be used for implementing telehealth remote monitoring for outpatient clinical services and must be used to: 

a) Pay for the acquisition costs of telehealth remote monitoring equipment and devices 

and 

b) Train staff to use, assess, and monitor telehealth remote monitoring equipment and devices.

The grant will go to eligible rural health care facilities (hospitals, rural health centers, or Federally Qualified Health Centers (FQHCs)) that provide outpatient clinical services in Colorado and are located in a designated rural county or a designated Health Professional Shortage Area (HPSA). 

The purpose of the grant program is to enable rural Coloradans to benefit from telehealth remote monitoring services. Access to these services results in better health outcomes and saves money, time, and energy spent on obtaining health care. 

Telehealth remote monitoring services will provide cost savings for the Health First Colorado (Colorado’s Medicaid program) system by improving rural access to primary care and helping prevent unnecessary trips to the emergency room. In addition, these services are a crucial step toward reducing health disparities and achieving health equity in Colorado. 

Important dates:

Applicants should have emailed HCPF their intent to apply by March 30, 2025.

Applications opened on March 31, 2025, and close on May 1, 2025.

Email address for questions/comments re the Telehealth Remote Monitoring Grant: hcpf_rmg@state.co.us

Visit the website for more information.

Child Health Plan Plus (CHP+) Prenatal Coverage Stakeholder Meeting:

Health First Colorado (Colorado's Medicaid program) and Children's Health Insurance Program (CHIP) Section 1115 waivers allow states to test new approaches to administering Medicaid and CHIP programs beyond what is required by federal statute. These waivers give states flexibility to design and improve their programs to better serve Medicaid and CHIP populations through experimental, pilot, or demonstration projects.

Colorado's Adult Prenatal Coverage in the CHP+ demonstration helps provide necessary prenatal, delivery, and postpartum care to low-income pregnant people. Interested stakeholders are invited to attend a public forum to hear the annual updates on the progress of the 1115 waiver demonstration. This public forum will be hosted by HCPF staff. Attendees are invited to learn and ask questions about the annual updates.

Meeting date and time: June 3, 11 a.m. to 12 p.m. 

Registration and location: the meeting will be virtual via Zoom. Register in advance for the meeting.

After registering, attendees will receive a confirmation email with information about joining the webinar.

A recording of the meeting may be requested by emailing HCPF_stakeholders@state.co.us.

For more information about the CHP+ Prenatal Waiver, refer to the webpage. 

Meeting Accommodation and Language Access Notice: Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Contact HCPF_stakeholders@state.co.us at least one week prior to the meeting to make arrangements. 

Working Adults with Disabilities Stakeholder Meeting:

The Health First Colorado Buy-In Program for Working Adults with Disabilities allows adults with a qualifying disability to "buy into" Health First Colorado (Colorado's Medicaid program). Members who work and earn too much to qualify for Health First Colorado may qualify for the Buy-In Program. Interested stakeholders are invited to a virtual stakeholder meeting to learn about updates to the Buy-in Program for Working Adults with Disabilities effective July 1, 2025.  

HCPF staff will present an overview of the changes to how Health First Colorado members enroll into the Buy-In Program for Working Adults with Disabilities. These changes will specifically impact Health First Colorado members who also receive services through Home and Community-Based Services (HCBS) waivers. Attendees are invited to learn and ask questions about the upcoming changes. 

Meeting date and time: May 8, 1 to 2:30 p.m. Mountain Time   

Registration and location: The meeting will be virtual via Zoom. Register in advance.   

Attendees will receive a confirmation email after registering with information about joining the webinar.  

For a recording of the meeting, email HCPF_stakeholders@state.co.us.  

Refer to the Health First Colorado Buy-In Program For Working Adults With Disabilities webpage for more information about the Health First Colorado Buy-In Program for Working Adults with Disabilities.   

Meeting Accommodation and Language Access Notice: Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Contact HCPF_stakeholders@state.co.us at least one week prior to the meeting to make arrangements.