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!

Budget Priorities

The Department of Health Care Policy & Financing (HCPF) invites you to keep up with the evolving discussions on HCPF’s overall fiscal year 2025-26 budget by listening to the Jan. 6 Joint Budget Committee budget hearing. Thank you in advance for your support of our $17.4 billion total funds and $5.4 billion General Fund request to cover eligible Coloradans under Health First Colorado (Colorado’s Medicaid program), Child Health Plan Plus (CHP+) and other safety net coverage programs. Our programs serve and cover about 1.3 million Coloradans today, including more than 40% of Colorado’s children and over 40% of births, as well as individuals with disabilities and older adults qualifying for long-term services and supports (LTSS).

With the end of federal stimulus funding, the state has returned to the more typical, tighter budgets of years gone by, further complicated by the difference between the lower inflationary factors used to calculate the TABOR limit compared to higher medical cost trends associated with Medicaid programs. Additionally, on average, members with higher medical needs have remained or returned to coverage through the PHE Unwind, while those disenrolling had lower medical needs. This is causing a significant increase in the average per member per month (per capita) cost of Medicaid membership. This increase is above expectations and reflects a net 1.16% over-expenditure against our FY 2023-24 services budget projection as well as higher costs in current and future fiscal years. Many states are facing similar increases in Medicaid spending despite lower enrollment post unwind (KFF Brief & News). This is concurrent with the increasing Medicaid trends and overexpenditures reflected in higher Medical Loss Ratios (MLRs) as reported by commercial carriers. 

We are grateful for our allocation in the Governor’s budget, 96% of which goes to our providers to care for the one in four Coloradans we are honored to serve. Four percent of these funds are allocated to HCPF administration expenses, such as our contracted partners, with 0.5% covering HCPF staff. This 4% is about one-third of the typical commercial health plans’ administrative expenses.

The largest part of the HCPF budget request reflects the $1.4 billion in additional total funds necessary to cover our current programs while preserving member benefits and care access in a time of very limited spending growth. HCPF’s proposed discretionary fiscal year 2025-26 budget requests focus 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; complying with federal requirements; and meeting federal requirements for modular health plan systems. Additional information is available on our website. 

On the PHE Unwind, HCPF continues to collaborate with counties to reconnect individuals to Medicaid coverage where appropriate. With very limited exceptions, our county partners have eliminated the new application and renewal processing backlogs that accumulated during the PHE Unwind (May 2023 - April 2024) due to the unprecedented 1.8 million member renewal volume moving through the renewal process, in alignment with member renewal anniversaries. Further, case escalations are also way down (consistently less than 250/month). Case escalations are submitted by providers, advocates, members and others to HCPF to help navigate eligibility cases through renewal barriers in collaboration with counties. More than 90% of these case escalations result in coverage being retained or restored. 

Given this progress, HCPF is working with counties to focus attention on eliminating any remaining “work task” backlogs; in processing those, members should be renewed back to their anniversary date if data was available but not applied during the initial renewal processing. Last, HCPF is also working with other state agencies and stakeholders to reconnect Coloradans back to Medicaid coverage where appropriate, while connecting Coloradans to other coverage like employer-sponsored, Medicare, or Connect for Health Colorado individual coverage to enable subsidies that make coverage more affordable. Open enrollment programs with coverage effective Jan. 1, 2025, provide an important opportunity to achieve this shared goal. Of course, all this is concurrent with continued work to improve system ex parte automation and HCPF’s “County Administration and Colorado Benefits Management System (CBMS) Enhancements,” which includes $38.2 million total funds and $4.1 million General Fund intended to address the issues identified through the SB 22-235 County Administration of Public and Medical Assistance Programs. (See my November message for more information).

Regarding the challenges with our Care and Case Management (CCM) system, HCPF is actively engaged with leaders of key vendor partners to address system defects and to drive improvements in service and support to members, case management agency (CMA) partners, providers and counties. Significant resources have been added to this mission-critical work to drive additional throughput of system fixes, with target stabilization in April. A dashboard is being built for a target January posting that provides optics into each major CCM system stabilization initiative, its target completion date, the responsible party, and its status against target.  

Thank you for collaborating with the state through difficult state budget decisions, to get Coloradans reconnected to coverage post the PHE Unwind, and to thoughtfully respond to emerging changes in the national policy landscape in the months to come. 

Best wishes for an enjoyable and healthy holiday season!

Prescriber Tool Alternative Payment Model (APM) Update:

The Prescriber Tool Alternative Payment Model (APM) is an upside-risk-only program designed to incentivize increased and consistent use of the Prescriber Tool by Health First Colorado providers receiving fee-for-service payments for their outpatient pharmaceutical claims, specifically the Real-Time Benefits Inquiry (RTBI) module, and prescription of preferred medications where clinically appropriate.

Two virtual webinars were held in October discussing the updates being made to Year 2 of the Prescriber Tool APM. The slides and webinar recording are on the Prescriber Tool Alternative Payment Model webpage. Program Year 2 for Prescriber Tool APM began in October 2024. The activity window begins in January 2025. Eligible providers should look for an email in January 2025 with a link to complete the activities required and be eligible for payment.

Contact HCPF_PharmacyAPM@state.co.us with questions or for more information.

Bariatric Surgery Rule Revision Stakeholder Meetings: 

HCPF invites stakeholders to participate in a series of virtual meetings to discuss revising the bariatric surgery rule. These meetings will build on feedback from earlier sessions, where stakeholders expressed a preference to revise the rule rather than remove or leave it unchanged.

HCPF staff will provide an overview of the current rule, present proposed revisions based on feedback and open the floor for discussion to gather stakeholder input.

Meeting Dates:

• Meeting 1: Thursday, Jan. 23, 2025, 9:30 a.m. to 12:30 p.m.
• Meeting 2: Thursday, March 13, 2025, 9:30 a.m. to 12:30 p.m.

Location: Virtual via Zoom. Register in advance

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. Please notify us at HCPF_Stakeholders@state.co.us at least one week prior to the meeting to make arrangements.

For more information, visit the HCPF Bariatric Surgery Rule Revision webpage or contact HCPF_Stakeholders@state.co.us.

Non-Emergent Medical Transportation (NEMT) Stakeholder Meeting:

HCPF invites the public to a virtual stakeholder meeting to learn more about moving to a statewide broker model. 

HCPF staff will review the reasons for and benefits of the proposal. Attendees are invited to listen, learn, ask questions, and provide feedback. 

Meeting date and time: Monday, Feb. 3, 9:30 to 11:30 a.m. 

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

For those who cannot attend, a recording will be shared afterward and posted to the NEMT HCPF 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. Please notify Patrick Potyondy at HCPF_Stakeholders@state.co.us at least one week prior to the meeting to make arrangements. 

Las ayudas y servicios auxiliares para individuos con discapacidades y servicios de idiomas 

para individuos cuyo idioma materno no sea inglés pueden estar disponibles por solicitud. 

Comuníquese con Patrick Potyondy a HCPF_Stakeholders@state.co.us al menos una semana antes de la reunión para hacer los arreglos necesarios.

If you have general questions, please contact Patrick Potyondy at HCPF_Stakeholders@state.co.us for more information. 

Disability Competent Care Stakeholder Meeting:

HCPF is committed to ensuring the equitable delivery of disability competent care throughout Colorado’s health care system for all Health First Colorado members. Interested stakeholders are invited to attend an upcoming meeting where HCPF will present updates on the progress being made and solicit input on next steps. 

HCPF will present an overview of where we are as a state, request feedback on the prioritization of upcoming projects, provide information on the obligations of the Regional Accountable Entities, and preview new disability competent care trainings. Attendees are invited to learn, ask questions and provide feedback.

Meeting date and time: Jan. 9, 3 to 4 p.m.

These meetings will be virtual via Zoom. Register in advance for the meeting on Jan. 9. After registering, attendees will receive a confirmation email containing information about joining the webinar.

This meeting will be recorded. Contact Kyra Acuna at HCPF_stakeholders@state.co.us for the recording.

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 Kyra Acuna at HCPF_stakeholders@state.co.us at least one week prior to the meeting to make arrangements. 

Las ayudas y servicios auxiliares para individuos con discapacidades y servicios de idiomas para individuos cuyo idioma materno no sea inglés pueden estar disponibles por solicitud. Comuníquese con Kyra Acuna a HCPF_stakeholders@state.co.us al menos una semana antes de la reunión para hacer los arreglos necesarios.

Contact Kyra Acuna at HCPF_stakeholders@state.co.us with questions or for more information. 

Published: HB24-1322 Feasibility Study:

House Bill 24-1322 directs HCPF to assess whether it is feasible to expand certain housing and nutrition services through Health First Colorado (Colorado Medicaid) that address members’ Health-Related Social Needs (HRSN). If any components are found to be budget neutral, HCPF must seek federal authorization no later than July 1, 2025.

HCPF determined that certain services are feasible based on ongoing expansion work and submitted an amendment request to add certain HRSN services to the 1115 SUD waiver this summer. For the rest of the components, while there is significant supporting evidence, and some infrastructure in Colorado to implement, the budget is difficult to estimate and would exceed federal financial requirements. HCPF also faces timeline constraints which make pursuing additional amendments at this time difficult. HCPF will continue to estimate the feasibility of expansions in a future study, HB23-1300 “Continuous Eligibility Medical Coverage,” due by the start of 2026. 

Read the full study and find webinar materials on the HRSN website. Contact hcpf_hrsn@state.co.us for more information.

Long-Term Services and Supports (LTSS) Stabilization Eligibility Systems Updates:

On Dec. 15, 2024, HCPF will launch a new long-term solution aimed at providing members with additional time to manage their benefits. This solution will temporarily extend eligibility for Long-Term Care (LTC), Working Adults with Disabilities (WAwD), and Colorado's Buy-in for Working Adults with Disabilities (CBwD) programs for 60 days after the noted termination date.

This extension will apply to most termination reasons, not just procedural ones, allowing members extra time to submit their renewal packets and supporting documents. However, there are specific termination reasons that will not be eligible for this 60-day extension, which include:

• Death
• No longer a Colorado resident
• Withdrawal
• Incarceration (for secondary aid codes)

During this period, an initial letter will be sent to members informing them that their termination has been paused and explaining the reasons for this pause.

Additionally, HCPF will automatically re-evaluate eligibility in the second month of the extension. If a member meets all eligibility requirements and submits the necessary documentation, their ongoing eligibility will be approved. If they do not meet the requirements or fail to provide the required information, their eligibility will terminate at the end of the 60 days.

Before the end of this period, members will receive a formal Notice of Action that outlines whether they remain eligible or if their eligibility will end, along with information about their appeal rights.

The sunsetting of current protections in place will be phased in, starting with renewals in January 2025. This approach aims to support members and workers by managing smaller cohorts instead of sunsetting everyone at once. 

If the eligibility worker manually updates the case, then the member may potentially terminate prior to their renewal date. These members will receive the 60-day extension mentioned above, but the member’s eligibility could end before their renewal date.

For questions, please contact hcpf_medicaid.eligibility@state.co.us. 

Member Correspondence Improvements:

HCPF is holding a series of quarterly virtual stakeholder meetings to present information about ongoing improvements to member correspondence.

At the meetings, HCPF staff will share

• updates on improvements being made,
• timelines for making changes,
• plans for future letter improvements, and
• opportunities for stakeholders to stay involved.

In January, HCPF will provide updates and seek additional feedback on the renewal packet. Registered attendees will receive materials to review at least one week in advance of the meeting. Please come prepared to provide feedback. 

Attendees will be able to submit questions to be answered live when possible. Frequently asked questions will be posted on the Member Correspondence Improvements website following the meeting. Attendees will also be able to submit feedback via Google form for two weeks following the meeting.

The meetings will be in English and Spanish. ASL interpretation will be provided.

Meeting dates and times: 

• Thursday, Jan. 16, 2025, 12 to 1 p.m.
• Thursday, April 17, 2025, 12 to 1 p.m.
• Thursday, July 17, 2025, 12 to 1 p.m.
• Thursday, Oct. 16, 2025, 12 to 1 p.m.

Please register for the meetings in advance. After registering, you will receive a unique link to join the meeting. For those who cannot attend the meetings, you may request a recording.

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. Please notify the Stakeholder Engagement Section at HCPF_stakeholders@state.co.us at least one week prior to the meeting to make arrangements. 

If you have general questions, please contact the Stakeholder Engagement Section at HCPF_stakeholders@state.co.us for more information. 

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Mejoras de la Correspondencia de los Miembros

Health First Colorado está trabajando para mejorar las cartas de miembros y están planeando cambios basados en los comentarios de miembros y las partes interesadas.

Únase a nosotros en enero para una reunión virtual para escuchar actualizaciones y compartir comentarios en el paquete de renovación. Todos los que se registren recibirán materiales para repasar al menos una semana anticipada de la reunión. Por favor, vengan preparados para proveer sus comentarios.

Para aquellos que no puedan asistir, una grabación será compartida después y publicada en la página web de correspondencia de miembros.

Los asistentes también serán capaces de someter comentarios a través de un formulario en línea por dos semanas después de la reunión.

Fechas y horarios de las reuniones: 

• Jueves, 16 de enero de 2025, de 12 - 1 p.m.

• Jueves, 17 de abril de 2025, de 12 - 1 p.m.

• Jueves, 17 de julio de 2025, de 12 - 1 p.m.

• Jueves, 16 de octubre de 2025, de 12 - 1 p.m.

Por favor, registrarse para las reuniones con anticipación. Después de registrarse, Usted recibirá un enlace único para unirse a la reunión. 

Las reuniones serán en inglés y español. Se proporcionará interpretación en lenguaje de señas (ASL, por sus siglas en inglés).

Aviso sobre las adaptaciones y el acceso lingüístico para las reuniones: Ayudas y servicios auxiliares para individuos con discapacidades y servicios de lenguaje para individuos cuya primera lengua no sea el inglés puede ser proporcionado bajo solicitud. Por favor, notifique a la Sección de Compromiso con las Partes Interesadas a HCPF_stakeholders@state.co.us al menos una semana previa de la reunión para hacer los arreglos.

Si usted tiene preguntas generales, por favor comuníquese con la Sección de Compromiso con las Partes Interesadas a HCPF_stakeholders@state.co.us para más información.