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! | | A Message from the Executive Director | | Federal Changes to Medicaid | | |
H.R.1 – the One Big Beautiful Bill Act (OBBB), was signed into law July 4 and represents the largest cuts to Medicaid since the program began in the 1960s. The Department of Health Care Policy and Financing (HCPF) anticipates that the bill will ultimately result in the large-scale loss of health coverage for Coloradans and an extraordinary, longer term funding shift from the federal government to our state that Colorado’s state budget cannot absorb.
One change took effect immediately - our ability to use federal funds to pay certain reproductive health care providers, largely impacting Planned Parenthood and the thousands of Medicaid members who use them for primary care and women’s health services. We are working to ensure members impacted by this change are connected to other providers to receive needed services.
Some provisions that affect Colorado Medicaid members and providers do not take effect until December 2026. This includes increasing eligibility renewal frequency from annually to every 6 months, as well as the new work requirements provision, both of which impact the 377,000 member Medicaid Expansion population. Implementing these federal mandates will require significant IT system investments, staffing resources, industry and efficiency advances, massive communications, stakeholder engagement and more. The work requirements aspect of the bill is especially concerning.
HCPF remains committed to improving efficiencies within our eligibility ecosystem while advancing automation where possible to reduce administrative burden for our members, county partners and others impacted by the bill. That said, creating an entire industry and ecosystem that captures and feeds work requirements related, member-specific data insights into the eligibility process required by the bill - like student status, work hours, and volunteer or community work - will be a very heavy lift, especially given the December 2026 deadline. Further, automating the processing of those insights into the eligibility ecosystem will also be an important part of the design, build and investment process to mitigate this new and significant barrier to Coloradans securing or maintaining eligibility. While federal waivers to states that need additional time to build this capability are a component of the bill, securing a waiver is not a certainty, nor is the additional time a waiver might allow.
HCPF efforts will focus on our north star, which is to mitigate inappropriate health care coverage loss and the challenging downstreaming results, such as increased uninsured rates, poor health outcomes and medical bankruptcies for those who lose coverage, increased provider uncompensated care, and the cost shifting that will increase commercial health insurance rates paid by Coloradans and employers as a result.
OBBB provisions that decrease provider fees and related federal funding will significantly reduce revenues to cover Medicaid and the Children's Health Insurance Program (CHP+) beginning October 2027. This reduction in federal funding will propel very difficult conversations necessary to balance program expenses with lower available revenues. Specifically, federal funding collected through HCPF, in partnership with the Colorado Healthcare Affordability and Sustainability Enterprise (CHASE) will decrease; this funding finances care for more than 425,000 Coloradans covered under Medicaid Expansion, Buy-In Programs for Individuals with Disabilities, and CHP+ coverage for children and pregnant women each year. This funding also significantly increases reimbursements to Colorado’s hospitals. Beginning October 2027, the amount of federal funds that states can draw down decreases each year by 0.5%. Each incremental reduction of 0.5% to the threshold would result in an estimated reduction of over $115 million in provider fees that can be collected from the hospitals and a loss of approximately $180 million to $525 million in federal matching funds for hospital reimbursement or expansion coverage, depending on policy decisions made by the state. Once the threshold reaches the target of 3.5% in federal fiscal year 2032, the estimated annual reduction would be over $550 million in collected fees from hospitals, generating a reduction in federal funds that could be drawn down ranging from $900 million to $2.5 billion annually, depending on policy decisions made by the state.
This federal reduction in funding to all states will further complicate our existing state budget challenges, requiring advanced planning, early action, efficiency partnerships, stakeholdering, and lots of collaboration to balance Medicaid and CHP+ costs with shrinking revenues.
Related, last month HCPF also submitted a State-Directed Payment (SDP) proposal for hospital payments to the Centers for Medicare and Medicaid Services (CMS) for review. The SDP is a mechanism that state Medicaid programs have used to allow targeted supplemental payments for care provided under Medicaid managed care arrangements. These efforts represent another step taken by hospitals, the Colorado Hospital Association, the CHASE Board and HCPF to address fiscal concerns, in accordance with HCPF’s Medicaid Sustainability Framework. The addition of hospital SDP funds would provide more ways to bolster inpatient and outpatient services for both urban and rural hospitals across Colorado, as well as psychiatric institutions. If CMS approves the proposal, the new SDPs could increase overall funds by an estimated $378 million beginning in the state fiscal year 2025-2026. This would represent more than $295 million of estimated net new funds going to urban hospitals, more than $75 million of estimated funds going to rural and critical access hospitals and $4 million of estimated funds going to psychiatric institutions. Thank you to all partners who worked so hard with HCPF experts to complete a huge amount of complex work in a short amount of time to make this happen.
HCPF recognizes that these new federally mandated changes will impact all Coloradans, not just those served by our safety net coverage programs. We will collaborate with other state departments and stakeholders to double down on efforts to mitigate the commercial health insurance price increases that will result from the provisions of this bill. We must also advance and increase efforts to mitigate the financial threats to doctors, hospitals, and other care providers from this bill - especially rural providers - that will occur as uninsured rates rise, driving increases in uncompensated care costs that will threaten care access, health care jobs, and ultimately the solvency of certain providers.
HCPF will continue to communicate broadly and transparently with members and stakeholders on these and other issues, and in advance of changes to program eligibility requirements, processes, benefits, coverage or provider reimbursements.
We will continue to post updates on our federal resource center. There you will find the most recent information and a variety of tools, such as:
With the federal changes creating more pressure on an already strained Colorado budget, we must focus on controlling Medicaid cost trends. One of the ways we are doing this is by advancing our Accountable Care Collaborative (ACC), the primary delivery system for Health First Colorado. On July 1, 2025, we transitioned to Phase III of this program. Designing ACC Phase III has been a multi-year effort with the participation of thousands of stakeholders across Colorado. Thank you to everyone who engaged in the stakeholder efforts. All efforts are now paying off in real time.
Phase III of the ACC makes comprehensive advances to increase accountability and transparency; enhance care and case management and health improvement programs; create Accountable Care Organization (ACO)-like primary care performance with a special focus on better supporting rural primary care providers and rural health clinics advance their infrastructure to drive quality of care, affordability and their sustainability; and advance technology across the board. Regional Accountable Entities (RAEs) are a critical component of the ACC and are responsible for promoting member health and well-being. As part of Phase III, RAEs will: increase focus around supporting member transitions of care from inpatient and residential settings; implement member incentives over time; and provide ACO-like primary care infrastructure support for independent rural primary care providers and Rural Health Clinics. In addition to RAEs, the ACC includes two managed care organizations (MCOs) that contract with providers and manage member physical health benefits in their service areas. HCPF’s new partners effective July 1, 2025, include:
- RAE Region 1 and MCO: Rocky Mountain Health Plans (RMHP) and RMHP PRIME
- RAE Region 2: Northeast Health Partners
- RAE Region 3: Colorado Community Health Alliance
- RAE Region 4: Colorado Access
- Elevate (Denver Health) Medicaid Choice
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HCPF’s RAE Regions match the Behavioral Health Administrative Service Organizations (BHASOs) regions, administered by the BHA, to the betterment of the provider and member experience, patient outcomes and administrative efficiencies. RMHP is also the BHASO in Region 1; Signal Behavioral Health Network is the BHASO in Regions 2, 3, and 4. For more information on ACC Phase III, please visit our website.
This and other HCPF priorities are included in our Department Performance Plan, which has been updated and posted to our website as of July 1.
We invite you to register for our Annual Stakeholder Webinar on August 12 from 9 -11 a.m., which will cover additional details on the OBBB provisions, the process to address them, state budget challenges, Medicaid cost trend drivers, and priorities for fiscal year 2025-2026. We look forward to engaging with you then.
Thank you again for your collaborative partnership in tackling our emerging, shared realities.
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HCPF Annual Stakeholder Webinar:
We invite you to join Health Care Policy & Financing leaders for our Annual Stakeholder Webinar on August 12 from 9 to 11 a.m. We will discuss emerging federal threats to Medicaid, state budget challenges, Medicaid cost trend drivers, and priorities for fiscal year 2025-2026. We look forward to your engagement and feedback at this important event. Please register on our website. Webinar materials will be available after the event.
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ACC Phase III Has Launched:
We are excited to share that Phase III of the Accountable Care Collaborative (ACC) began July 1, 2025. More information about ACC Phase III, including the new Regional Accountable Entity (RAE) contracts and region map, is available on our website.
Thank you to each and every one of you who have supported this program. This has been a multi-year, stakeholder-informed effort with over 135 stakeholder meetings with more than 5,700 attendees to design the next iteration of this program, and we couldn’t have done it without your help!
Resources
While we are thrilled to reach this important milestone, we also know that no matter how much you prepare, there will always be unexpected issues that arise.
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Providers: If you experience issues due to the transition or you have questions around contracting, payment, attribution or member care coordination and support, contact your RAE first.
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Members: Members with questions or concerns about this transition can contact Health First Colorado Enrollment or their RAE.
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For Critical Issues: Complete this form if you have been notified of or are experiencing a critical issue due to the transition that could not be resolved through the above steps. Identified issues that may impact a larger number of stakeholders will be documented on this System-Wide Issues and Resolutions Log.
Informational Resources about ACC Phase III
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Medicaid Sustainability: Behavioral Health and Managed Care Actions Memo:
HCPF prepared the Medicaid Sustainability: Behavioral Health and Managed Care Actions Memo to transparently share with the Regional Accountable Entity managed care entities expectations for the coming 2025-26 fiscal year to maintain alignment with the Medicaid Sustainability Framework. This memo helps frame for all stakeholders, HCPF’s policy strategies to successfully navigate Colorado’s fiscal challenges as well as the evolving federal Medicaid funding threats. It is critical at this time that HCPF evaluates and monitors the impact of the implemented changes on Medicaid behavioral health cost trends and the shared Medicaid Sustainably framework and goals.
The Medicaid Sustainability Memo is on HCPF’s Behavioral Health webpage. For more information, contact hcpf_bhbenefits@state.co.us.
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Important Updates About Behavioral Health Crisis Services in Colorado:
The 988 Colorado Mental Health Line is now the primary way to connect to free emotional, mental health, or substance use support 24/7, as a result of Colorado legislation, Senate Bill (SB) 25-236. Get connected and learn more at 988Colorado.com.
What does this mean for the Colorado Crisis Services (CCS) line?
As of July 1, 2025, anytime someone contacts the Colorado Crisis Services via phone or text, they are connected to 988 Colorado.
What are the impacts to the CCS Peer Support Line?
As of July 1, Coloradans in search of peer support services should call 988 to receive support. During the consolidation process, the previous peer support line will continue to be available; however, we encourage people to make the transition to 988.
When can more updates be expected? The 988 Team is providing monthly updates on the 988 Colorado Crisis Services webpage until the transition is complete. Sign up to receive the monthly 988 Colorado newsletter. Contact the 988 team at 988Colorado@state.co.us with any questions.
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You're Invited: Nutrition Benefit Stakeholder Webinars:
HCPF invites you to participate in upcoming webinars to share feedback and ask questions about the development and implementation of the Nutrition Benefit under the Health-Related Social Needs (HRSN) initiative.
This benefit aims to improve health outcomes through targeted services, including:
- Nutrition counseling and education
- Medically tailored meals
- Pantry stocking or home-delivered meals
The HRSN benefit rollout will occur in phases, beginning with housing on July 1, 2025. Stakeholder webinars will inform nutrition service delivery, billing, and policy design. The Nutrition Benefit will go live no sooner than Jan. 1, 2026.
Webinar Details:
HCPF will host three virtual webinars via Zoom. Please register in advance or at the start of the webinar. Once you register, you will receive a confirmation email with information to join the webinar.
Audience: Providers, members, advocacy groups, and impacted communities.
Webinar Schedule and Topics:
- Aug. 13, 12 to 1:30 p.m. | Nutrition Counseling/Education & Pantry Stocking or Home-delivered Meals
- Sept. 10, 12 to 1:30 p.m. | Medically Tailored Meals
- Oct. 15, 12 to 1:30 p.m. | Other Benefit Details
Unable to attend?
Webinar recordings and materials will be emailed to registrants and posted to the HRSN website within 10 days.
Webinar Accommodation and Language Access Notice:
Audio will be available in English and Spanish.
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 webinar organizer, Ryan Lazo at hcpf_stakeholders@state.co.us, or the Civil Rights Officer at hcpf504ada@state.co.us at least one week prior to the webinar 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 el organizador de reuniones, Ryan Lazo a hcpf_stakeholders@state.co.us, o con el oficial de derechos civiles a hcpf504ada@state.co.us al menos una semana antes de la reunión para hacer los arreglos necesarios.
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Certified Community Behavioral Health Clinics Planning Grant Stakeholder Engagement Opportunities:
HCPF and the Behavioral Health Administration (BHA) continue to learn from our stakeholders as we work together on the Certified Community Behavioral Health Clinics (CCBHCs) Planning Grant Project. We are seeking feedback from all stakeholders, including providers, advocates, those who receive behavioral health services, and their loved ones. Please join us for any and all of the following stakeholder engagement opportunities:
Monthly CCBHC Stakeholder Meeting
Held on the last Wednesday each month from 1 to 2 p.m.
HCPF and BHA host a monthly public meeting for all stakeholders to review progress and share input on CCBHC Planning Grant efforts. The forum is open to members, providers, individuals with lived experience and their families, advocates, state agencies, managed care entities, and anyone interested in learning more about the CCBHC model in Colorado.
Please register in advance to attend.
CCBHC Steering Committee
Held on the last Monday each month from 3 to 4 p.m.
A CCBHC Steering Committee (CCBHC-SC) meets monthly to provide input throughout the CCBHC planning process. CCBHC-SC Meetings are open for public observation with time reserved for comments and questions.
Please register in advance to attend.
The CCBHC-SC is guided through contractor consultation, state leadership, stakeholder feedback, and the work of the following subcommittees:
- Prospective Payment System and Finance Subcommittee
- Held on the third Wednesday of each month at 2 p.m.
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Please register in advance to attend.
- Certification and Provider Readiness Subcommittee
- Held on the first Tuesday of each month at 2 p.m.
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Please register in advance to attend.
- Quality Measure Data Management Subcommittee
- Held on the third Tuesday of each month at 2 p.m.
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Please register in advance to attend.
Subcommittees will include subject matter experts from clinics and organizations who render care to the CCBHC Planning Grant’s populations of focus, Colorado’s priority populations, as well as urban, rural, and frontier communities to ensure CCBHC-SC and subcommittees are reflective of Colorado's geographic and cultural diversity.
All CCBHC meetings are open to the public. We value the feedback and participation of all stakeholders from all levels and perspectives.
Thank you for helping us continue to improve the Behavioral Health system in Colorado.
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Provide Feedback on 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, and
- plans for future letter improvements.
In addition to providing updates, attendees will have the opportunity to provide feedback on member letters in smaller workgroups. Registered attendees will receive materials to review at least one week in advance of the meeting. Please come prepared to provide feedback. 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, July 17, 2025, 12 to 1:30 p.m.
- Thursday, Oct. 16, 2025, 12 to 1:30 p.m.
- Thursday, Jan. 15, 2026, 12 to 1:30 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 Ryan Lazo 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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