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 | | Accountable Care Collaborative: Major Lever to Curb Cost Trends | | |
The fiscal year 2025-26 Department of Health Care Policy & Financing (HCPF) budget includes $18.2 billion total funds and $5.5 billion General Fund, representing an increase over fiscal year 2024-25 of 7.4% in total funds, 6.8% in General Fund and 5.4% in the number of Coloradans covered by HCPF’s safety net programs.
Controlling Medicaid cost trends is essential to the sustainability of our safety net programs and the proper management of the state budget. The HCPF Medicaid Sustainability Framework seeks to organize emerging budget reduction concepts and strategies to enable the thoughtful navigation of the state’s multi-year fiscal challenge, while fostering collaboration and alignment between HCPF and key stakeholders to achieve the shared goal of mitigating draconian Medicaid cuts.
The Accountable Care Collaborative (ACC) is a major lever to better control Medicaid cost trends. The ACC is the delivery system for Colorado’s Medicaid Program. Phase III of the ACC makes comprehensive advances starting July 1, 2025, and is designed to increase accountability and transparency; enhance care and case management and health improvement programs; create Accountable Care Organization (ACO)-like primary care performance; better support rural provider sustainability and affordability; and leverage advances in technologies across the board.
Regional Accountable Entities (RAEs) are managed care entities (MCEs) that are a critical component of the ACC. RAEs are expected to understand the nuances among populations in the geographic area they cover to create cohesive provider and community support networks that deliver coordinated, whole-person care that improves health outcomes and better controls Medicaid cost trends. 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.
ACC Phase III will build on innovations and tools in Medicaid to help curb cost trends:
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eConsults allow primary care and specialty providers to work together to decide the best treatment options with a member-centered approach to care that reduces unnecessary specialist visits, lowers cost trends, improves member access to care, and reduces specialist visit “no-shows.”
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Prescriber Tool automates the prescribing and prior authorization process to reduce provider admin burden, improve member drug compliance to drive better patient outcomes, improve trend control by increasing preferred drug list compliance and provide information on prescription drug costs so providers can be part of the affordability solution and earn value based payments that reward their efforts.
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RAE ACO-like primary care tools as well as an analytics platform alternative developed in collaboration with HCPF, the Office of eHealth Innovation and the Colorado Community Managed Care Network that provides improved coordination between health care providers through ACO-like analytics, resulting in better trend controls, improved patient outcomes, and ease of administration for providers.
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Providers of Distinction drives quality and affordability indicators and insights to providers and members to help inform decisions on where to access care. Providers can receive value based incentives and referrals for higher quality and trend management performance.
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Value Based Payments incentivize providers to prioritize patient health outcomes as well as affordability. Currently, 52% of Colorado Medicaid payments are value based, exceeding the 50% CMS target for 2025.
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Member incentives will be incorporated under the ACC Phase III in time to improve member engagement in programs like pre-natal care or case management, which improve member health outcomes and trend management.
In ACC Phase III, there will be four RAE regions, plus two managed care organizations (MCOs). This structure creates greater efficiencies and membership volumes necessary to support the increased demands on the RAEs and MCOs, associated with the requirements and advances explained above. 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: Northeastern Health Partners
- RAE Region 3: Colorado Access
- RAE Region 4: Colorado Community Health Alliance
- Denver Health Medicaid Choice MCO
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HCPF’s RAE Regions match the Behavioral Health Administration’s Behavioral Health Administrative Service Organizations (BHASOs) regions, as promised, 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.
Thank you to the thousands of participants who engaged in the stakeholder process to inform the ACC Phase III development. All that work comes to fruition effective July 1, 2025. For more information on ACC Phase III, please visit our website.
From a rural perspective, HCPF is working with hospital leadership to implement these innovations, tools and programs as a priority, as they enable rural PCPs to significantly improve quality of care and affordability performance across not just Medicaid, but Commercial and Medicare Advantage plans as well, and earn value based payments for doing so - creating a win/win/win for rural providers, payers and Coloradans. We are also collaborating to identify rural hospital efficiencies in licensure, structure, rural collaborative partnerships and expense sharing through SB23-298 and SB25-078, as well as care coordination infrastructure. This evolution across rural hospitals, rural health clinics and independent rural PCPs is critical to their sustainability, as pillars in care access to rural communities across the state.
On the federal landscape, HCPF continues to monitor the Congressional Reconciliation process. We should begin to have optics into emerging legislation around May 7, which will help inform specific areas of risk for Medicaid. Right now, top threats to Medicaid funding seem to relate to:
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Reducing or eliminating provider taxes: putting in jeopardy Colorado Healthcare Affordability and Sustainability Enterprise (CHASE) federal dollars, which finances coverage for over 425,000 Coloradans covered by Medicaid and CHP+ Expansion; increases Medicaid reimbursements to hospitals, especially rural hospitals while providing an additional $12 million a year in rural hospital assistance to 23 of the lowest revenue rural hospitals; and finances Coloradans with disabilities who buy-in to Medicaid, thereby enabling them to be gainfully employed, while accessing critical support services.
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Medicaid fraud, waste and abuse (FWA), including federal penalties and funding claw-backs for performance in areas such as: not employing comprehensive or aggressive enough efforts and programs; not being in compliance with emerging requirements; and findings associated with federal audits of Medicaid claim payments or eligibility performance. Here is a fact sheet on HCPF’s current and advancing FWA efforts. While FWA has always been a focus for HCPF, all stakeholders should expect continued HCPF advances in this area, in parallel with federal direction and the trend control needs of the state.
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Reducing the federal match rates (FMAP): decreasing the 90% Expansion factor or the CHASE factors that determine the provider fee and the related federal match, such as the Net Patient Revenue 6% formula factor; decreasing the base FMAP (for Colorado, that impacts our 50% base match rate); eliminating or reducing the FMAP floor, which is now at 50%; and reducing or eliminating enhanced administration federal match rates.
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Mandating Work Requirements on the Expansion population or other adult populations.
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Creating a per member funding capitation model.
We continue to update our Impact of Federal Funding Cuts to Medicaid webpage. There you will find the most recent information and a variety of tools:
Given the systemic challenges with the state budget and the continued federal threats to Medicaid funding, we thank you in advance for your engagement in HCPF efforts to educate Congressional elected officials on the impact of Medicaid cuts, to better control Medicaid trends and expenses, to support our rural providers, and to evolve our budget reduction options in a way that mitigates draconian cuts and impact to benefits, populations and providers. And thank you for your partnership and collaboration as we implement ACC Phase III effective July 1.
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ACC Phase III New Resources for Providers:
Are you a Health First Colorado provider currently contracted with one or more of the RAEs? If you’d like to continue providing services for Health First Colorado members, check out our contracting reminders for both behavioral health providers and primary care medical providers (PCMPs).
For PCMPs, we recently published the following resources:
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ACC Phase III Attribution fact sheet: HCPF has made several updates to the attribution methodology for Phase III after receiving significant feedback about the current methodology in ACC Phase II. Learn more about those changes in this fact sheet.
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ACC Phase III PCMP Payment fact sheet: HCPF is introducing an updated primary care alternative payment model structure for all PCMPs that integrates programs previously operated separately by HCPF and the RAEs. The result is a single, comprehensive primary care payment structure that aims to elevate the quality of primary care services provided to Health First Colorado members.
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Primary Care Payment Structure webinars: HCPF hosted a series of webinars to review the components of the primary care payment structure. Recordings, slide decks and other materials are under the “Past Presentations and Materials” section of the ACC Stakeholder Engagement webpage.
General updates:
Website updates are in progress! Check out the ACC Provider and Stakeholder Resource Center webpage to see reorganized information, new fact sheets and links to other helpful resources. We are continuing to update our existing webpages with resources for the transition to Phase III. Be sure to check frequently for the latest updates.
HCPF and the RAEs are continuing to work closely on the transition to ACC Phase III. We are grateful to all of the stakeholders, especially those in our advisory committees, that have continued to provide feedback to improve the transition experience for members, providers and community partners. We regularly discuss ACC Phase III topics at our monthly Program Improvement Advisory Committee (PIAC) and subcommittee meetings. These meetings are also open to the public, though your ability to participate may vary. Agendas and other information about joining is on the ACC PIAC webpage.
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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.
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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.
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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.
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