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Responding to this shared priority, FY 2025-26 R-7 Decision Item, “County Administration and Colorado Benefits Management System (CBMS) Enhancements,” 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 study completed in partnership among HCPF, Colorado Department of Human Services (CDHS) and the counties. That report and budget request were released on Nov. 1 to address the opportunities raised by care providers, members, advocates, contracted partners and legislators to improve our state-county eligibility system, with specific focus across the following:
- Improving access and connectivity to public programs like Medicaid and CHP+
- Improving the timeliness and accuracy of application and renewal processing
- Improving administrative efficiencies and cost effectiveness
- Conducting studies for Long Term Services & Supports (LTSS) financial eligibility, which would allow HCPF to leverage county staff-to-caseload ratio staffing standards for LTSS case processing, while also exploring the resources needed to implement dedicated or designated LTSS financial eligibility resources in counties.
Within the $38 million, R-7 includes $21 million total funds to right size the county funding allocation, which enables an increase in both county staff and wage rates. This HCPF budget request is in complement to CDHS’s parallel investment of $4 million total funds for non-Medicaid programs and is in addition to CDHS’s permanent funding increase to counties of $16 million total funds last year. R-7 also includes funding to increase the capacity and volume of Colorado Benefits Management System (CBMS) enhancements that can be implemented in response to changes in Medicaid programs or benefits, Centers for Medicare and Medicaid Services requirements, and legislative policies. It further includes investments in CBMS processing automation (ex parte) and other operational modernizations intended to improve the member experience and reduce county workload.
Finally, R-7 continues HCPF’s effective County Case Escalations Unit, provides resources to assist counties with complex cases, evolves county business process standards, and assists counties with real-time policy guidance through CBMS enhancements and dedicated HCPF staff.
In order to balance the state budget, HCPF’s budget includes a reduction of $77 million total funds and $23 million General Fund. These include targeted rate reductions to 95% of Medicare rate for any services currently above the benchmark, a change to the pharmacy pricing methodology for certain drugs with a goal of paying a fair and reasonable rate, and financing adjustments.
Within HCPF’s discretionary requests, R-6 Accountable Care Collaborative (ACC) Phase III reflects a reduction of $2.5 million total funds, including $1.3 million General Fund. The ACC is Colorado’s Medicaid care delivery system responsible for the administration of behavioral health benefits, the cost-effective coordination of Medicaid services and the delivery of primary care. Phase III is effective July 2025 and is designed to increase accountability and transparency; enhance care and case management; support providers; and leverage advances in technologies. 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 trends. R-6 also includes implementing member incentive programs, a centralized credentialing process, and requirements for RAEs to improve primary care infrastructure support (ACO-like) for rural health clinics (RHCs) and smaller rural independent providers to enable better performance under value based payments, while advancing care outcomes and affordability as well.
We appreciate your partnership and support of these priority discretionary items, which aligns directly with stakeholder feedback.
In the new fiscal year budget, HCPF would typically be informing you of an across-the-board (ATB) provider reimbursement rate increase; unfortunately, the budgets were too tight to enable this. Over the past four years, there have been ATB provider reimbursement rate increases of 2% in FY 2024-25, 3% in FY 2023-24, 2% in FY 2022-23 and 2.5% in FY 2021-2022, all of which are substantially higher than the prepandemic average increase of 0.5%.
Our efforts to reduce the uninsured rate post the PHE Unwind have been focused on collaborating with counties to reduce eligibility processing backlogs, increasing the rate of automated renewals (ex parte), and connecting disenrolling individuals to coverage. We are pleased to report the following:
- For the months of August, September and October, counties have processed 96% of new applications within the required targets of 45 days for MAGI (adults, families, children) and 90 days for Non-MAGI (individuals with disabilities). For renewals, counties are processing at 91% for MAGI renewals for the months of September and October (compared to 95% target), meaning about 700 case renewals remain in excess of target processing across the state. This represents a major improvement in processing backlog elimination.
- September ex parte renewal automation rates are exceeding 70% for income based members (MAGI) and 43% for non-MAGI which have income and other eligibility criteria, with intentions to leverage technology and innovations to push these figures even higher;
- Renewal approval rates are consistently achieving 76% -78% (and higher when considering the 90-day reconsideration period) for the five month period of June through October, compared to 57% pre-pandemic (calendar years 2018 and 2019).
Visit our website for more comprehensive enrollment and related performance data. These improved eligibility performance metrics in combination with the application and renewal backlog reduction should help those who submitted a new application or their renewal information late to reconnect to Medicaid. Further, we are collaborating with counties to eliminate any “work task” backlogs, which may result in retrospectively renewing members if submitted information was not properly processed or considered during the renewal process.
In addition to these efforts, HCPF has also taken the following actions to reduce the state’s uninsured rates:
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Outreached again in September to more than 350,000 households previously covered by Medicaid or the Child Health Plan Plus (CHP+) with information on coverage options, including Medicaid and CHP+;
- Continued to encourage providers to get patients re-enrolled in Medicaid, where appropriate, when they show up for care without health coverage;
- Paused coverage terminations for vulnerable populations through December; and
- Collaborated with key partners like Connect for Health Colorado and employer chambers to leverage the January 1 enrollment period going on now to further connect disenrolling Medicaid members to other coverage options.
We look forward to working with all stakeholders and legislators through the budget process and on continued efforts to reduce the uninsured rate. Thank you for your ongoing partnership and collaboration with HCPF to achieve shared goals.
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