The Need
The Department has identified several underserved populations in HCBS programs, including individuals with disabilities living on tribal lands, those who identify as Black, Indigenous, and People of Color (BIPOC), and individuals with behavioral health needs. As a state focused on meeting the needs of all Coloradans, ensuring access across all populations through disability and culturally competent, whole-person care is a key priority for the Department.
Initiative 3.06. - Expand the Behavioral Health Safety Net
The Department has an opportunity with these funds to strengthen and expand the behavioral health safety net through provider training, workforce development, enhanced standards, high-intensity outpatient services, and value-based pay for performance models supporting whole-person care.
Over the past two years, the Department, in partnership with the RAEs, have aligned on a definition for high intensity outpatient services through a collaborative stakeholder engagement process. The safety net expansion effort will build upon and implement this definition through the following four projects:
- Conduct a gap analysis for high intensity outpatient services: The Department needs to assess the extent to which its current delivery system provides adequate high intensity outpatient services and to identify any needed improvements.
- Develop training and technical assistance to build capacity with providers and health plans: Providers will need technical assistance and other support to improve their capacity to deliver high intensity outpatient services.
- Develop value-based payment framework for high intensity services and whole person care: Providers will also need alternative financing models that better support whole person care and reward improved outcomes. The Department will create a new value-based reimbursement model to support the implementation of high intensity outpatient services and to improve capacity of the service networks.
- Assess and review regulatory foundations for high intensity outpatient services: To build adequate networks for high intensity outpatient services and to financially support these networks, the Department, working with the Office of Behavioral Health, needs to review and align their credentialing and contracting policies with the safety net framework. The Department will assess and revise critical regulations concerning high intensity outpatient services.
Initiative 3.07. - Wrap-Around Services, including Peer Supports, for Members with Complex Needs
The Department will fund and develop a sustainability strategy for wrap-around services, including housing support services and community-based peer support, for recipients of complex social service benefits such as housing vouchers and supportive housing services. This will be focused on individuals with serious mental illness and a history of homelessness and repeat hospitalizations and will not include any funding for room and board. Initiative 3.07 consists of two grant projects described below.
The Statewide Supportive Housing Expansion (SWSHE) Pilot Project
The Department will implement a pilot program to provide supportive housing services for at least 500 Medicaid members. Participating members will receive housing vouchers from the Colorado Department of Local Affairs (DOLA). This initiative is modeled on the evidence-based social impact bond project in Denver. It focuses on individuals who have serious mental illness and have a history of homelessness and emergency care. The Department has also been awarded a technical assistance program by the National Academy for State Health Policy (NASHP) about how to best integrate services across state agencies to expand housing options to their shared clients who are unhoused.
With the support of the NASHP technical assistance grant, the Department will conduct an analysis of funding mechanisms and payment models. The Department will then develop recommendations on how to improve support models of care for individuals with extensive history of complex social and behavioral health needs.
For providers, this will create options for them to expand their business models, increasing their solvency and the populations they are able to serve. It will build provider capacity, including housing service providers, and sustainability in rural areas where traditional care models are becoming more difficult to provide due to changing economic and population needs. It also aligns with Colorado’s broader behavioral health safety net initiative in that it expands the network and financing of behavioral health specialty providers
Peer Support Grants for Housing Stability
The purpose of this grant project is to expand access to Peer Support Services for Medicaid members with complex needs and a history of homelessness. Funding shall be awarded to cover costs associated with outreach, engagement, hiring, training, retention, and supervision of Peer Support Professionals that can provide billable services in the context of housing stability. Funding shall also be awarded to support costs associated with building administrative capacity to become a Medicaid provider and successfully provide and bill for Peer Support Services. SWSHE Pilot Project grant recipients may also apply for this grant.
✅Initiative 3.01. - Equity Study - Completed
Key Project Achievements and/or Activities:
The 3.01 ARPA Equity Study Project achieved the following:
Developed a webpage: ARPA HCBS Initiative 3.01 - Equity Study
HCPF Research & Analysis team, with support of the Data Analytics Section, developed and released two reports analyzing the literature around equity in HCBS as well as equity issues unique to Colorado's HCBS programs.
A Colorado Analysis of HCBS Representation and Utilization with a Focus on Race/Ethnicity
Overall general finding is that there is underrepresentation in Colorado HCBS waiver programs among non-white races/ethnicities and overrepresentation among white members.
Based on the underrepresentation finding, HCPF contracted with Civic Consulting Collaborative to work together on stakeholder analysis and engagement to understand the barriers to enrollment in HCBS among communities of color.
Conducted a survey (350 providers and 140 members and caregivers) and two virtual convenings and released a report of findings.
Conducted 10 Learning Exchanges with community-driven organizations to both understand why underserved communities are not accessing HCBS and provide a brief overview of HCBS to build capacity at these organizations to support their communities in enrolling.
Released a report that provides a set of comprehensive recommendations to promote equity, increase awareness, and improve enrollment in HCBS, focusing on building trust, integrating HCBS into the system, establishing accountability structures, and engaging users in materials design. In addition, it outlines how community-driven organizations currently support people in their communities in navigating complex health care systems to get their needs met, driving health equity in their communities.
Executed a second contract with Civic Consulting Collaborative to build on the recommendations to promote equity, increase awareness and improve enrollment in HCBS among underserved communities.
Worked with the existing Medicaid Certified Application Assistance Sites (CAAS) to build capacity by providing information about HCBS and how to help people enroll.
Conducted a survey to understand current capacity about helping people enroll in HCBS and interest in doing more.
Hosted 5 virtual convenings to provide HCBS information.
Conducted Learning Exchanges to continue to promote and understand barriers to HCBS enrollment among underrepresented communities.
Developed an HCBS 101-style presentation and recording to be disseminated to CAAS.
Conducted specific outreach to organizations serving indigenous people in Colorado to better understand why enrollment in HCBS is particularly low and built relationships to further efforts to enroll indigenous people.
Outreached Community Health Worker certification programs to infuse the training programs with HCBS enrollment information.
Worked with the Case Management Agencies to better understand their efforts to increase Equity, Diversity, Inclusion and Access (EDIA).
Engaged over 65 community-based organizations from April 2023-September 2024, providing information about HCBS and learning about barriers.
Summary / Project Outcome:
This project succeeded in gaining a better understanding of disparities within HCBS and what’s driving those disparities. Based on that understanding, the project was then able to reach underserved communities by conducting HCBS 101 learning sessions with myriad organizations who work with underserved populations. Further, the project resulted in recommendations and ways to increase knowledge and capacity within underserved communities to help assisters/navigators become resources for members going through the HCBS enrollment process.
Outcomes include:
Four reports posted on the ARPA 3.01 website, including a literature review, internal data analysis report, summary of a survey conducted, and a final recommendations report outlining findings from the stakeholder engagement
Creation and refinement of the new “Learn about LTSS” webpage on HCPF’s website
Conversations with over 65 organizations, increasing knowledge and capacity to navigate and enroll community members in HCBS in underserved communities
Development and refinement of an HCBS 101 style presentation and recording that can continue to be used and distributed
External Facing Reports/Websites:
Additional information about this project can be found on the project website: ARPA HCBS Initiative 3.01 - Equity Study
✅Initiative 3.04. - HCBS Training for Members & Families - Completed
Key Project Achievements and/or Activities:
With stakeholder engagement, a new web page has been deployed to provide culturally competent training materials, including videos, pamphlets, flyers, enrollment guide with supplemental information and a poster on HCBS transitions benefits and services for members. These resources provide information to navigate through the different waivers, the services within each waiver, state plan benefits, contacts, and explain member’s right to choose.
Summary / Project Outcome:
- To identify Member’s needs, the project team hosted Stakeholder engagement sessions and contracted with Civic Consulting to lead a User Design Group.
- The project team identified the content to create such as Long-Term Services & Supports (LTSS) programs, waivers, specific benefits and high-utilized state plan benefits.
- Learn About LTSS resources were developed through collaboration with stakeholders, subject matter experts, instructional designers, and a graphics designer.
- The HCPF In Reach team distributed Transition Posters and LTSS Pamphlets to nursing facilities throughout the state of Colorado.
- The project team engaged the HCPF web team for content organization and creation.
- The project team engaged the HCPF Comms team for a social media strategy and campaign.
- The project team made all materials accessible to those living with disabilities
External Facing Reports/Websites:
Initiative 3.05. - Translation of Case Management Material
The Department does not currently have member-facing case management material translated into all necessary languages. The Department will translate public facing case management materials, such as waiver charts, waiver flow charts, specialized behavioral health programs and benefits, and other basic information about waivers and other long-term services and support programs, into multiple languages for members and caretakers to understand in their own language. This work would also take into consideration other accessibility needs such as hearing and vision impairments.
Initiative 3.08. - AI/AN Culturally Responsive Services Capacity Grants
(previously named Behavioral Health Capacity Grants)
To finalize the suite of projects to expand the behavioral health safety net in Colorado, the Department will complete a final project focused on community identified service gaps that members experience when seeking behavioral health services. The Department will award small grants that focus on the following needs: rural behavioral health, tribal behavioral health, integrating care and treatment options in communities, substance use services, and filling other locally identified gaps in the care continuum. There will be a technical assistance component for grantees provided through a learning collaborative.
Funds will be distributed to smaller sub-awardees using evidenced-based practices. Awards would be prioritized to agencies mitigating care deserts or better serving the Colorado American Indian/Alaskan Native (AI/AN) population. This grant program will prioritize providers and programs that are improving their ability to serve individuals with disabilities on an HCBS waiver, who also have co-occurring behavioral health (SUD and MH) needs with a focus on lower acuity services and smaller community-based providers compared to the previously mentioned initiatives. This includes Behavioral Health Services provided through Colorado’s 1915(b)3 waiver.
✅Initiative 3.02. - Buy-In Analysis - Completed
Key Project Achievements and/or Activities:
Through this project, HCPF now has educational materials available pertaining to both Working Adults with Disabilities (WaWd) and Children’s Buy-In. Materials for each program include brochures, infographics, posters, videos, a communication toolkit, and FAQs. Additionally, the vendor developed a “heads up” letter that can be sent to members to alert them of the reinstatement of premiums in the future. All materials were developed after extensive research and focus group discussions with stakeholders to better understand identified areas of concern or lack of information about the Buy-In program.
Summary / Project Outcome:
Through this project, HCPF has successfully developed multimedia assets for both the adult and children's buy-in programs. These assets will be deployed by HCPF’s communications team to educate members on these programs and dispel any myths members may have. Moreover, a member facing letter has been drafted and can be sent to members pertaining to the reinstatement of premiums. The distribution date of this letter is still being determined.
✅Initiative 3.03. - Community Transitions Support - Completed
Key Project Achievements and/or Activities:
The In-Reach team planned to visit 75% of skilled nursing facilities in Colorado. They exceeded this goal and visited 100% of the 181 skilled nursing facilities in the state.
The In-Reach team met with 1,090 individuals, including members and their families/guardians, resulting in 344 referrals to either options counseling or transitions coordination.
Summary / Project Outcome:
The project team successfully implemented Group In-Reach counseling, providing Group In-Reach to 100% of nursing facilities across the state, and created standardized materials and training for ongoing In-Reach services. The In-Reach team also created materials and processes for ongoing diversion and rapid reintegration activities. The team continues to develop a new eligibility escalation process for cases needing immediate financial eligibility determination.
Project teams successfully implemented two Rule Changes that increased Transition Coordination Units and increased the Transition Setup cost maximum, enabling HCPF to further expand member services.
External Facing Reports/Websites: