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 - Completed
Key Project Achievements and/or Activities:
Launched 50 training modules for providers
Funded grants to expand high-intensity therapy with Regional Accountable Entity (RAE) partners
Developed a value-based payment framework for behavioral health providers
Established cost reports for safety net providers
Developed a strategy to grow Child and Youth Services
Developed a rate model for Prospective Payment System (PPS)
Completed a behavioral health services gap analysis
Supported 1115 Substance Use Disorder (SUD) waiver work
Completed behavioral health provider satisfaction survey
Summary / Project Outcome:
This project supported significant behavioral health safety net reforms by developing improved standards and funding rates for providers, developing mechanisms for ongoing support, training, and technical assistance for new and existing providers, and expanding a critical level of services to help individuals achieve treatment success in the most appropriate level of care. The outcomes of this work have resulted in improved access for Coloradans who have some of the greatest needs to successfully achieve wellness and have also developed a system to fund and support providers who offer some of the most critical services to Members. The changes and areas of improvement born of this project can be found on the Behavioral Health Safety Net Provider website, and HCPF will continue to publish reports and notifications regarding the ongoing improvements to Colorado’s behavioral health system.
External Facing Reports/Websites:
✅Initiative 3.07. - Wrap-Around Services, including Peer Supports, for Members with Complex Needs - Completed
Key Project Achievements and/or Activities:
The Statewide Supportive Housing Expansion (SWSHE) Pilot Project and the Peer Support Grants for Housing Stability grants increased provider capacity, including support for providers operating in rural areas where traditional care models have been difficult to provide due to changing economic and population needs. These grant projects aligned with Colorado’s broader behavioral health safety net initiative by expanding the network and financing of community-based organizations serving as specialty service providers for members with behavioral health needs. Additionally, both grants helped support providers in identifying mechanisms to expand their capacity and increase their ability to sustain services for the people they serve.
Statewide Supportive Housing Expansion (SWSHE) Pilot Project:
The SWSHE Pilot Project expands permanent supportive housing across Colorado. This pilot project provided grant funding for 28 supportive housing providers across the state of Colorado, with representation in urban, suburban, rural and frontier communities. SWSHE combined affordable housing through housing vouchers and expanded access to wrap around supportive services to create high-quality supportive housing opportunities, promoting housing attainment and retention for Health First Colorado members with complex needs. In total, the project served 869 Medicaid members over the course of the grant.
HCPF contracted with external vendors for the SWSHE Pilot Project to provide administrative support, a supportive housing service model design, develop provider onboarding plans and materials, provide technical assistance (TA) to grantees, and evaluate the work done during the SWSHE Pilot Project for cost feasibility and impact as a pilot program.
Peer Support Grants for Housing Stability Project:
The Peer Support Grants for Housing Stability project set out to expand access to Peer Support Services for Medicaid members with a history of homelessness who qualified for permanent supportive housing. Funding was awarded to 24 organizations to cover the costs associated with outreach, engagement, hiring, training, retention, and supervision of Peer Support Professionals. Additionally, funding supported costs associated with building administrative capacity to become a Medicaid provider able to bill for Peer Support Services.
To provide project management and technical assistance (TA) services to support the Peer Support Grants for Housing Stability project, HCPF contracted with an external vendor. To support these community-based housing service providers in transitioning to sustainable services funding through Medicaid HCPF contracted with a vendor to provide grantees with individualized TA to become Medicaid providers.
Summary / Project Outcome:
Statewide Supportive Housing Expansion (SWSHE) Pilot Project:
The SWSHE Pilot Project provided grant funding to 28 organizations to provide supportive housing services across Colorado. Medicaid members were identified as eligible to participate in the grant-funded services through data matching with Colorado’s Homeless Management Information System (HMIS) and a referral process through the Continuum of Care (CoCs). The grantees were given flexibility in using grant funding to select which non-billable services were most critical to each individual member in obtaining and retaining housing. Additionally, non-healthcare supportive services, historically difficult to fund, such as storage and cleaning costs, moving and move-in costs and pantry stocking were permitted. The program set a stretch goal of reaching 500 individuals but surpassed that goal by the midpoint and went on to serve a total of 869 participants.
Peer Support Grants for Housing Stability Project:
The Peer Support Grants Project provided grantees with opportunities to enhance and expand their delivery of Peer Services, specifically for individuals experiencing homelessness or housing instability. This project provided funding for training opportunities, salaries, supervision, and other support for 24 organizations, some of whom were small and rural organizations.
A vendor provided 24 hours of direct individual provider technical assistance throughout the grant period. Eleven (11) organizations took advantage of the Medicaid Provider enrollment Technical Assistance (TA). The vendor also created a provider training outline of how to enroll as Medicaid providers. The focus was understanding enrollment from the perspective of small, community-based organizations who may have limited administrative experience with Medicaid. HCPF will be able to adapt this training to provide support for other community-based organizations interested in Medicaid provider enrollment.
A vendor was onboarded to assist HCPF in managing project timelines, deliverables, outcomes, and reporting obligations. This vendor provided direct technical assistance to grantees through multiple means including email, office hours, one-on-one meetings and webinars and then collected data and provided program evaluation to ensure progress and outcomes were tracked and reported on.
Outcomes of this grant project include a total of 130 new Peer Support Professionals hired by grantee organizations. All of the grantees used grant funding to provide training for Peer Support Professionals and supervisors, totaling 7,798 hours of training. Grantees reported significant impact in the areas of enhancing skills, safety, cultural awareness and leadership development for peers and supervisors as a result of training provided during the grant period.
External Facing Reports/Websites:
✅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 - Completed
Key Project Achievements and/or Activities:
This project supported the translation of public-facing case management and other member-facing materials, such as forms, waiver charts, waiver flow charts, and other basic information about waivers and other long-term services and support programs, into multiple languages for members and caregivers to understand in their own language.
Additionally, this project contracted with a vendor to build a document management system. This system will support the efforts being made to identify, consolidate, update, and maintain case management and member-facing materials within a single system.
Summary / Project Outcome:
The translation efforts of this project successfully translated 116 documents (63 unique source documents) in up to six languages totaling over 142,000 words translated. These documents include Member Letters, Forms, Applications, Guides, Charts, Fact Sheets, Brochures, Social Media Messaging, and more. The audience of these documents includes case managers, members, direct care workers, stakeholders, and providers.
In partnership with Colorado Department of Health Care Policy & Financing (HCPF) Communications Team staff, a new document management system software leveraging the Google Workspace interface was installed, customized, tested, and deployed for use within HCPF to inventory, track, and manage a consistent review cycle for member-facing communications. This tool will allow for key communications staff to know who the Subject Matter Experts (SMEs) are for every document, whether it is subject to enhanced review and scrutiny tied to Senate Bill 17-121, as well as when it was last reviewed for plain language, accessibility, member feedback, and translation, if needed. The database will then automate a review cycle that is custom defined by communications staff and SMEs based on the context and sensitivity of the document. Finally, a tracking dashboard will provide HCPF leadership with insight into document statuses and process efficiency.
✅Initiative 3.08. - AI/AN Culturally Responsive Services Capacity Grants - Completed
Key Project Achievements and/or Activities:
This grant program provided funding for one of the few Denver-based Indian Health Service (IHS) providers, Denver Indian Health and Family Services (DIHFS), to expand access to community based behavioral health treatment, support mobile services and outreach, support metro-based tribal members in accessing culturally aware treatment, as well as efforts to incorporate traditional healing into treatment.
The project supported one of the two sovereign tribal nations in Colorado, the Southern Ute Indian Tribe (SUIT), in increasing access to substance use disorder treatment and recovery services, recovery housing, medication assisted treatment, mobile treatment options, and efforts to incorporate traditional healing into treatment.
Summary / Project Outcome:
This project provided funding for improving access to community based behavioral health services for tribal members, regardless of their geographic proximity to tribal land. The tribal and IHS provider partners have funded numerous projects including capital expenses, training and certification for staff, pre-construction planning, outreach and engagement, staffing, and consultation for adding services new to tribally affiliated providers. To date, less than a third of the funding has been spent due to contracting delays; as a result, CMS approved a spending deadline extension to June 30, 2025, for this project. SUIT and DIHFS both received funding through prospective payments, approved by the Office of State Controller, and funding must be spent on or before June 30, 2025.
Outcomes for this project organized by grantee included:
DIHFS: The successful purchase of a vehicle to support client transportation, the purchase of a mobile health vehicle to provide behavioral health services in homes and communities for people who cannot otherwise access care, crisis intervention training for staff, supporting staff to obtain additional credentials for delivering more behavioral health services, operation of the Denver-based mobile outreach vehicle, and the renovation of a health clinic that will offer behavioral health and MAT services to tribal members.
SUIT: Establishing a new treatment center, developing recovery residences, and conducting street outreach and mobile services to improve engagement in treatment services.
✅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: