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Strengthen the Workforce & Enhance Rural Sustainability

The Need

The direct care workforce is the backbone of the HCBS system. These frontline workers enable members to remain living safely in their homes and communities. Unfortunately, pre-COVID workforce shortages have been further exacerbated by the impacts of the pandemic as well as the increase in demand for HCBS services. Additionally, our direct care workforce has served on the frontline, risking their health and safety to ensure our members maintain theirs.

Recruitment and turnover among frontline staff are the most frequently reported provider challenges. Provider recovery payments and wage pass-throughs will provide short-term relief to ensure provider solvency and a wage increase to both reward and retain committed direct-care staff. This will be done in a reasonable ratio and in complement to longer-term, transformational strategies. Incentives to these workers to both thank them for their commitment throughout the pandemic and to recruit and retain them into the future, are also important rewards that will help strengthen and grow the workforce. In addition to direct payments to workers, enhancing the system to better train, support, and advance direct care workers, will ensure higher quality services are delivered resulting in better health outcomes for members. The capacity of the provider network, particularly in rural communities, is thin - driven by the limited workforce availability, difficult economic conditions, and long distances that must be traveled to serve community-based members. Investments in the workforce to expand recruitment and improve retention will bolster both provider capacity and members’ quality of care. A particular emphasis on rural provider sustainability will be made to ensure access to care across the state.

Initiative 1.01. - Increase Payments to Providers and Workers

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Infographic titled "Increase Payments to Providers and Workers" from the Colorado Department of Health Care Policy & Financing, highlighting a project funded by the American Rescue Plan Act (ARPA). It emphasizes the need to stabilize the Home and Community-Based Services (HCBS) direct care workforce by increasing base wages. A purple box labeled "Project Investment Category" lists "Workforce & Rural Sustainability" as the focus, noting that 62% of stakeholders prioritized this area, and $345 million was invested. The impact section lists accomplishments including raising the base wage to $15.75/hour in 2023, launching a wage dashboard, developing wage reporting mechanisms, conducting compliance reviews, securing ongoing funding for a $17/hour wage by March 2025, and making direct payments to providers. A final section titled "Going Forward" states that compliance reviews will continue. Icons denote universal benefit and economic stability.

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Initiative 1.02. -  Direct Care Workforce Data Infrastructure

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Infographic titled "Direct Care Workforce Data Infrastructure" from the Colorado Department of Health Care Policy & Financing, funded by the American Rescue Plan Act (ARPA). It outlines the community need to understand supply and demand for Direct Care Workers (DCWs) and evaluate strategies impacting recruitment, retention, and turnover. Under the “Impact” section, it describes two surveys: (1) the expanded State of the Workforce Survey targeting turnover, vacancy rates, and wages for the aging and disability population; and (2) the Direct Care Worker Survey, addressing job satisfaction, compensation, benefits, career growth, and training. Survey responses from 2,000 individuals showed: 89% enjoy their jobs, 67% are unsatisfied with pay, and 45% are concerned about benefits. The "Going Forward" section notes that HCPF will continue using these surveys to inform program, policy, and rule changes. A purple box categorizes the project under "Workforce & Rural Sustainability," stating 62% of stakeholders prioritized this issue and $345M was invested. At the bottom, an icon denotes focus on "Healthcare Access & Quality." A photo shows a woman kneeling and smiling while interacting with a child in a medical setting.

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Initiative 1.03. -  Standardized Core Curriculum & Specialization

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Infographic titled "Standardized Core Curriculum & Specialization" from the Colorado Department of Health Care Policy & Financing, supported by the American Rescue Plan Act (ARPA). It addresses the need for standardized, no-cost training for Direct Care Workers (DCWs) on personal care and specialized topics like dementia and behavioral health, available both online and in person. The “Impact” section lists: stakeholder input on training development, creation of 19 core and 12 specialized training modules, and incentives to complete training and provide feedback. Outcomes include improved worker knowledge and qualifications, improved quality of care, and potential pathways to wage increases. The “Going Forward” section commits to maintaining and promoting these modules to train as many DCWs as possible in Colorado. A purple sidebar under “Project Investment Category” highlights “Workforce & Rural Sustainability,” noting 62% of stakeholders prioritized this area and $345M was invested. The bottom includes icons representing “Economic Stability” and “Education Access & Quality.” A photo depicts a caregiver placing a hand on the shoulder of an older adult.

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Initiative 1.04. - Resource and Job Hub

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Infographic titled "Resource and Job Hub" from the Colorado Department of Health Care Policy & Financing, funded by the American Rescue Plan Act (ARPA). It highlights the need for a centralized platform to support job searches, employer matching, and access to resources for providers serving HCBS Medicaid members. The “Impact” section explains the development and launch of the Direct Care Careers (DCC) Hub, which enhances recruitment and care quality through training. In its first year, the hub saw: 245 direct care workers registered, 60 employers registered, and 43 job postings. A computer monitor graphic shows a screenshot of the hub interface. The “Going Forward” section notes that HCPF will maintain and expand the hub to support job searches, recruitment, and continuous learning for Direct Care Workers. A purple sidebar identifies this initiative as part of the “Workforce & Rural Sustainability” investment category, noting that 62% of stakeholders prioritized it and $345M was invested. Bottom icons highlight “Universal Benefit” and “Social & Community Context.”

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Initiative 1.05. - HCBS Workforce Training Fund

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Infographic titled "HCBS Workforce Training Fund" from the Colorado Department of Health Care Policy & Financing, funded by the American Rescue Plan Act (ARPA). It addresses the need to attract and retain Direct Care Workers (DCWs) by offering free specialized training, certifications, and career advancement opportunities. The “Impact” section states that 4,427 DCWs were trained and 1,062 certifications obtained. Grants were awarded to 87 provider organizations and 41 individual DCWs. The infographic highlights a partnership with the University of Colorado School of Medicine to develop a Disability Cultural Competency Training for Behavioral Health (DCCBH) to improve workforce skills. A quote from an HCBS provider notes: “We are currently serving 400% more individuals in 2024 than we could serve in 2023 thanks to the ARPA training funding.” The “Going Forward” section emphasizes that Medicaid members will benefit from a more skilled and culturally competent workforce. A purple sidebar classifies this project under “Workforce & Rural Sustainability,” with 62% of stakeholders identifying it as a top priority and $345M invested. Icons at the bottom represent “Healthcare Access & Quality,” “Education Access & Quality,” and “Universal Benefit.”

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Initiative 1.06. -  Career Pathways

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Infographic titled "Career Pathways" from the Colorado Department of Health Care Policy & Financing, supported by the American Rescue Plan Act (ARPA). It outlines the need for more experienced and trained Direct Care Workers (DCWs) in Colorado and the importance of providing simple, affordable, and centralized opportunities for skill development and career advancement. The “Impact” section explains that HCPF collaborated with the Department of Higher Education (CDHE) and Department of Labor and Employment (CDLE) to expand the Direct Care Careers hub, offering: 20 foundational skill training modules, 5 healthcare career pathway modules, and over 20 DCW career pathways outlining advancement opportunities. A screenshot of the hub interface is shown, featuring navigation menus and a photo of older adults being assisted outdoors. Under “Going Forward,” it states that HCPF staff will maintain and update these resources for ongoing access by DCWs. A purple sidebar categorizes the initiative under “Workforce & Rural Sustainability,” with 62% of stakeholders naming it a top priority and $345M invested. Icons at the bottom denote “Economic Stability” and “Education Access & Quality.”

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Initiative 1.07. - Public Awareness Campaign

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Infographic titled "Public Awareness Campaign" from the Colorado Department of Health Care Policy & Financing, supported by the American Rescue Plan Act (ARPA). It highlights the need to increase public awareness of the value of Direct Care Workers (DCWs) to help with recruitment and motivation. The infographic shows social media engagement metrics: 882,805 adults reached via Instagram, 927,566 video views on YouTube, and 723,000 adults reached via Facebook. The “Impact” section states that HCPF created educational materials and launched a Direct Care Worker Spotlight website featuring DCW videos and shareable resources. A campaign was conducted using digital and traditional media along with grassroots efforts to foster appreciation for DCWs and aid recruitment. The “Going Forward” section notes that these materials will remain available for stakeholder use. A screenshot displays the video hub with thumbnail previews of DCW spotlight stories. A purple sidebar designates this initiative under “Workforce & Rural Sustainability,” with 62% of stakeholders naming it a top priority and $345M invested. Bottom icons indicate “Universal Benefit” and “Education Access & Quality.”

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Initiative 1.08. - Home Health Delegation

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Infographic titled "Home Health Delegation" from the Colorado Department of Health Care Policy & Financing, supported by the American Rescue Plan Act (ARPA). It describes the need for Certified Nurse Assistants (CNAs) to have the skills and training to support Health First Colorado members with coexisting behavioral health (BH) and physical health needs. The “Impact” section outlines the development of a three-tiered Behavioral Health CNA certification program: Tier One: Build foundational BH literacy, Tier Two: Develop targeted BH skills, and Tier Three: Enhance BH knowledge & skills. The program is designed to benefit both CNAs and members by expanding CNA roles and improving service quality. The “Going Forward” section states that a plan has been created and is ready to launch when funding is available, aiming to improve member health and offer CNAs new growth opportunities. A purple sidebar classifies this as part of the “Workforce & Rural Sustainability” investment category, highlighting that 62% of stakeholders prioritized it and $345M was invested. The bottom includes an icon for “Economic Stability.”

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Initiative 1.09. - Workforce Compensation Research

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Infographic titled "Home Health Delegation" from the Colorado Department of Health Care Policy & Financing, supported by the American Rescue Plan Act (ARPA). It describes the need for Certified Nurse Assistants (CNAs) to have the skills and training to support Health First Colorado members with coexisting behavioral health (BH) and physical health needs. The “Impact” section outlines the development of a three-tiered Behavioral Health CNA certification program: Tier One: Build foundational BH literacy, Tier Two: Develop targeted BH skills, and Tier Three: Enhance BH knowledge & skills. The program is designed to benefit both CNAs and members by expanding CNA roles and improving service quality. The “Going Forward” section states that a plan has been created and is ready to launch when funding is available, aiming to improve member health and offer CNAs new growth opportunities. A purple sidebar classifies this as part of the “Workforce & Rural Sustainability” investment category, highlighting that 62% of stakeholders prioritized it and $345M was invested. The bottom includes an icon for “Economic Stability.”

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Initiative 1.10. - Rural Sustainability and Investment

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Infographic titled "Rural Sustainability and Investment" from the Colorado Department of Health Care Policy & Financing, supported by the American Rescue Plan Act (ARPA). It addresses the persistent shortage of direct care workers in rural areas, leading to "care deserts" where Medicaid members face gaps in service. The “Impact” section describes the creation of a mapping tool to identify these care deserts and guide recommendations such as increasing hourly wages and creating shared resources (e.g., supplies, knowledge, and workforce). A color-coded map of Colorado is included, showing counties on a spectrum from “Care desert” to “Good Access.” An image of a stethoscope on dry, cracked soil symbolizes the rural care gap. The “Going Forward” section states that HCPF will use this tool to assess rural areas statewide and implement needed actions. A purple sidebar places the project under “Workforce & Rural Sustainability,” noting that 62% of stakeholders prioritized this area and $345M was invested. Bottom icons highlight “Social and Community Context,” “Healthcare Access & Quality,” and “Universal Benefit.”

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