A Message from the Executive Director

Kim Bimestefer

March 2025

Navigating Federal Funding Threats to Medicaid Concurrent with State Budget Concerns

Concerns about federal threats to Medicaid funding are on everyone’s mind. Here are four tools that will help our partners get their arms around these threats to Colorado, which could impact members and benefits, and climb well above $1 billion General Fund, depending on which options Congress passes. To put that figure in perspective, HCPF’s projected fiscal year 2024-25 General Fund budget is $5.2 billion, meaning a $1 billion federal cut would represent about a 20% impact.

1. We crafted two CO Federal Medicaid Funding Threats tools (see the links in the Federal Resources box on the right at the top of the page). One version helps individuals understand funding cut options under consideration to achieve the Congressional Energy and Commerce Committee $880 billion target reduction. The version includes budget reduction projections at the federal level over 10 years, largely provided by the Congressional Budget Office (CBO) and also provides an annual Colorado General Fund budget reduction impact estimate. The second version of the tool leverages the same base information but removes the federal budget reduction estimates.
2. To help individuals understand the impact to their local community, HCPF has made available county by county fact sheets with enrollment information, total population in each county covered by Health First Colorado (Colorado’s Medicaid program) or Child Health Plan Plus (CHP+), total Medicaid funding for members covered in that county and top provider types receiving Medicaid funding by county.
3. The Medical Assistance Coverage Fact Sheet (see the first link under Overviews and Fact Sheets) answers many questions coming into HCPF, such as: income requirements for Medicaid, CHP+ and to secure Connect for Health subsidies; Medicaid mandatory versus optional benefits; federal and state funding splits by populations, and more.
4. HCPF’s Annual Report is on our website, providing a lot of specific information on our safety net coverage specific to fiscal year 2023-24, such as populations covered, payments to providers, federal funding and more.  

HCPF is closely monitoring emerging federal revenue reduction or budget cut concepts that may impact Medicaid, our state budget and our members. We will keep you informed as the landscape evolves. Time for HCPF and the state to respond to Federal rule, policy and funding changes may be more challenging due to the recent communication by the U.S. Department of Health and Human Services (HHS), indicating that they are rescinding the policy on Public Participation in Rule Making (Richardson Waiver) and re-aligning HHS’s rule-making procedures. We thank you in advance for your collaboration given this reality.

Colorado Medicaid Sustainability Efforts

Unique to Colorado is the combination of state constitutional provisions impacting our balanced budget requirement as well as revenue limitations propelled by Colorado’s Taxpayer Bill of Rights (TABOR). Accordingly, reductions to Federal Medicaid funding may disproportionately impact Colorado’s Medicaid and CHP+ benefits, coverage, eligibility requirements and provider reimbursements.

The Joint Budget Committee (JBC) is in the process of making very difficult balancing decisions as they tackle a $1 billion budget deficit challenge, though that is subject to change with the next revenue forecast scheduled for March 17. HCPF’s budget represents about one-third of the state’s budget and moves at a historic cost trend of about 7-8% annually, while state General Fund revenues move at a rate of about 3-4% annually. The HCPF Medicaid Sustainability Framework seeks to organize emerging budget reduction concepts and strategies to enable the thoughtful navigation of Medicaid’s multi-year, fiscal challenge while fostering partnership and collaboration to achieve the shared goal of mitigating draconian Medicaid and CHP+ cuts due to our state budget challenges.

Our February forecast update to the JBC included an increase for the current fiscal year 2024-25 ($114 million) and fiscal year 2025-26 ($83 million) based on our most updated insights. This forecast is our best projection of our expenditures for Health First Colorado and CHP+ services and will inform this month’s JBC’s figure setting decisions. The Office of State Planning and Budgeting (OSPB) sent the JBC a letter including potential HCPF budget reduction offsets for the JBC's consideration, given our forecast need for additional funds. The balancing proposals total $22.8 million General Fund in fiscal year 2024-25 and $132.5 million General Fund in fiscal year 2025-26. Ninety-six percent of HCPF’s budget goes to pay health care providers rendering services to our members, while 4% goes to cover HCPF’s administration costs, making Health First Colorado the most efficiently run health plan in the state. More information is available on our budget website and Legislator Resource Center.

HCPF released its annual, statutorily required Hospital Transparency reports on January 15. These reports measure Colorado hospital profits, costs, expenses, the level of community benefit that tax-exempt hospitals offer their communities in lieu of paying taxes, and more. The hospital reports and other materials have been posted on the Hospital Reports Hub website. Key findings from these reports, including Hospital Financial Transparency, Colorado Healthcare Affordability and Sustainability Enterprise (CHASE), and Hospital Community Benefit Accountability, were reviewed during HCPF’s Hospital Transparency Reports Webinar on February 13. Recordings of this event are available in English and Spanish, as is the slide deck. 2025 Hospital Reports Webinar - English/ASL; 2025 Hospital Reports Webinar - Spanish; 2025 Hospital Reports Webinar - Slide Deck.

I want to thank our many partners who serve our members. Your insights and collaboration are important as we navigate the state’s fiscal challenges in combination with the emerging Federal threats to Medicaid. We thank you in advance for your partnership on both these fronts. We are in this together!

February 2025

Collaborating through a Challenging Chapter

The state is in the midst of balancing a challenging budget, with the Joint Budget Committee (JBC) making difficult balancing decisions over the coming weeks. A contributing factor is the mismatch between medical inflation and related Medicaid cost trends versus TABOR’s impact on available revenues. At the same time, the evolving federal landscape may also impact Medicaid's fiscal challenges. It will take all of us working together to navigate this reality.

HCPF’s Medicaid Sustainability Framework seeks to organize emerging concepts and strategies to enable the thoughtful navigation of this multi-year, fiscal challenge while fostering partnership and collaboration to achieve shared goals. The six points of this framework include:

1. Address Drivers of Trend: Better address all the controllable factors that drive Medicaid cost trends.
2. Maximize Federal Funding: Leverage and maximize HCPF’s ability to draw down additional federal dollars. 
3. Invest in Coloradans: Continue investing in initiatives to drive a Colorado economy and educational system to reduce the demand for Medicaid over the long term as Coloradans rise and thrive.
4. Make Reasonable Medicaid Cuts or Adjustments: Identify where programs, benefits, and reimbursements are comparative outliers or designed in such a way that we are seeing - or will experience - higher than intended trends or unintended consequences.
5. Reassess New Policies: Consider pausing or adjusting recently passed policies not yet implemented.
6. Exercise Caution in Crafting Increases to the Medicaid program going forward.

For your convenience, we are providing links to our fiscal year 2025-26 Budget Agenda Summary, Joint Budget Committee budget hearing documents, and December message on the HCPF budget.

We continue to monitor and respond appropriately and thoughtfully to federal actions impacting our programs and will keep you posted with quick but informative communications, as needed.

HCPF’s 2025 legislative agenda includes proposals that merge waivers for children with complex health needs, ensure Medicaid is the payer of last resort with commercial carriers, create a cash fund to support 1115 Demonstration Waiver programs, and create a permanent waiver program offering benefits to specific members. We also welcome your review of our Jan. 22 SMART Act hearing materials and our fiscal year 2023-24 annual report to the community to learn more about HCPF’s strategic priorities, opportunities and challenges, legislative agenda, performance against published goals, and more.

Hospital Transparency Reports Webinar

Thank you to all who attended our recent Hospital Transparency Reports Webinar. These reports measure Colorado hospital profits, reserves, costs, expenses and the level of community benefit that tax-exempt hospitals offer their communities in lieu of paying taxes. Hospitals are essential pillars within the communities they serve. These reports provide insight into hospital financial health. The reports and materials are on our website.

Thank you for your collaborative partnership and thoughtful engagement. We truly appreciate it.

December 2024

Budget Priorities

The Department of Health Care Policy & Financing (HCPF) invites you to keep up with the evolving discussions on HCPF’s overall fiscal year 2025-26 budget by listening to the Jan. 6 Joint Budget Committee budget hearing. Thank you in advance for your support of our $17.4 billion total funds and $5.4 billion General Fund request to cover eligible Coloradans under Health First Colorado (Colorado’s Medicaid program), Child Health Plan Plus (CHP+) and other safety net coverage programs. Our programs serve and cover about 1.3 million Coloradans today, including more than 40% of Colorado’s children and over 40% of births, as well as individuals with disabilities and older adults qualifying for long-term services and supports (LTSS).

With the end of federal stimulus funding, the state has returned to the more typical, tighter budgets of years gone by, further complicated by the difference between the lower inflationary factors used to calculate the TABOR limit compared to higher medical cost trends associated with Medicaid programs. Additionally, on average, members with higher medical needs have remained or returned to coverage through the PHE Unwind, while those disenrolling had lower medical needs. This is causing a significant increase in the average per member per month (per capita) cost of Medicaid membership. This increase is above expectations and reflects a net 1.16% over-expenditure against our FY 2023-24 services budget projection as well as higher costs in current and future fiscal years. Many states are facing similar increases in Medicaid spending despite lower enrollment post unwind (KFF Brief & News 10/23). This is concurrent with the increasing Medicaid trends and overexpenditures reflected in higher Medical Loss Ratios (MLRs) as reported by commercial carriers.

We are grateful for our allocation in the Governor’s budget, 96% of which goes to our providers to care for the one in four Coloradans we are honored to serve. Four percent of these funds are allocated to HCPF administration expenses, such as our contracted partners, with 0.5% covering HCPF staff. This 4% is about one-third of the typical commercial health plans’ administrative expenses.

The largest part of the HCPF budget request reflects the $1.4 billion in additional total funds necessary to cover our current programs while preserving member benefits and care access in a time of very limited spending growth. HCPF’s proposed discretionary fiscal year 2025-26 budget requests focus on increasing support for county administration to improve efficiencies and customer service in connecting Coloradans to our safety net programs; ensuring Colorado supports an equitable system resulting in high-quality, coordinated Medicaid services through the Accountable Care Collaborative Phase III; complying with federal requirements; and meeting federal requirements for modular health plan systems. Additional information is available on our website.

On the PHE Unwind, HCPF continues to collaborate with counties to reconnect individuals to Medicaid coverage where appropriate. With very limited exceptions, our county partners have eliminated the new application and renewal processing backlogs that accumulated during the PHE Unwind (May 2023 - April 2024) due to the unprecedented 1.8 million member renewal volume moving through the renewal process, in alignment with member renewal anniversaries. Further, case escalations are also way down (consistently less than 250/month). Case escalations are submitted by providers, advocates, members and others to HCPF to help navigate eligibility cases through renewal barriers in collaboration with counties. More than 90% of these case escalations result in coverage being retained or restored.

Given this progress, HCPF is working with counties to focus attention on eliminating any remaining “work task” backlogs; in processing those, members should be renewed back to their anniversary date if data was available but not applied during the initial renewal processing. Last, HCPF is also working with other state agencies and stakeholders to reconnect Coloradans back to Medicaid coverage where appropriate, while connecting Coloradans to other coverage like employer-sponsored, Medicare, or Connect for Health Colorado individual coverage to enable subsidies that make coverage more affordable. Open enrollment programs with coverage effective Jan. 1, 2025, provide an important opportunity to achieve this shared goal. Of course, all this is concurrent with continued work to improve system ex parte automation and HCPF’s “County Administration and Colorado Benefits Management System (CBMS) Enhancements,” which 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. (See my November message for more information).

Regarding the challenges with our Care and Case Management (CCM) system, HCPF is actively engaged with leaders of key vendor partners to address system defects and to drive improvements in service and support to members, case management agency (CMA) partners, providers and counties. Significant resources have been added to this mission-critical work to drive additional throughput of system fixes, with target stabilization in April. A dashboard is being built for a target January posting that provides optics into each major CCM system stabilization initiative, its target completion date, the responsible party, and its status against target.  

Thank you for collaborating with the state through difficult state budget decisions, to get Coloradans reconnected to coverage post the PHE Unwind, and to thoughtfully respond to emerging changes in the national policy landscape in the months to come.

Best wishes for an enjoyable and healthy holiday season!

November 2024

HCPF’s Fiscal Year 2025-26 Budget

On Nov. 1, the Governor released his budget for fiscal year (FY) 2025-26. The state has returned to the more typical, tighter budgets of years gone by - a reality that we will have to navigate for the next several years. Financial pressures on the state budget are driven largely by impacts of TABOR, the end of COVID-related federal stimulus dollars, and the increasing Medicaid per member claim costs (acuity).

HCPF is grateful for its allocation within the Governor’s budget of $17.4 billion total funds, including $5.4 billion General Fund to cover an average of 1.4 million Coloradans under Medicaid and CHP+. This represents about 38% of the total state budget and about 31% of the state’s General Fund operating budget. HCPF’s proposed annual budget for FY 2025-26 reflects an increase of nearly $1.4 billion total funds, including $438 million General Fund. Our budget increase is fueled by a few major factors, including the higher than expected per capita expenditures for Medicaid traditional medical expenses like hospital, prescription drug and professional claims, which aligns with Medicaid cost trends nationally; increased utilization of behavioral health services and long-term services and supports (LTSS); and increases in Medicaid enrollment after the PHE Unwind, including eligibility expansions through Cover All Coloradans (HB 22-1289) starting January 1, 2025.

More than 96% of HCPF’s budget goes to pay providers for the care they deliver to eligible members while less than 4% of our funding is allocated to pay for administration costs including contracted vendor partner services as well as HCPF staff, which represents only 0.5% of our budget allocation. HCPF continues to be the most efficiently run health plan in the state - by far – operating almost 10 points below the average administration and profit costs associated with commercial carriers.

Of HCPF’s 40+ Department goals and more than 125 projects supporting those goals, investing in our state-county eligibility system reflects our largest discretionary request in the FY 2025-26 Governor’s budget. That decision aligns with stakeholder feedback captured during our annual webinar held in August; specifically, 1500+ attendees shared their thoughts through a live webinar poll on what HCPF’s most prominent priorities should be, with 45% agreeing that investment in Colorado’s state-county eligibility system infrastructure is their top priority.

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:

• 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.

October 2024

Advancing the Medicaid Delivery System

The Accountable Care Collaborative (ACC) is the primary delivery system for Health First Colorado (Colorado’s Medicaid program). Phase III of the ACC, scheduled to begin July 1, 2025, was designed through HCPF’s engagement with more than 5,700 stakeholder participants, including advocates, providers, community organizations, and members across 135 stakeholder meetings over 18 months. Phase III will build on the foundation set over the past 13 years to improve quality of care, close health disparities, improve care access, improve the member as well as provider experience, and manage costs, which is critical to protecting member coverage, benefits and provider reimbursements, especially in tight state budget years. We are excited to incorporate so many advances into ACC Phase III, including improving communication with members, member incentives, value-based payments, community‐based health equity plans, connecting members to health related social needs supports like housing and food assistance, standardizing care coordination, moving to a primary care model that ties payment to performance with increased supports for rural independent as well as Rural Health Clinic providers, and more. Additional information is on the ACC Phase III webpage.

A key component of the ACC is the Regional Accountable Entity (RAE). HCPF has issued an intent to award four RAE contracts for ACC Phase III. 

• Rocky Mountain Health Plans (RMHP) in Region 1 is a returning RAE partner, inclusive of the Managed Care Organization (MCO) offering in this region, in the same counties.​
• Northeast Health Partners (NHP) in Region 2 is a returning RAE partner, with a new administrative subcontract with RMHP.
• Colorado Community Health Alliance (CCHA) in Region 3 is a returning RAE partner, consisting of a jointly managed partnership between Anthem Partnership Holding Company, LLC (now branded Elevance) and CCHA.​
• Colorado Access in Region 4 is also a returning RAE partner.​
• Denver Health’s MCO will continue to serve the physical health needs of many members within Region 4, and collaborate with Colorado Access for their member’s behavioral health benefits.

With these awards, HCPF is working with each vendor to finalize and execute new contracts, in accordance with the new RAE Regions illustrated below.

On the affordability front, HCPF released the new Hospital Price Transparency Tool last month. This free tool displays over 2.5 million commercially negotiated prices for more than 5,000 procedures provided by 82 Colorado hospitals. Since hospitals represent the biggest part of the health care dollar, this innovative and easy-to-use tool can fuel productive conversations between communities and hospitals to improve affordability for Coloradans, employers, municipalities and taxpayers. I and members of HCPF’s Affordability team will be meeting with employer chambers and other purchasing organizations starting this month to help them learn how to use this new tool.

Other efforts to save Coloradans and employers money on health care that will be discussed at these meetings include opt-in actions that self-insured employers need to take to secure savings on their prescription drug costs through the following laws passed in the state of Colorado: (1) House Bill 22-1370, which beginning in 2024 requires 100% of prescription drug rebates to be passed through from carriers and pharmacy benefit managers (PBMs) to employers and consumers. Savings for that depend on the amount of rebates the employer is receiving under their PBM or carrier contract, and can range from 10-20%; and (2) House Bill 23-1201, effective Jan. 1, 2025, eliminates “spread pricing,” or up-charging, of prescription drugs by carriers and PBMs. Savings can range from 10-25%.

At these meetings, HCPF will also share messaging intended to increase employer outreach going forward to better connect employees losing Medicaid coverage to employer sponsored coverage. This messaging is critical as we approach employers’ open enrollment periods to help individuals who lost Medicaid coverage enroll in their employer’s benefit plan coverage. Resources for employers are on our website. Thank you to all our partners who are working alongside HCPF to reduce the uninsured rate and Keep Coloradans Covered.

We also continue to propel a number of critical initiatives to improve Colorado’s Medicaid eligibility processes, county and Medical Assistance site performance, and system efficiencies. Due to the legislature in November 2024, the Senate Bill 22-235 County Administration Long-Term Support Plan will provide recommendations to improve county administration of eligibility and enrollment and related activities, including properly resourcing our state-county infrastructure, addressing county staff wage rate gaps, advancing the eligibility tools employed by county workers, and more.

Comparing prepandemic, pandemic, PHE Unwind and post-PHE Unwind periods, all Medicaid eligibility metrics are moving in the right direction. In accordance with our February 2024 budget assumptions, membership has returned to prepandemic levels. As of August 2024, and including the impact of the 90-day reconsideration period, Health First Colorado and Child Health Plan Plus (CHP+) combined enrollment for children, adults and those accessing Long-Term Services & Supports all have higher enrollment than before the pandemic.

As noted in the performance metrics chart on our website, all eligibility processing metrics are headed in the right direction. Increased efforts underway will further improve performance going forward. Performance measures include the 90-day reconsideration period, when members are able to submit their renewal information late and still be renewed without having to submit a new application. Counties also leverage this period to catch-up on their renewal processing backlogs. Thank you counties for focusing on reducing backlogs. Statewide, the Medicaid application processing backlog has decreased 75% from October 2023 to August 2024, while the renewal backlog has decreased 35% from January 2024 to August 2024. We also appreciate the parallel county efforts to reduce backlogged verifications and other processing tasks. As counties catch up on their renewal backlogs, verification processes and related work, individuals may receive new notices regarding their updated eligibility with potential retrospective approvals back to their renewal anniversary date. More information is on our website.

HCPF has 95 projects to achieve 45 Department goals during fiscal year 2024-25. This message covers just a few of them. We appreciate your support and collaboration across all HCPF’s work to help us address your areas of interest and to achieve our mission to improve health care equity, access, and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.

September 2024

Public Health Emergency Unwind Data & Select Priorities

Thank you to the more than 2,100 registrants and 1,550+ attendees at the Department of Health Care Policy & Financing (HCPF) Annual Stakeholder Webinar on August 27. We reviewed major initiatives for fiscal year (FY) 2023-24, priority initiatives for FY 2024-25 and held a Public Health Emergency (PHE) Unwind panel that provided valued insights from HCPF experts and special guests, including our county partners, Connect for Health Colorado and the Colorado Health Institute. Recordings and materials are posted on our website.

One of the goals of our Annual Stakeholder Webinar is to query and document the perspectives of our partners and stakeholders. When asked to rank their top three HCPF FY 2024-25 priorities, attendees selected improving the eligibility system infrastructure and supports (45%), transforming behavioral health (41%), and stabilizing long-term supports and services (37%) as the most important.

Other highlights of our Annual Webinar include:

Keep Coloradans Covered. In accordance with our February 2024 budget assumptions, Colorado’s Medicaid membership is returning to pre-pandemic levels. Our PHE Unwind was May 2023 through April 2024, plus the 90-day reconsideration period, which ended July 2024. Post PHE Unwind metrics are reflecting some of the advances made during the PHE and the PHE Unwind, to the betterment of the member experience and county eligibility processing workloads. More information is available on our PHE website. Some key metrics include:

• Unwind renewal approvals were within 2% of prepandemic norms (55% vs 57%), and disenrollments were as well (43% vs 41%). Since then, renewals have improved significantly: In May, 80% of renewals were approved (after 60 days of the 90 day reconsideration period); In June, 79% of renewals were approved (after 30 days of the 90 day reconsideration period), and in July, 78% remain covered. These percentages continue to increase over the next 90 days, during the reconsideration period.
• Automation is critical to improving the member renewal experience and reducing county workloads. In May 59%, June 56% and July 62% of household renewals were completed through automation innovations (or ex parte). That’s a significant and meaningful improvement over the 33% average during the PHE Unwind. This improvement is to the betterment of the member experience and county workload. (Note: ex parte can only occur on renewal approvals, not denials).
• Procedural denials are now below the 12% prepandemic levels, at 9% for May renewals (after 60 days), 10% for June (after 30 days) and 10% for July.

All renewal performance metrics are headed in the right direction, but we still have a lot of work to do.

	Prepandemic	Unwind	Post Unwind
	CYs 2018- 2019	May 2023- April 2024	May 2024	June 2024	*July 2024
Renewal Rate	57%	55% (after 90 day reconsideration period)	80% (after 60 days of the reconsideration period)	79% (after 30 days of the  reconsideration period)	78%
Auto Renewal Rate (ex parte at household level)	N/A	33% - All	59% - All 67% - MAGI	56% - All 66% - MAGI	62% -All 72% - MAGI
Disenrollment Rate	41%	43% (after 90 days)	17% (after 60 days)	18% (after 30 days)	17%
Pend Rate	2%	2-8%	4%	5%	5%
Disenroll: Eligibility	29%	19% (after 90 days)	8% (after 60 days)	8% (after 30 days)	6%
Disenroll: Procedural	12%	25% (after 90 days)	9% (after 60 days)	10% (after 30 days)	10%
Disenroll: Re-Enrolled	42%	33%	N/A	N/A	N/A

*July 2024 marked the implementation of additional automation for renewing members with incomes at and below the federal poverty level.  

Leveraging American Rescue Plan Act (ARPA) for Long Term Transformation. HCPF is on track to leverage one-time federal stimulus funds for long term transformation to the betterment of our members. We have completed 92% of the 61 projects; thank you to the almost 11,000 partners who engaged in our stakeholder meetings to frame the goals and focus areas associated with this work. We are pleased that more than 90% of our funds are directly benefiting the community (with 3.5% for administration). We have spent 74% of the $550 million to date. You can find more information on our ARPA website.

Transforming Behavioral Health. HCPF continues to collaborate with the Behavioral Health Administration (BHA) to strengthen Colorado’s Behavioral Health Safety Net System. This includes a new set of safety net services and connecting new provider types to new Medicaid payment models to ensure sustainable access to a full continuum of BH care for Medicaid members.

These changes were specifically designed to expand the provider network and develop an updated model for Comprehensive Providers (previously called community mental health centers, or CMHCs), and a new payment model for small and medium sized providers. These Essential Safety Net Providers offer care coordination, one or more of a select set of behavioral health services, and often specialize in services for certain populations like children in foster care, individuals with co-occurring disabilities, or people experiencing homelessness. These providers have long been part of the safety net, but previously did not have access to safety net funding. Starting July 1 of this year, Essential Providers are eligible to apply for an enhanced payment if they can demonstrate their ability to meet a safety net standard of care.

As of August 23, BHA has received 327 total applications from providers to become Comprehensive or Essential Safety Net Providers. So far BHA has issued 18 Comprehensive Provider approvals and 87 Essential Provider approvals, and HCPF has successfully enrolled 5 Comprehensive Providers across 28 locations and enrolled 60 Essential Providers. If you are interested in becoming a safety net provider, please visit the BHA Behavioral health licensing, designation and approvals website to learn more!

Webinar attendees also shared their views via the poll below on the behavioral health areas they would like more focus on from HCPF, in our efforts to help transform Colorado’s BH system.

Colorado Social Health Information Exchange (CoSHIE). The CoSHIE leads the next phase of evolving prescriber tools. It will enable providers, care coordinators, Regional Accountable Entities (RAEs) and community health workers to better support individuals through payer programs, state programs and community supports. Long term, the tool will help provider care teams, RAEs and community workers connect individuals to payer health improvement programs like prenatal and related maternity programs, diabetes management and other payer-based, health improvement related supports. It will also help connect individuals and patients to state health related social needs (HRSNs) programs such as Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants and Children (WIC), or Housing Vouchers. Last, it will further connect individuals and patients to community food banks, homeless shelters and other related supports. The first wave of the CoSHIE starts September 30, 2024 with behind the scenes improvements in systems aimed at coordinating care. Webinar attendees shared that they were most excited about rent/temporary housing up to 6 months (59%), CoSHIE connecting Medicaid members with HRSNs (46%) and pre-tenancy and housing transition services (38%).

Drive Value Based Care. We continue to prioritize value based payments in primary care, maternity care, prescription drugs, hospital care, and behavioral health to reward improved access to high-quality, equitable and affordable care. In 2022, 36% of Medicaid payments were value based payments and we continue to grow this.

Thank you for your ongoing partnership in leading transformative advances to the betterment of our members and all Coloradans.

August 2024

Invitation to Annual Meeting & Update on Select Priorities

We invite you to register for our Department of Health Care Policy & Financing (HCPF) Annual Stakeholder webinar on Aug. 27, from 8 to 11 a.m. This event will review HCPF major initiatives for fiscal year (FY) 2023-24, priority initiatives for FY 2024-25, and public health emergency (PHE) unwind insights and opportunities going forward. We look forward to your attendance and feedback.

Transforming Behavioral Health. On July 1, 2024, years of planning finally came to fruition as new safety net provider types and payment models were instituted across the behavioral health system. Inherent in the new payment model is the Prospective Payment System, or PPS, which was built and tested over the past three years with providers, advocates, and payers. The PPS model is sustainable, reliable, data driven, nationally supported, cost-based, accountable, and long overdue.

Comprehensive safety net providers (previously called community mental health centers) shared their “must-haves” for a payment model, and HCPF was able to meet almost all of their voiced requests through the PPS. This new payment model pays in advance instead of reimbursement, adds an increase for inflation and future costs, and accounts for new BHA compliance standards. Available only for BHA-approved safety net providers, the PPS rate is unique to each comprehensive provider and is calculated based on their actual operating costs. That includes the cost of serving people who are uninsured or underinsured and reflects the specific needs of communities across Colorado. Sustainable payment models will be key to mitigating the foreseeable changes and financial cliffs that have come with the end of the public health emergency, especially the end of federal PHE stimulus dollars.  

Health Related Social Needs. On Aug. 13, 2024, HCPF submitted a proposal to our federal partners at the Centers for Medicare and Medicaid Services to expand coverage for services that address health related social needs. If approved, Medicaid members that meet additional eligibility criteria would have coverage for the following services:

• Housing services including pre-tenancy & housing navigation services, tenancy sustaining services, rental assistance for temporary housing or vouchers for up to 6 months (including utilities), and one-time transition and moving costs.
• Nutrition services including home delivered meals or pantry stocking, medically-tailored meals, and nutrition counseling/education.

Thank you to all of the community partners who showed up fast and ready to help us move this policy forward at a record speed. This was only possible because state and community leaders have prioritized researching, advocating, piloting, and promoting programs that address the whole person, and recognize that housing, food security, and other social determinants are all part of achieving health and wellness.

Advancing the Medicaid Delivery System Through ACC Phase III. The Accountable Care Collaborative (ACC) is the primary vehicle for delivering health care to Health First Colorado members, with Regional Accountable Entities (RAEs) as the central component responsible for propelling members’ physical and behavioral care coordination, case management and health. Phase III of the ACC, scheduled to begin July 1, 2025, is designed to improve access to care, health care equity, quality outcomes, and member and provider experience, while managing costs to protect member coverage, benefits, and provider reimbursements. The Request for Proposal (RFP) closed July 13, 2024, and we intend to announce contract awardees by October 2024. Thank you to the 5,700+ attendees across 135 stakeholder meetings for partnering on developing the ACC Phase III RFP over the past 18 months. More information is on the ACC Phase III webpage.

Keep Coloradans Covered. In accordance with our February 2024 budget assumptions, Colorado’s Medicaid membership is returning to pre-pandemic levels. Our PHE Unwind was May 2023 through April 2024, plus the 90-day reconsideration period, which ended July 2024. Post PHE Unwind metrics are reflecting some of the advances made during the PHE and the PHE Unwind, to the betterment of the member experience and county eligibility processing workloads. 

• Unwind renewal approvals were within 2% of prepandemic norms (55% vs 57%), and disenrollments were as well (43% vs 41%).  For the first two months post unwind (both May and June 2024 renewals), 76% of those up for renewal were approved as still eligible for Medicaid/CHP+, a significant improvement. 
• About 57% of May and June 2024 households were renewed through automation innovations (ex parte). That’s a significant and meaningful improvement over the 33% average during the PHE Unwind. This improvement is to the betterment of the member experience and county workload.
• Procedural denials have also returned to prepandemic levels, at 13% and 12% for May and June 2024 renewals, respectively.

That said, there is still more work to do, and we are committed to completing that work. As explained in our July message, major initiatives designed to improve the eligibility process include:

• SB22-235 County Administration of Public Assistance Programs: A County Administration Long-Term Support Plan that provides recommendations to improve county administration of eligibility and enrollment and related activities, including properly resourcing our state-county infrastructure, addressing county staff wage rate gaps, advancing the eligibility tools employed by county workers, and more. Target Completion Date: This report is due to the legislature in November 2024. 
• Improve our renewal automation rates and PEAK performance, our member digital tool.
• Improve clarity in 55 common member eligibility communications, and ultimately eligibility renewal results. Target Completion Date: December 2024.
• Through the Joint Agency InterOperability (JAI) project, we will advance county consistency through the use of shared, universal tools that support counties in eligibility task management, including new applications, renewals, case changes and other tasks; dashboarding; document capture; and related critical work. Target implementation date: Anticipated 2026 - 2027.
• The Colorado Benefits Management System (CBMS) Vision & Strategy project is driving alignment and clarity around CBMS operational advances, infrastructure, and priorities. Target completion date: June 2025.

Stabilize Long Term Supports and Services (LTSS). We continue to prioritize stabilizing the Medicaid LTSS system. This includes protecting coverage for LTSS members, paying providers timely to protect access to services, identifying and resolving known issues in the new Care and Case Management Tool (CMM), reducing case management and county backlog, and leveraging the escalation process.

Save Coloradans Money on Prescription Drugs. We are awaiting approval of our State Importation Plan from the FDA, submitted in February 2024, to import lower-cost prescription drugs from Canada. Additional strategies HCPF has advanced to increase the affordability of prescription drugs include Medicaid value-based arrangements for specialty drugs, prescriber tools to drive affordability and quality already used by 55% of Medicaid prescribers, and policies to save Coloradans money on prescription drugs, including rebate pass through, the elimination of spread pricing (up-charging), and active engagement in the Prescription Drug Affordability Advisory Council, which advises the Prescription Drug Affordability Board.

HCPF has moved! HCPF has officially moved all operations to 303 E. 17th Ave., Suite 1100, Denver, CO 80203. Please be sure to update your records so you and your mail don’t end up at our prior Grant Street address. 

July 2024

A Return to Prepandemic Enrollment Levels

We invite you to register for our HCPF annual webinar on August 27 from 8 to 11 a.m. This event will review HCPF major initiatives for FY 2023-2024, priority initiatives for FY 2024-2025, and public health emergency (PHE) unwind insights and opportunities going forward. We look forward to your attendance and feedback at this meeting.

During the COVID-induced PHE, Colorado grew Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+) enrollment by more than 45%, or about 550,000 Coloradans, from 1.25 million to 1.8 million (covering about 30% of the population, at its high in May 2023). That percentage increase, according to our research, puts us among the top Medicaid expansion states for growth during the pandemic. We were there for Coloradans when they needed us as the coverage safety net, and we appreciate your partnership in achieving that important goal.

With the end of the federal PHE, all states, including Colorado, were required by the federal government to return to “business as usual operations,” disenrolling Medicaid members who no longer qualified (“PHE Unwind”). Colorado took the full 12 months (14 months including March noticing) allowed to redetermine coverage for all 1.8 million Coloradans covered at the start of the PHE Unwind. The PHE Unwind went from May 2023 to April 2024. As a result, Health First Colorado and CHP+ enrollment has returned to prepandemic levels of about 1.27 million members as of May 1, 2024, in alignment with our February 2024 forecast. Note that enrollment numbers for each month increase after the 90 day reconsideration period, meaning we won’t have final optics into the impact of the PHE Unwind until August (reflecting July, and the end of April’s 90-day reconsideration period).

The impact of the PHE “return to business as usual,” as directed by the federal government, has not been easy - not for members, providers, eligibility processing partners, those who advocate for all these important communities or HCPF staff. We appreciate your collaborative partnership in navigating this unprecedented chapter.

Through the PHE, advancing our renewal automation technology has been a key focus because it mitigates required member renewal action and county processor action, and ultimately increases renewal approval rates in support of our shared goal of Keeping Coloradans Covered. We are very encouraged that our May 2024 and June renewals show much higher levels of renewal automation at 59% in May and 56% in June versus an average of about 33% during the PHE Unwind. For those determined eligible based on income (MAGI population), renewal automation hit 67% in May and 66% in June. We are also seeing far higher renewal approvals, at 76% for both May and June, compared to our prepandemic 57% approval rate and our 55% PHE Unwind approval rate. That final PHE Unwind approval rate will change through the finalization of the 90-day reconsideration period and the impact of pending renewals yet to be completed. Our procedural denials have returned to prepandemic norms, at 12%, which is also welcome news. This dramatic improvement in automation, renewal approval rates and procedural denials are all solid indicators of future eligibility determination performance, to the betterment of our members, providers, county partners, and the state’s coverage rates.

That said, there is still more work to do, and we are committed to completing that work. Although April 2024 was the last month of the PHE Unwind, Keeping Coloradans Covered remains a focus, as we continue to work towards ongoing improvements to the Medicaid renewal process while collaborating with partners to connect Coloradans to affordable coverage. Major initiatives include:

• We are working in collaboration with the Colorado Department of Human Services (CHDHS) and the counties on three long-term projects that better support our county eligibility partners, while improving the member experience and our overall eligibility performance, including: 
  • Colorado Benefits Management System (CBMS) Vision & Strategy: driving alignment and clarity around CBMS operational advances, infrastructure, and priorities. CBMS is the state-owned eligibility system, which operates in conjunction with SalesForce, Amazon Web Services, and member applications (PEAK, PEAKPro) to make up the state’s eligibility infrastructure. Target completion date: June 2025.
  • Joint Agency InterOperability (JAI): advances and creates consistency through the use of shared, universal tools that support counties and the state in eligibility task management, including new applications, renewals, case changes and other tasks; dashboarding; document capture; and related critical work. Target implementation date: Anticipated 2026 - 2027.
  • SB22-235 County Administration of Public Assistance Programs: A County Administration Long-Term Support Plan: provides recommendations to improve county administration of eligibility and enrollment and related activities, including properly resourcing our state-county infrastructure, addressing county staff wage rate gaps, advancing the eligibility tools employed by county workers, and more. Target Completion Date: This report is due to the legislature in November 2024. 
• We are updating our standard CBMS eligibility correspondence to improve clarity in 55 common member eligibility communications, and ultimately eligibility renewal results. While this work is ongoing, the target first round completion of these 55 common communications is December 2024.
• Internal experts continue to collaborate with external consultants and other states to improve our renewal automation rates while additional enhancements are being made to PEAK (our member digital tool). This is a Governor’s Wildly Important Goal (WIG) for HCPF for FY 2024-25.
• From a commercial coverage perspective, we continue to collaborate with employers, chambers, providers, Connect for Health Colorado and other partners to help disenrolling Medicaid members connect to commercial coverage. 
• We will continue to drive health care affordability initiatives, partnering with other state agencies, providers and stakeholders to Save Coloradans Money on Health Care, thereby mitigating the biggest barrier to coverage once Coloradans disenroll from Medicaid - its affordability.

You can learn more about all these efforts and more at our HCPF webinar on August 27 from 8 to 11 a.m. Register to attend the webinar. In the interim, we invite you to visit our Colorado Continuous Coverage Unwind Data Reporting webpage. You may also view our recent presentations to the Joint Budget Committee (June 20) and the Joint Technology Committee (July 8), 2024 at our Legislator Resource Center.

In addition to these goals that help us Keep Coloradans Covered, driving Medicaid affordability will continue to be a HCPF priority. Unfortunately, we are observing increased per capita costs under the Medicaid program for those individuals who remain covered after the PHE Unwind - higher costs than we expected. Driving advances that better manage Medicaid cost trends, including those included in our Accountable Care Collaborative (ACC) Phase III Request for Proposal (RFP), is paramount to protecting Medicaid member benefits and access to coverage, which are also key HCPF priorities.

Thank you for your continued partnership and collaboration.

June 2024

Public Health Emergency Unwind Update

During the COVID-induced Public Health Emergency (PHE), Colorado grew its Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+) safety net enrollment by more than 45%, or about 550,000 Coloradans. That percentage increase, according to our research, is amoung the highest in the nation of the Medicaid Expansion states. Our collaborative efforts helped to renew and enroll 1.8 million Coloradans, or 30% of the population, into our programs. These are historic, unprecedented milestones and accomplishments achieved without warning or playbook. We should all be incredibly proud of that. Together, we were there for Coloradans when they needed us, and that is why safety net coverage programs like Health First Colorado and CHP+ exist. Thank you. This was a massive, impressive team effort, and we are very grateful for your engagement and partnership.

As the nation’s economy recovered, the federal government called an end to the PHE. For Colorado, April 2024 marks the last month of our year-long “unwinding” of the Medicaid continuous coverage requirement (“PHE Unwind”), reflecting the federal directive for Medicaid program eligibility operations to return to normal. While our work is not yet done, we have a lot of emerging data to share as the optics into this historic year and chapter become clearer. Those insights can help further collaboration to address opportunities and challenges.

First, we want to recognize and thank our members, health care providers, health plan partners, community partners, advocates, counties and medical assistance sites, state agency partners, stakeholders, and the legislature for your collaboration and partnership in preparing for and executing the PHE Unwind. Thank you for doing your part. Your engagement has been continual, and we are deeply appreciative.

It was expected that the hundreds of thousands of Coloradans we enrolled into our safety net programs during the COVID-induced economic downturn would largely return to employer-sponsored coverage given the state’s economic recovery, thereby returning the percent of Coloradans covered by employer-sponsored coverage back to its historic 50% norm. Still, we want to recognize that returning to business-as-usual renewal processes has not been easy - not for members, providers, eligibility processing partners, or those who advocate for all these important communities. We appreciate your partnership through the PHE Unwind to achieve our shared goal to Keep Coloradans Covered.

As we continue to pursue this important goal, the emerging data can help inform our evolving strategies to the betterment of Coloradans, providers, counties, medical assistance sites, and all stakeholders. In addition to the below, more information is available on our website:

• Through the PHE Unwind, Health First Colorado and CHP+ enrollments have returned to prepandemic levels of about 1.28 million members, meaning that about the same number of members disenrolled during the PHE Unwind (estimated net reduction of 519,000) as were enrolled during the PHE (about 550,000). Ultimately, the PHE Unwind enrollment level should track within 2% of the prepandemic enrollment levels.  
  PHE Unwind renewals (approvals) and disenrollments are within 3% of prepandemic norms:
  • 57% prepandemic renewal approval rate versus 54% during the PHE Unwind 
  • 41% prepandemic disenrollments versus 44% during the PHE Unwind
• For member renewals due in May 2024, the first month after the PHE Unwind, the renewal rate (approval rate) was 76%, which is a historic high and reflects a favorable 40% increase over the PHE Unwind renewal approval rate and a 33% increase over the prepandemic renewal approval rate. This 76% renewal approval rate milestone illustrates that while there is still a great deal of work to do to improve our safety net eligibility processes and systems, the automation, innovation, and policy adjustments implemented during this PHE chapter have significantly improved Colorado’s overall processing results to the betterment of those served, mitigation of a rising uninsured rate, and the reduction in county workloads, which is also a critical priority.
• Automation of renewal processing (ex parte) improves accuracy, timeliness and efficiency. It also improves the member experience while reducing workload for counties. Ex parte rates have significantly increased from an average of about 33% through the PHE Unwind to 59% overall for renewals that were due in May 2024. Ex parte rates are even higher, at 67%, for households where eligibility is determined based on income (MAGI). 
• Procedural disenrollments for May renewals have also returned to prepandemic levels at 12%, down from about 25% during the unwind - a 50% favorable reduction.
• Reducing Whereabouts Unknown (members we can’t find at renewal) has decreased from 22% in May 2023 to 5% in May 2024.
• County enrollment levels are very close to prepandemic enrollment levels. Our PHE website provides two charts to illustrate each county’s comparative metrics. (See “Enrollment Changes by County and Enrollment as a Percent of Population”).
• Colorado will have more individuals disenroll from our rosters through the PHE Unwind compared to other states for several reasons:
  • We grew Medicaid enrollment as a percent by so much more than other states did during the PHE - 45% enrollment growth - meaning we will disenroll more people as we return to prepandemic enrollment numbers.
  • Since we expanded Medicaid through the Affordable Care Act, this enabled Colorado to grow its membership during the COVID-induced economic downturn more than states that did not expand Medicaid. 
  • Our economy recovered faster and stronger than the nation’s, coming out of the COVID-induced economic downturn. 
    • Low unemployment rate: Colorado’s unemployment rate was 2.8% in December 2019 (prepandemic) and then increased significantly due to the COVID-induced downturn. It returned to prepandemic levels of 2.8% in June 2022. The nation’s unemployment rate followed the same trend from a timing perspective, but was 28% less favorable in comparison at 3.6% in December of 2019 and June 2022. Colorado’s unemployment rate today continues to be lower than the national average.
  • Our minimum wage is higher than other states, while the federal poverty level to qualify for Medicaid is the same, meaning that in states where pay is higher, fewer people qualify for Medicaid. Between 2020-2024, Colorado’s minimum wage increased by 20% ($12.02 to $14.42 per hour), making it the 8th highest in the nation; that means 42 other states have minimum wages lower than ours. Denver’s minimum wage increased 42% ($12.85 to $18.29 per hour). To illustrate this impact, a single person working full-time in Colorado at a minimum wage job will likely not qualify for Medicaid based on income, while a person working a full-time job in another state, at say a $10 hourly wage, is far more likely to qualify. Further, the national minimum wage is $7.25 per hour, with 13 states at the federal minimum wage, meaning those working at such wages are far more likely to qualify.
  • On a temporary basis, our Medicaid disenrollments may seem comparatively high because we have fewer renewals “pended” than most other states; further, Colorado has finished its PHE Unwind 12-month period. As other states complete their Unwind and address their “pended” renewals through that process, the comparisons will grow more reliable. That clarity should occur in the coming months.

Are Coloradans disenrolling from Medicaid getting connected to other coverage? What we know from our analysis performed using data through December 2023 from the All Payer Claims Database (APCD) is that approximately 33% re-enroll into Medicaid and at least 25% of people disenrolling from Medicaid have other insurance. The breakdown of that 25% is: 18% have Employer Sponsored Commercial coverage, 5% are enrolled into Medicare, and 2% are enrolled in an individual plan through the Connect for Health Colorado Marketplace Exchange. We also know that 33% of those who disenrolled from Medicaid actually re-enrolled at a later date - better than the 40%+ re-enrollment prepandemic comparative norm.

Re-enrolled into Medicaid: 33%
Enrolled in Employer Sponsored Commercial Coverage: 18%
Enrolled in Medicare: 5%
Enrolled in Connect for Health Marketplace Exchange: 2%
Unknown - more information pending from the APCD: 42%

We don’t have optics into the other 42% at this time, but we will have additional insights as the data becomes available. Further, we are conducting two surveys now that will help us better understand: (a) if disenrolling members are connecting to other coverage and if so, what type, and (b) why members re-enrolled in Medicaid after disenrolling. While we await all those findings, we are concerned about the known barriers to individuals enrolling in other coverage, such as:

• Individuals disenrolling from Medicaid likely did not have the traditional support they needed to enroll in employer sponsored or Medicare coverage because more than 80% of Coloradans disenrolled off cycle with the traditional open enrollment educational and outreach periods.
• Disenrolling members may have missed the window to enroll in their employer’s coverage. Specifically, employers may not have expanded the time Coloradans had to enroll after a qualifying event, such as being disenrolled from Medicaid. This enrollment period has historically been 60-days, but the federal government recommended that employers, plan sponsors and issuers extend this period to 1 year during the national PHE Unwind.
• Some may be prioritizing other household expenses over paying for health insurance coverage after being enrolled with Medicaid; Colorado Medicaid does not charge premiums, deductibles or co-pays for most services, making it far more affordable than other coverages.

Although April was the last month of the PHE Unwind, our work is not done! Keeping Coloradans Covered remains a focus, as we continue to work towards ongoing improvements to the Medicaid renewal process while collaborating with partners to achieve shared goals, including:

• We are working in collaboration with CDHS and the counties on three long term projects to improve the eligibility process: CBMS vision and strategy; Joint Agency InterOperability; SB22-235 Long Term plan (provides recommendations to properly resource our state-county infrastructure).
• We are updating our standard eligibility correspondence to improve clarity by December 2024, and we will continue to implement improvements that increase ex parte automation and PEAK capabilities (our member digital tool).
• We will continue to drive the analytics that identify what we can do to continually improve our systems and procedures to the betterment of members, counties and providers.
• We continue to collaborate with employers, chambers, providers and other partners to raise awareness of all coverage options and thereby help connect disenrolling Coloradans to other affordable coverage. 
• We will continue to work to maintain the affordability of Medicaid and CHP+ coverage, while partnering with other state agencies, providers and stakeholders to Save Coloradans Money on Health Care, thereby mitigating the biggest barrier to coverage - its affordability.

In addition to the work being done to Keep Coloradans Covered, HCPF has published the Accountable Care Collaborative (ACC) Phase III Request for Proposal (RFP) on May 10, 2024; proposals are due July 13, 2024. The ACC is Health First Colorado’s care delivery model designed to improve access to care, health care equity, quality outcomes and value. ACC Phase III is scheduled to begin July 1, 2025. Thank you to the 5,700+ attendees across 135 stakeholder meetings for your feedback over the past 18 months as we partnered on developing the ACC Phase III RFP. More information is on the ACC Phase III webpage. HCPF has also been closely collaborating with the Behavioral Health Administration (BHA) and stakeholders to thoughtfully align the Medicaid ACC Phase III with the BHA’s Behavioral Health Administrative Services Organization (BHASO) model, where appropriate. That RFP was also posted in May. BHASOs and the ACC Phase III have the same July 1, 2025, launch date and regional map to improve the member and provider experience, facilitate contractor transitions, and enhance collaboration in each region.

We appreciate your active engagement, and we thank you for your continued partnership to achieve shared goals.

May 2024

2024 Legislative Recap

Thank you for your partnership throughout the 2024 legislative session. This session, the Department of Health Care Policy and Financing (HCPF) tracked 63 bills, successfully navigated 15 agenda and priority bills through the process, and completed 78 fiscal analyses of 71 unique bills. Thank you for your partnership in helping pass bills of interest, with 85% of final votes in support. We are now working to implement all the bills and budget requests that impact HCPF safety net programs or leverage our expertise to the betterment of Coloradans. This includes 45 bills, eight legislative requests for information and nine new or changed legislative reports. Please visit our Legislator Resource Center for our latest fact sheets on the 2024 legislative session.

Thank you to the General Assembly, advocates, providers and other stakeholders for partnering to advance bills that support the Coloradans we cover and serve, provide added supports for Coloradans in need of substance use disorder (SUD) and behavioral health care, protect the health and safety of members, and expand eligibility and services for some of our most vulnerable members. We are also very thankful for new policies and funding that continue to support our health care providers who provide valued access to care for our members. Below are key highlights of the legislative session.

HCPF was involved in two bills that address substance use disorders (SUD). HB24-1045 creates and expands programs and services for SUD treatments while SB-047 creates several measures regarding the prevention of SUD. HCPF also focused on creating and expanding programs for youth who are in, or at risk of being placed in, out-of-home care through HB24-1038.

Both HB24-1400 and HB24-1229 address Colorado Medicaid’s eligibility procedures. HB24-1400 allows HCPF to no longer require additional verification during a member's Medicaid redetermination if certain criteria are met. HB24-1229 gives HCPF the authority to pursue an 1115 waiver to expand presumptive eligibility to include individuals with disabilities and facilitate prompt delivery of services in a community setting. Both of these bills support the Polis-Primavera Administration goal of Keeping Coloradans Covered.  

As part of the Joint Budget Committee and Long Bill, bills were passed to extend the Rural Stimulus Grants funding through the end of 2024 (HB24-1465), as well as sunset the Colorado Indigent Care Program (CICP) as a distinct program due to funding for CICP clinics being repealed in 2021 (HB24-1399).

Other bills passed protect the health and safety of members and state dollars in cases of organized crime or organized fraud schemes (HB24-1146); make a variety of technical changes to multiple state agencies’ required legislative reports to ensure relevancy, timeliness, accountability and transparency (SB24-135); allow a one-time payment of $5 million to safety net hospital Denver Health (HB24-1401); and retroactively discontinue transfers to the autism treatment fund while transferring any remaining balance to the tobacco litigation settlement cash fund (HB24-1208).

HCPF’s fiscal year 2024-25 budget is $15.9 billion Total Fund and $5.0 billion General Fund, reflecting about one-third of the state’s budget. 96% of that budget goes to pay our valued health care providers caring for Medicaid and Child Health Plan Plus (CHP+) members. This includes a 2% increase in provider reimbursement rates across the board, on top of last fiscal year’s 3% increase and prior year increases of 2% and 2.5%, targeted provider rate increases, and direct care workers wage increase across the state to $17 per hour and to $18.29 per hour in Denver, effective July 1, 2024.

In addition to our collaborative work this legislative session, thank you for your continued partnership in helping Keep Coloradans Covered throughout the 14-month public health emergency (PHE) unwind. April was the final month of Colorado’s PHE unwind process, reflecting the state’s and the nation’s return to business-as-usual eligibility processing. Still, our work is not done! Members can still leverage the 90-day reconsideration period to submit their renewal information late, or after that, submit new applications for coverage at any time. More information is on our updated website, reporting webpage and in our newsletters. Providers and partners, please continue to leverage the following tools to support Medicaid and CHP+ members through the renewal process as a best practice to achieve shared goals: Update Your Address, Understanding the Renewal Process and Take Action on Your Renewal (available in the top 11 languages spoken by our members). Flyers have been developed for employers to distribute to employees to remind them to look for their Health First Colorado renewal packet and where appropriate, how to transition to employer-sponsored coverage, and the importance of doing so in a timely manner.

Thank you for your collaboration throughout this legislative session to advance important policies for the betterment of all Coloradans. We appreciate the hard work, passion and expertise of our elected officials, advocates, providers, partners and stakeholders.

April 2024

Social Determinants of Health System Transformation to Improve Whole Person Health

Thank you for partnering with the Department of Health Care Policy & Financing (HCPF) to evolve Colorado’s social determinants of health supports, improve whole person health, and reduce health disparities. Key HCPF initiatives include:

• Working with the Office of eHealth Innovation (OeHI) to finance and build the Social Health Information Exchange (SHIE). The Social Health Information Exchange (SHIE) leads the next phase of evolving prescriber tools. It will enable providers, Regional Accountable Entities (RAEs) and community workers to better support individuals through payer programs, state programs, and community supports. Long term, the tool will help connect individuals to payer health improvement programs like prenatal and related maternity programs, diabetes management, cardiac or asthma programs; it will help refer individuals to state health related social needs (HRSNs) program such as Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants and Children (WIC), or Housing Vouchers; it will also aid provider care teams and community workers in connecting individuals to community food banks, homeless shelters and other related supports. The SHIE has been successfully financed through two sources. First with HCPF American Rescue Plan Act dollars, which need to be spent by September 2024 on designing and building the initial foundation for the tool. The second source is through a HCPF/OeHI budget request enabling a 90/10 federal match, with the 10% state funds approved by both the Joint Technology Committee (JTC) and the Joint Budget Committee (JBC) during this legislative session. The contract with Resultant, the state’s vendor partner, was executed in November of 2023.
• Working with national experts and the Center for Improving Value in Health Care (CIVHC) leadership, who is the appointed administrator of the state’s All Payer Claims Database, and its Advisory Committee to determine how to code and capture payments related to social determinants of health for future analysis, tracking and reporting.
• Collaborating to increase access to SNAP and WIC enrollment to improve food access and security.
• Including member incentives in the Accountable Care Collaborative (ACC) Phase III that encourage engagement in health improvement programs as well as value-based payments that encourage provider care teams to connect patients to whole person care programs that improve Health First Colorado (Colorado’s Medicaid program) member health. 
• Exploring permanent supportive housing benefits through an 1115 waiver. HCPF hosted our first stakeholder meeting in March to launch our work on the feasibility of leveraging Medicaid to help pay for food and housing. Over 200 participants attended to provide their thoughts and perspectives. The goal is to amend HCPF’s existing 1115 waiver to include HRSNs.
• HCPF is engaged with the Colorado Food is Medicine Summit and evolving movement, along with more than 200 stakeholders from almost 80 organizations. Together we’re working to tackle the critical issue of how to increase health through access to essential nutrition programs. This is in complement to home delivered meals HCPF already provides for older adults and people with disabilities discharged from inpatient hospital care and through community based services available through Long-Term Services and Supports (LTSS) services.
• Pursuing authority to expand coverage to certain populations through an 1115 waiver. HCPF submitted an amendment to our 1115 waiver on April 1, 2024, seeking: 
  • Criminal justice reentry services effective July 2025
  • Serious mental illness and serious emotional disturbance (SMI & SED) inpatient care effective July 2025
  • Continuous eligibility coverage for children 0-3 years effective January 2026
  • Continuous eligibility coverage for adults released from Colorado Department of Corrections facilities effective January 2026

The ACC is the primary vehicle for delivering health care to Health First Colorado members, with RAEs as the central component responsible for propelling members’ physical and behavioral care coordination, case management and overall health. As such, Phase III of the ACC, scheduled to begin July 1, 2025, is designed to incorporate HRSNs support and advance whole person care to improve member health and reduce health disparities. This is one of the most important advances in the ACC Phase III Draft Contract, which outlines the RAE contractual requirements for prospective bidders. The Draft Contract is based on the policy and programmatic recommendations outlined in the ACC Phase III Concept Paper, which leveraged the tremendous feedback received from about 1,000 stakeholder across 20 stakeholder meetings.

April is the twelfth month of Colorado’s public health emergency (PHE) unwind process, reflecting the state’s and the nation’s return to business as usual eligibility processing, post the Continuous Coverage PHE chapter. All members can still leverage the 90-day reconsideration period to submit their renewal information late, or after that, submit new applications for coverage. More information is on our updated website, reporting webpage and newsletters. Please help members and partners complete the renewal process: Update Your Address, Understanding the Renewal Process and Take Action on Your Renewal (available in the top 11 languages spoken by our members). Flyers have been developed for employers to distribute to employees to remind them to look for their Health First Colorado renewal packet and where appropriate, how to transition to employer-sponsored coverage, and the importance of doing so in a timely manner. We ask that all stakeholders leverage these tools.

We are also continuing to implement supports and flexibilities for counties, Case Management Agencies (CMAs) and Health First Colorado members with disabilities who are eligible for LTSS. This is in response to concurrent challenges impacting the LTSS system, including:

• System issues with the implementation of the new Care and Case Management IT platform that are causing work-arounds and longer processing time for case managers; 
• Unforeseen complications with the transition of members to new CMAs to achieve the federally required conflict-free case management; 
• A backlog of requests for medical records acquired from hospitals and other providers by industry vendors, providing critical information necessary for the federal disability determination required for long-term care eligibility; 
• Increased county workload due to the end of the PHE combined with a record number of Health First Colorado and SNAP renewals

In the coming months, the IT innovations and case management redesign modernizations will create a better system for members, providers and CMAs. But the unintended impact of all three occurring at once has caused short-term challenges to member program eligibility, provider reimbursement, CMAs processing and member service response time.

HCPF has been pursuing a number of solutions to address these issues and protect coverage for LTSS members through system and process changes, mitigating payment delays for providers to ensure care access, resourcing escalation processes for members struggling to navigate the renewal process, supporting counties and CMAs, and working with providers and vendors to address unprecedented backlogs in securing medical records necessary for disability determinations. Please visit CO.gov/HCPF/stabilizing-LTSS for more information.

Thank you for engaging to propel system transformation that improves whole person health, for your continued engagement to Keep Coloradans Covered, and for your partnership to navigate and address LTSS system transformation challenges.

March 2024

Important HCPF February Forecast Information and Materials from our Feb. 26 Medicaid Behavioral Health Webinar

The Department of Health Care Policy & Financing (HCPF) provides the Joint Budget Committee with caseload and budget forecasts in November and February of each year. This Feb. 15 forecast included updates to our fiscal years 2023-24 and 2024-25 Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+) enrollment, leveraging a more expansive public health emergency (PHE) unwind period of insights based on actual renewal data. The new forecast for fiscal year 2023-24 estimates a net 519,000 member enrollment reduction. This reflects the net of individuals losing Health First Colorado and CHP+ coverage through the PHE unwind and those who newly enroll. Providers and partners should plan on a post unwind enrollment that more closely aligns with pre-pandemic levels. 

We began our PHE unwind process with March notices for May 2023 renewals, meaning April 2024 reflects the last month of the 12-month unwind period. This new estimate takes into account the actual enrollment changes we have experienced thus far, historic norms, and our projected changes through the next year given current economic conditions. Consider the following specifics:

• As a result of our collaborative efforts to get Coloradans covered during the COVID-induced economic downturn, when so many lost their employer-sponsored coverage, Health First Colorado enrollment grew by more than 40% compared to national growth of about 31%, as measured through January 2023 results, before the PHE unwind began. Further, Colorado’s unemployment rate has been lower (3.4%) than the national average (3.7%) through the pandemic and as of December 2023, indicating the state recovered faster than the nation from the COVID-induced economic downturn. Last, the Colorado economy has recovered faster than anticipated, and faster than national norms. As people regain employer-sponsored coverage through the economic recovery, more disenroll from Health First Colorado.
• We anticipate the PHE unwind will cause the emerging, aggregate composition of our members to more closely resemble pre-pandemic norms, where historically eligible members with higher medical needs stay covered, while the vast majority of those who enrolled during the COVID-induced economic downturn — a generally healthier population — no longer qualify.
• HCPF has underscored the importance of analyzing the 90-day reconsideration period, as covered members leverage this period to submit their renewal information late. This February forecast considers information through December, while relying heavily on the data through September, which incorporates the impact of this 90-day reconsideration period.
• We have also been tracking PHE unwind data compared to historic norms (calendar years 2018 and 2019), which shows that PHE unwind renewals are tracking within 2% of pre-pandemic norms, while disenrollments are within 3% of pre-pandemic norms. However, our procedural denials are higher than historic, pre-pandemic levels, while our income based and other qualified eligibility based denials are far below historic (about half). To verify income, Colorado sends a renewal packet to all individuals who did not meet eligibility income criteria through the ex parte process. If the recipient does not verify their income through this added process, it is considered a procedural denial, even if the individual is over income and simply not responding to renewal inquiries. We are implementing short-term and long-term solutions to improve the overall eligibility process, and appreciate your partnership.

To achieve our shared goal to Keep Coloradans Covered, we ask that all stakeholders please read our updated website, reporting webpage and newsletters, as well as use toolkits to help members and partners complete the renewal process or transition to other affordable health coverage. These are available in the top 11 languages spoken by our members: Update Your Address, Understanding the Renewal Process and Take Action on Your Renewal. Flyers have been developed for employers to distribute to employees to remind them to look for their Health First Colorado renewal packet and where appropriate, how to transition to employer-sponsored coverage, and the importance of doing so in a timely manner.

Thank you to the approximately 700 who joined our webinar on Medicaid behavioral health transformation, policy changes, how changes are impacting communities, and what is coming next. Recordings and materials are being posted on our website. This webinar was hosted jointly with the Behavioral Health Administration (BHA). While Dannette R. Smith, the new BHA Commissioner was unable to co-host, we welcome her March 18 start date and the ability to leverage her vast experience, positivity, and passion to transform Colorado's behavioral health system in partnership.

February 2024

Legislative Agenda, KeepCOCovered and Timely Reminders

New Colorado Hospital Transparency Reports and Tools

This month, HCPF released three reports: the Hospital Financial Transparency Report, the Colorado Hospital Community Benefit Annual Report, and the Colorado Healthcare Affordability and Sustainability Enterprise (CHASE) Annual Report. Hospitals represent over 40% of commercial health care dollars, which is why we are continually collaborating with hospitals, employers and other purchasers as well as stakeholders on hospital financial and pricing transparency, accountability, and tools. We appreciate hospitals’ partnership to address Colorado’s traditionally high prices, costs and profits to save Coloradans and our employers money on health care. Hospital efforts over the last several years have been meaningful and measurable in lowering the rate of price increases ultimately paid by Coloradans and our employers.

Overall, the reports show that compared to 2021, in 2022, Colorado hospitals’ net operating income (profit not including investment income) dropped 50%, total net income (profit including investment losses) dropped by 90%, while Colorado’s urban and system-affiliated hospitals maintained a median of 183 days cash on hand (reserves) in 2022, which is higher than the 149 in 2019. Community benefit investments increased $125 million from the previous fiscal year to $1.09 billion. Consider the below.

• The 2024 Hospital Financial Transparency report reflects data from 2022, and illustrates that Colorado hospitals’ operating expenses grew 10.4% from 2021 while patient revenue grew 5.9% and operating income decreased by $981 million or 50%. This reflects a sharp pivot from 2014-2021 reporting periods when patient revenue growth was substantially higher than expense growth. Contributing to the changes seen in 2022 were hospitals’ increased labor costs, including an alarming chapter of contracted labor expenditure up 247.6% from 2019, in addition to inflationary pressure. Uncompensated care costs also rose 12.5% or $60.5 million between 2021 and 2022 to a total of $544 million, primarily driven by increases in charity care. Despite the shift seen in 2022, numerous indicators show much of Colorado’s hospital industry is healthy, with some exceptions, such as many of the state’s rural hospitals and the state’s largest safety net hospital, Denver Health. The report shows that net patient revenues are returning to trends seen before the pandemic and the median hospital reserve was 183 days cash on hand, meaning hospitals could operate without additional revenue for about six months. This compares to pre-pandemic 2019 reserve levels of about five months. While the investment market returns have turned around since the 2022 outlier losses and the alarming staffing agency impact is largely in the rearview mirror, the increase in frontline staff base wages over the last three years has created a new and higher operating expense baseline while the increase in migrants is having a pivotal impact on Denver Health and a measurable impact on hospitals largely in the greater Denver area.
• Colorado’s Hospital Community Benefit report enables communities to examine how much hospitals are investing in their communities, in lieu of paying taxes, while also illuminating those investment decisions. During hospitals’ fiscal year 2021, their community benefit investment rose 13% to $1.09 billion. Of that spending, 55% was directed into social determinants of health, such as housing, food, transportation, interpersonal violence, education, and job opportunities; 24% into charity care, including free or reduced-cost health care services; and 5% spent on programs addressing health behaviors/risks. HB23-1243 took effect in August 2023 and requires more specific, community benefit reporting categories that will help HCPF better report on specific investment while comparing community investment spending directly to identified needs, starting in 2025.
• The Colorado Healthcare Affordability and Sustainability Enterprise (CHASE) Annual report illustrates that CHASE enabled hospitals to reduce cost-shifting to Coloradans and employers covered by private or commercial payers. In 2022, Colorado hospitals received $0.81 on their dollar of cost of care for Medicaid patients, far and above the $0.70 on the dollar of cost of care they received for Medicare patients. Additionally, in 2022-23, the CHASE provided $464 million in increased reimbursement to hospital providers, and funded health insurance coverage through Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus for more than 622,000 Coloradans - with no increase in Colorado General Fund expenditures. We invite all to celebrate this shared partnership and its tremendous result.

More information is in our press releases and on our Hospital Reports Hub.

HCPF also released the Price Transparency Posting report, which shows that 59% of all Colorado hospitals have a ‘Good’ quality rating, which is about 33% better than the November 2022 measures, reflecting significant improvements in hospital price postings. This tool leverages state and federal legislation that requires hospitals to post their prices by their respective network based product contracts with carriers. Additionally, HCPF launched the Payment Variation Tool that compares hospital inpatient payments to identify low-cost providers. These new transparency tools are part of a shared effort to illuminate and influence more competitive hospital prices that are ultimately paid by Coloradans and employers. Thank you to our hospital partners for your cost and pricing improvements and for your continued collaboration to save Coloradans and our employers' money on health care.

Continued Partnership to Keep Coloradans Covered

A top priority continues to be to Keep Coloradans Covered, now that Colorado has resumed regular eligibility reviews for people with Health First Colorado and CHP+ after a 3+ year pause during the COVID-19 public health emergency (PHE). Thank you for your active engagement with members, community partners, and advocates leading up to and during the unwind period, and for your continued dialogue to improve the renewal process. Please continue to read our updated website, reporting webpage and newsletters, as well as utilize toolkits to help members and partners complete the renewal process or transition to other affordable health coverage. These are available in the top 11 languages spoken by our members: Update Your Address, Understanding the Renewal Process and Take Action on Your Renewal. Flyers have been developed for employers to distribute to employees to remind them to look for their Health First Colorado renewal packet and where appropriate, how to transition to employer-sponsored coverage, and the importance of doing so in a timely manner. We ask that all stakeholders leverage these tools.

Timely Updates

Please register to join HCPF and the Behavioral Health Administration for a Medicaid Behavioral Health webinar on Feb. 26 from 11:30 a.m. to 1:30 p.m. The webinar will cover Medicaid behavioral health transformation, relevant policy changes, how changes are impacting communities, and what is coming next.

Finally, we have published the Accountable Care Collaborative (ACC) Phase III Draft Contract, which outlines the emerging contractual requirements for Regional Accountable Entities (RAEs) for Phase III of the ACC that is scheduled to begin on July 1, 2025. The Draft Contract is based on the policy and programmatic recommendations outlined in the ACC Phase III Concept Paper as well as feedback from stakeholders. We have published several documents, available on the ACC Phase III Draft Contract webpage, intended to help stakeholders review and provide feedback. Please provide feedback by March 10 through: Draft Contract Feedback Form, Offeror Questions Feedback Form, or via email at HCPF_ACC@state.co.us.

January 2024

Saving People Money on Health Care and Keeping CO Covered

HCPF’s 2024 Legislative Agenda

The Department of Health Care Policy & Financing’s 2024 legislative agenda includes proposals that address the needs of children with autism, people with disabilities, uninsured Coloradans and the providers who care for them, as well as Deferred Action for Childhood Arrivals (DACA) recipients. It also increases government efficiency and decreases regulatory burden for certain providers. As our legislative agenda is still evolving, we invite you to monitor HCPF’s 2024 Legislative Agenda Overview to keep pace with our emerging intentions and high priority bills, some of which are explained below:

• Expand Child Health Plan Plus (CHP+) to Include Services for People with Autism.  Autism Spectrum Disorder (ASD) treatment is not currently covered under CHP+. This bill expands CHP+ to provide ASD coverage, which is even more important given the end of the public health emergency; if a child with autism moves from Health First Colorado to CHP+ through the renewal process, that child will lose access to services that address ASD without this coverage addition.
• Presumptive Eligibility for Individuals with Disabilities. This bill allows HCPF to pursue an 1115 waiver to expand presumptive eligibility, which will facilitate more timely access to services in a community setting for individuals with disabilities.
• Revise and Clarify Safety Net Requirements for Primary Care and Hospital Services. This bill sunsets the Colorado Indigent Care Program (CICP) as a distinct program due to repealed funding in 2021. It adds funding to the Primary Care Fund so that Federally Qualified Health Centers (FQHCs) can receive payments for care provided to uninsured Coloradans up to 250%, from the current 200% of the Federal Poverty Level (FPL).
• Medicaid for Certain DACA Recipients. This bill aligns state law with proposed federal regulations. It would allow HCPF to draw a federal match to cover DACA pregnant adults and children under 19 years of age who are qualified noncitizens and meet Medicaid eligibility criteria other than citizenship.
• Interagency Legislative Report Cleanup. This multi-agency government efficiency bill eliminates duplicative and outdated reporting, reduces administrative burden, aligns due dates to improve statutory alignment, and creates implementation efficiencies. It further makes a variety of technical changes to multiple state agencies’ required legislative reports to ensure relevancy, timeliness, accountability and transparency.

HCPF is also working with the legislature on significant commitments to support the families of youth with high-acuity behavioral health needs.

We also invite you to review our fiscal year 2024-25 Budget Agenda Summary, our Joint Budget Committee hearing materials from our hearing on Dec. 19, and my related November message on the budget. HCPF’s proposed fiscal year 2024-25 budget includes $16.4B Total Fund and $5.0B General Fund, assuming an average of 1.6M covered lives over the fiscal year. This represents about 38% of the Governor’s Total Fund operating budget and 31% of the General Fund operating budget. HCPF’s budget requests focus on increasing community provider rates through targeted and across-the-board rate adjustments, ensuring access to behavioral health services for Health First Colorado members, increasing access and support for evidence-based programs that have proven successful, and ensuring Colorado is in compliance with federal laws and regulations. Review the materials associated with OSPB’s December Forecast and look for HCPF’s February forecast, which will update our prior November fiscal year 2024-25 forecast. These factors play importantly into the final Joint Budget Committee Figure Setting process, which typically takes place in March.

We also invite you to listen to our Jan. 19 SMART Act hearing to learn more about HCPF’s strategic priorities, opportunities and challenges, legislative agenda, performance against published goals, and more. And we welcome your review of our fiscal year 2022-23 annual report to the community.

Call to Action: Help Us Keep Coloradans Covered
Our top priority continues to be to Keep Coloradans Covered, now that Colorado has resumed regular eligibility reviews for people with Health First Colorado and CHP+ after a 3+ year pause during the COVID-19 public health emergency (PHE). Thank you for your active engagement with members, community partners, and advocates leading up to and during the unwind period and for your continued dialogue to improve the renewal process. Based on stakeholder feedback, we have made the following changes:

• Renewal packets are shorter, and a colored Colorado State seal has been added to help mitigate it being mistaken for junk mail.
• HCPF is leveraging additional flexibility from the federal government to provide vulnerable populations with a 60-calendar-day extension to complete the renewal process. This includes long-term care (LTC) members on waivered services and buy-in recipients who have not returned their renewal packet on time. This flexibility will remain in place through June 2024. 
  We’re improving the PEAK and Health First Colorado app user experience by making it easier to submit renewal materials and monitor the status of a submitted renewal.
• HCPF has created and advanced toolkits to help members and partners complete the renewal process or transition to other affordable health coverage. These are now available in the top 11 languages spoken by our members: Update Your Address, Understanding the Renewal Process and Take Action on Your Renewal. Flyers have been developed for employers to distribute to employees to remind them to look for their Health First Colorado renewal packet and where appropriate, the means to transition to employer-sponsored coverage, and the importance of doing so in a timely manner. We ask that all stakeholders leverage these tools.

All related materials are on our website, and our reporting webpage is updated monthly. Thank you for continuing to visit our websites and reporting pages to secure updated information and tools.

Timely Reminders

January is also the beginning of tax filing season. The Colorado Child Tax Credit is available to Colorado residents with incomes of $75,000 or less ($85,000 for married taxpayers filing jointly) and with children under age six as of Dec. 31, 2023. Thanks to state lawmakers and the Governor for new relief for kids, older adults and low income Coloradans — take advantage, for this upcoming tax season only (2023 Tax Year), of lower property taxes, increased tax refunds for low-income Coloradans, increased earned income tax credits for working low-income Coloradans, rental relief, and free lunches for low-income kids through summer of 2024. Please visit Get Ahead Colorado for assistance as needed.

Also, employers interested in hiring new Americans legally eligible and ready to work can complete this short form, and the Office of New Americans will soon be in touch.

Finally, please save the date! On Feb. 26 from 11:30 a.m. to 1:30 p.m., please join experts from HCPF and the Behavioral Health Administration for a webinar on Medicaid behavioral health transformation, relevant policy changes, how changes are impacting communities, and what is coming next. Registration links and information coming soon.

Thank you for your continued partnership, and best wishes for a healthy, rewarding and transformational 2024!