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.
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.
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.
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!
- December 2023
Behavioral Health Transformation, Protection and Coverage
The Department of Health Care Policy & Financing (HCPF) is collaborating with other state agencies and stakeholders to develop a comprehensive, equitable, accountable and effective behavioral health safety net. This requires development of new policies and accompanying payment models to support a robust and diverse behavioral health provider network. Effective January 2024, the State Board of Human Services unanimously passed new Behavioral Health Administration (BHA) rules that update the definition of behavioral health providers, safety net services, and licensing for substance use and mental health providers.
Among other changes, community mental health centers will transition and Comprehensive Behavioral Health Safety Net Providers and Essential Behavioral Health Safety Net Providers will start to be approved. HCPF has created new Medicaid payment models that help ensure these organizations have flexible, sustainable funding that reflects the significant costs of safety net services. Comprehensive Behavioral Health Providers will have an increased focus on substance use, recovery, and whole person health. Essential Behavioral Health Providers will specialize in substance use disorder, opioid addiction and medication assisted treatment, families involved with child welfare, health related social needs, or serving those who have a history with the criminal justice system. Both will serve high priority populations. Thank you to the many providers, advocates, stakeholders and more who helped inform these rules and accompanying payment models, as part of achieving our shared goal of transforming the behavioral health system.
HCPF is also working with the legislature on significant commitments to support the families of youth with high-acuity behavioral health needs. We also welcome you to review our recently released behavioral health reports: 2023 Behavioral Health Annual Report, House Bill 23-1269 Directed Payment Legislative Report, Accountable Care Collaborative Implementation Report, and the Criminal Justice Coverage Reports. Please look for an invitation to register for our upcoming webinar on key behavioral health policies, initiatives and highlights from these recently released reports - all designed to transform our behavioral health system.
Our transformative behavioral health advances are also incorporated into our Accountable Care Collaborative (ACC) Phase III redesign work, which modernizes and advances our Medicaid care delivery approach beginning July 2025. The ACC Phase III Concept Stage Summary reflects responses from >1,100 attendees at >30 stakeholder sessions and >160 responses to our online feedback survey between August 2023 to October 2023. After careful consideration of the available data, stakeholder feedback and collaboration with the BHA, HCPF is moving forward with the four-region map, as proposed in the Concept Paper for ACC Phase III. Over the past six months, HCPF has held stakeholder meetings with more than 1,000 attendees to inform this decision. We also published our ACC legislative report Dec. 1, which reviews performance for the last fiscal year.
HCPF’s fiscal year 2024-25 budget includes about $1.2 billion Total Funds allocated to behavioral health. Visit our legislator resource center to learn more about how our budget invests in behavioral health.
As winter is upon us, remember that vaccination is the best way to protect individuals from flu, respiratory syncytial virus (RSV), COVID-19, and other preventable infections. There is no out of pocket cost for Health First Colorado and CHP+ members, for appropriate vaccines; those who need help making a COVID-19 vaccine appointment may call 1-800-232-0233. Health First Colorado members who need help finding a ride to a vaccine appointment can use the Non-Emergent Medical Transportation benefit. And feel free to leverage resources in these CDPHE toolkits on flu, RSV and COVID-19 and childhood and adolescent immunizations to achieve our shared health and wellness goals.
To Keep Coloradans Covered, please continue to use our prepared toolkits, available in the top 11 languages used by our members, to help people complete the renewal process or transition to other affordable health coverage: Update Your Address, Understanding the Renewal Process and Take Action on Your Renewal. Employers can post these flyers to remind employees about Health First Colorado renewals and where appropriate, transitioning to employer-sponsored coverage.
Last, to keep up with the evolving discussions on HCPF’s overall fiscal year 2024-25 budget, feel free to listen to HCPF’s Dec. 19 Joint Budget Committee budget hearing.
Best wishes for an enjoyable and healthy holiday season!
- November 2023
HCPF’s FY 2024-25 Budget, Public Health Emergency Update, Community Engagement
On Nov. 1, the Governor released the proposed budget for FY 2024-25, which takes important steps toward bold goals, builds on the successful work of these last five years, and reflects the voices of Coloradans from across our state with important investments in housing, public safety, education, workforce development, saving people money on health care, and achieving our renewable energy goals.
HCPF’s proposed budget for FY 2024-25 is $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 state’s Total Fund operating budget and about 31% of the state’s General Fund operating budget.
Our budget proposal includes a 1% across the board (ATB) provider reimbursement rate increase (representing about $29M in General Fund investment). This is on top of the 3%, 2% and 2.5% ATB increases in the three previous fiscal years during the period of unprecedented distribution of federal stimulus dollars; this year’s ATB increase is more than double the less than 0.5% normative or average ATB increase between FY 2010-11 and FY 2020-21 (shown in the table below).
Average Across the Board Provider Reimbursement Increase
The budget also includes $103M Total Fund and $25.9M General Fund in targeted rate increases. Recall that HCPF and the Joint Budget Committee (JBC) collaborated last year to increase the frequency of these targeted provider rate increases, including the access analysis, rate comparison to benchmarks, and related stakeholder engagement that occurs as part of the Medicaid Provider Rate Review Advisory Committee (MPRRAC) process. The frequency of the reviews has now moved from every 5 years to every 3, meaning more provider types are going through the process each year.
This FY 2024-25 budget reflects the first increase in the number of provider types moving through the MPRRAC process based on the 3-year cycle and includes Pediatric Behavioral Therapies, ambulatory surgical centers (ASCs), surgical, behavioral health, maternal health, dental services and anesthesiology. Visit our legislator resource center to review the entire MPRRAC report. In addition, HCPF’s budget also includes an off-cycle investment of $53.9M Total Fund and $13.6M General Fund in base wages to the direct care workforce, who serve Health First Colorado members through Home and Community-Based Services (HCBS). It further includes a $5M General Fund one-time investment to support eligibility processing and health care information technology and innovation advances within the state’s largest safety net provider, Denver Health, as well as an investment in the primary care fund.
HCPF’s budget also seeks to modernize our eligibility and claims systems, advance provider tools to improve whole-person health (sometimes called the social health information exchange or Phase II of the Prescriber Tool), improve access to services for members with complex needs, and maintain the compliance and support needed to effectively run our programs.
Our proposed budget makes significant investments to continue transforming the behavioral health system, including working with the legislature on unprecedented commitments to support the families of youth with high-acuity behavioral health needs. Overall, HCPF’s budget includes about $1.2B Total Funds allocated to behavioral health.
The budget further adds Autism Spectrum Disorder (ASD) treatment coverage into the Child Health Plan Plus (CHP+) program and accounts for Colorado expanding Health First Colorado coverage to pregnant adults and children who are DACA recipients, pending federal requirements.
In addition to reviewing the budget submission with stakeholders, answering questions and securing the appropriate allocation to advance our safety net coverages and programs, another top HCPF 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 2+ 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 a 60-calendar-day extension to complete the renewal process for our vulnerable populations, including 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 extensive partner 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 used 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.
Thank you to the more than 150 partners, advocates, and stakeholders who joined our Oct. 25 quarterly PHE Unwind webinar. All related materials are on our website. Our reporting webpage is updated monthly. Thank you for continuing to visit our websites and reporting pages to secure updated information and tools.
Over the last few months, I visited with partners and industry leaders in many communities. During these visits, we discussed efforts to Keep Coloradans Covered, expand the health care workforce, drive affordability, transform behavioral health, advance care and support for individuals with disabilities and older adults, propel health equity and innovations, refine the Accountable Care Collaborative Phase III concepts, improve our capabilities and partnerships, and more. Thank you to the many chambers and employer groups, legislators, hospitals, community health centers, mental health centers, Regional Accountable Entities, counties and other key partners who met with me and HCPF leaders across Pueblo, Colorado Springs, Grand Junction, Denver, Northern Colorado and the Eastern Plains. We truly appreciate your feedback and collaborative efforts to achieve shared access, quality, equity, and affordability goals.
- October 2023
Partner to Keep Coloradans Covered
Our top priority continues to be partnering with stakeholders throughout the state to achieve our shared goal to Keep Coloradans Covered. With the end of the public health emergency, all states, including Colorado, resumed eligibility renewals after a three-year pause. In Colorado, this means renewing each of our 1.7M Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+) members on their annual anniversary date.
May-August 2023 Point-in-Time Reported Data
Based on point-in-time information, an average of 49.0% of members with renewal anniversaries between May-August were renewed, according to initial data pulls (see below on how this figure improves over time). Of those renewed, just under half were automatically renewed through advances in processing technology, while the other half were renewed after completing their renewal packet. An average of 48.5% of individuals up for renewal May-August were disenrolled (2.5% applications were pending on average). Of those disenrolled, an average of 17.2% no longer qualified due to exceeding the income levels for their household size or eligibility classification. An average of 33.4% lost eligibility for procedural reasons such as not completing the renewal paperwork submission process. That figure was 12% prior to the pandemic. More information is available on our website.
Improved Renewal Rates 90 Days Later
We expect the data to change as late renewal paperwork is received or individuals receiving termination notices complete and return their renewal packets. For members up for renewal in May, this was indeed true - after the 90-day reconsideration period, 60% have now been renewed, which is better than the pre-pandemic average of 57%. For the same set of members, losing eligibility for procedural reasons fell by 4% to 22%, an improvement. Members with renewal anniversaries in June and July are still within the 90-day timeframe, but we are already seeing some take late action on their renewals, tracking similarly to the May cohort. More information is available on our website.
Focus on Special Populations
We are closely monitoring more vulnerable populations. Regarding members with long-term care waiver supports, procedural denials are tracking with rates pre-pandemic at 17% then versus 18% now. Less than 1% of members with long-term care waiver supports have “whereabouts unknown,” meaning this population is receiving renewal notices. Renewal rates for children are better than for the general membership: For May, June and July renewals, 69% of children remained enrolled, better than the overall 58% of all Colorado individuals who renewed during the same period. Also, we are not finding racial disparities between people of color and white people: for example, children who identify as Hispanic are being renewed in Colorado at a higher rate than non-Hispanic white children (72% versus 68% from May renewals).
Employer Chamber Engagement
We also met with several employer organizations over the last 60 days (i.e., Denver Chamber, Pro15, Club20, Colorado Springs Chamber, and more), helping them understand the impact of the end of the public health emergency on coverage and providing tools to message employer affiliates about coverage renewals and transitions, including how to help employees covered by Health First Colorado understand how to enroll in available employer-sponsored programs should they be disenrolled from Health First Colorado or CHP+ coverage. This work, in conjunction with the outreaches from Connect for Health Colorado to disenrolling Health First Colorado members, is intended to help connect individuals to affordable coverage.
Changes in Process to Keep Coloradans Covered
Keep Coloradans Covered is our top priority, which is why we – with our partners – are conducting multiple outreaches and following up to disenrolling members, refining renewal notices and improving PEAK access and efficiencies, among other strategies. HCPF is also leveraging additional flexibility from CMS to provide a 60 calendar day extension to complete the renewal process to those accessing Long-Term Care (LTC) waiver services and supports or Buy-In recipients who have not returned their renewal packet on time. This extension enables HCPF to conduct additional outreach and is in effect starting Sept. 5, 2023, through June 2024. Additional CMS guidance requires a change to our ex parte process for renewals. As we take a phased approach to the change, HCPF is implementing a temporary renewal extension for all members up for renewal in September and October. Thank you, Regional Accountable Entity partners, for additional outreach to affected members. For more information, please see our Special Edition Newsletter.
Call to Action: Help Us Keep Coloradans Covered
Our ability to Keep Coloradans Covered depends on all of us engaging to do our part. Thank you to providers, educators, counties, community leaders, advocates and employers - you are our trusted messengers on the ground, seeing our members when they walk through your doors. Please leverage the HCPF resources in public areas and through email - flyers, posters, messaging, social media, and more - to achieve our shared goals. And thank you for all you’re doing to Keep Coloradans Covered.
Accountable Care Collaborative
The Accountable Care Collaborative (ACC) is our Health First Colorado delivery system to meet members’ health needs. We are in the process of designing Phase III of the ACC, a critical part of HCPF’s efforts to improve care quality, service, equity and affordability, which will begin July 1, 2025. Phase III will build on investments, innovations and advances to improve member experience, access to care, health equity, home and community-based care, behavioral health, the health care workforce and affordability. Thank you to the more than 3,500 stakeholders across 75 stakeholder meetings to date who have contributed to shaping our Phase III priorities.
We are pleased to announce that we have officially published the ACC Phase III Concept Paper on the ACC Phase III webpage. This Concept Paper outlines the overall vision and design for Phase III and discusses several proposed policies and programs in detail, such as behavioral health transformation, care coordination, payment structure, and more. The proposals in this paper combine extensive research completed by several internal work groups as well as the feedback from stakeholders captured in the ACC Phase III Vision Stage Summary. Please join upcoming meetings to share feedback on these proposals. Stakeholders will also be able to submit comments using an online survey through the end of October. More information about upcoming meetings can be found on the ACC Phase III Stakeholder Engagement webpage.
- August 2023
Historic Legislative Session for Health Policy
Please join Health Care Policy & Financing (HCPF) leaders for a webinar Aug. 8, from 9 to 11 a.m. This event will share what we accomplished together last fiscal year, address our priorities for this fiscal year, and invite stakeholder feedback and comments. Join us Aug. 8 for HCPF’s annual meeting.
Of all the important work we have in progress, HCPF’s #1 priority has been working with our stakeholders - care providers, advocates, counties, and more - to achieve our shared goal to Keep Coloradans Covered, now that the end of the public health emergency (PHE) is upon us. As federally required for all states, we are now acting on Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+) program renewals for the first time since March of 2020. Thank you for helping us renew those who continue to qualify for our safety net health coverage programs and connect those who no longer qualify for our programs to affordable, alternative coverage.
Emerging renewal data can help us determine where we need to focus and refine our strategies to achieve our shared goals. It is too early for any trends, but we are closely reviewing the data we have now. To better understand the PHE unwind data, we looked at history. As you may know, members often lose eligibility for Health First Colorado or CHP+ during the renewal process because they no longer qualify. Commonly, individuals will enroll and be disenrolled from Health First Colorado or CHP+ due to changes in their life circumstances, like losing or gaining a job or changes in their household composition.
As we return to regular renewal processes, we certainly expected that more individuals would no longer qualify for our safety net coverage programs because Colorado’s economy is so strong. That’s important, because the vast majority of those newly enrolled in Health First Colorado over the last three years did so during the COVID-induced economic downturn. As of May 2023, Colorado’s unemployment rate was lower than pre-pandemic levels, at 2.8% - we are one of the strongest economies in the nation - with an increasingly positive outlook. We will be actively monitoring the economy this fiscal year based on its direct impact on our coverage numbers.
Colorado’s data on those up for renewal in May, pulled June 26, offers a snapshot of the first month of the required return to regular Medicaid eligibility operations. The point in time data shows very similar renewal metrics compared to the two years prior to the pandemic, with 56% of those with May renewal anniversaries being renewed for Health First Colorado or CHP+ coverage (compared to 57% pre-pandemic). Of the 56% renewed in May, 43% were automatically renewed through advances in our processing technology (“ex parte”) made over the last few years, while 57% were renewed after completing the renewal packet. 42% of individuals initially no longer qualified for public safety-net coverage, which also closely aligns with the 41% pre-pandemic average. We say “initially” because we expect that percent to change as late applications are received or individuals receiving termination notices choose to send in their renewal information within the 90-day reconsideration period. Of the 42% disenrolled, 16% no longer qualify due to exceeding income criteria and 26% lost eligibility for procedural reasons such as not completing the renewal paperwork submission process (compared to 12% prior to the pandemic). Of the 26% who were denied due to procedural reasons, 36% could not be located.
We’re prioritizing finding ways to reach people who are procedurally denied, including those we can’t find. Our Centralized Return Mail Center has updated addresses for nearly 70% of cases for which we have received a piece of returned mail so that we can successfully reach them when it’s time to send renewal packets. We are outreaching the remaining 30% who are locked into coverage that we couldn’t find the month before their renewal anniversary to help prevent them from being procedurally denied due to whereabouts unknown. We appreciate your partnership in spreading the word to members that it’s critical they update their contact information.
Our success in our united effort to Keep Coloradans Covered - including your active and engaged partnership - will mitigate the consequences of individuals going without coverage - impacting families, providers, employers and our economy. Data on those up for renewal in June, pulled in early July, reinforce the same areas of focus: 48% renewed (we expect this number to go up as pending applications and late applications are processed throughout the 90-day reconsideration period), 49% no longer qualified and 34% lost eligibility for procedural reasons such as not completing the renewal paperwork submission process; of that 34%, 36% could not be located. These data are points in time and will continue to change, especially as our reporting evolves to provide updated data on historic months and better reflect those that come right back onto coverage and those that voluntarily disenroll because they have other coverage. Please visit our Continuous Coverage Unwind Data Reporting webpage for data, further details and FAQs.
Since each state is approaching the renewal implementation process differently, comparisons across states are not as relevant as looking at prior trends for renewals within that state. That said, on July 28, CMS released information on 18 states which started processing renewals for April. Note that Colorado is not one of these states since we returned to regular renewal processing in May. Accordingly, CMS will release our May data in late August. CMS’s national data from April showed an average of 22% of applications still pending determinations, which further complicates comparisons given Colorado’s far lower 1-3% pending applications. All that said, the national average for those 18 states for April renewals is: 45.5% renewed, 32.2% no longer qualified for eligibility reasons, and 25.6% no longer qualified for procedural reasons.
We are also analyzing data by race/ethnicity, age and region to help identify and mitigate any emerging inequities. Based on the limited information available so far, we have not yet observed any race related disparities in the tracked renewal metrics between white people and people of color, which is good news. That said, it is important to mitigate disparities overall for low income people of color through this important work, and we are indeed focused on achieving that important shared goal.
To avoid health coverage gaps and disparities that historically impact communities of color, LGBTQ+, rural, non-English speakers and people with disabilities, we all need to work together to Keep Coloradans Covered - a key health equity priority. Providers, educators, community leaders and advocates - you are our trusted messengers on the ground, seeing our members when they walk through your doors. We ask that you meet them where they are, post flyers, send notifications, make phone calls, talk to them when they’re in front of you, and remind them to open the renewal mail and complete and send in the packet by the renewal deadline.
HCPF is indeed working diligently, quickly and comprehensively to identify gaps and more importantly, to address emerging issues. We have met with other states to share findings and we are holding a series of stakeholder meetings to identify member communication strategies that are working as well as those proven less effective. These learnings will inform our future collaborative outreach efforts.
Please consider these requests as you also refine your outreach and communication strategies to Keep Coloradans Covered:
- It is common for individuals to miss their renewal date submission. Individuals should use their existing renewal application instead of starting a new one if they are within the 90-day window of their renewal anniversary. If they do not take action within those 90 days, they must reapply (fill out and submit a new application along with verifications) to regain coverage if they are eligible.
- The renewal process may take longer for individuals with disabilities who access HCBS waiver supports. Please encourage this population and their support community to take action early and seek help with their renewals if they need it. HCPF is actively working with advocates, Regional Accountable Entities, case management agencies and counties to implement initiatives that focus on this population.
- Please remind parents that their children may still qualify for Health First Colorado or CHP+ coverage even if the parents no longer do.
- If individuals no longer need Health First Colorado or CHP+ coverage - usually because they secured a job with employer-sponsored coverage - they can voluntarily disenroll at CO.gov/PEAK or by contacting their county Human Services Department. We are working on making that process easier. Knowing who no longer needs our coverage will help us focus on reaching people who do.
- Only 3% of Coloradans voluntarily disenrolled from Health First Colorado and CHP+ coverage, despite the massive reduction in Colorado’s unemployment rate from its COVID-induced high. We expect many of these people are eligible or currently have employer-sponsored coverage. We’re working with Chambers of Commerce and other employer-organizations across the state to promote employer-sponsored coverage for people who disenroll from Medicaid including raising awareness with their employees on how to enroll in their employer-sponsored coverage.
Thank you for leveraging these tools to help members take action to renew their coverage and update their contact information so we can reach them with important renewal information. Partners and providers, please keep educating staff and patients about the return-to-regular renewal process. Resources are available to help you:
- Take Action Toolkit/flyers and Keep CO Kids Covered posters to print, hang and hand out to increase member awareness
- New flyers for employers to educate employees about their coverage options
- PHE Planning Resource Center for toolkits and FAQs
- KeepCOCovered.com has outreach resources about coverage options
- HealthFirstColorado.com/renewals has plain language resources in English and Spanish with links to help members with what they need to know about the renewal process and where to find help completing a renewal.
We truly appreciate your partnership to Keep Coloradans Covered as well.
- June 2023
Historic Legislative Session for Health Policy
Thank you for your partnership in a historic legislative session for health policy. This session was unprecedented for HCPF: we tracked 79 bills, successfully navigated eight Agenda bills through the process, and completed 94 fiscal analyses of 76 unique bills and their associated 18 amendments. Thank you for your partnership in helping pass bills of interest, with 87% 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 38 bills, 11 legislative requests for information and 16 new or changed legislative reports. Please visit our Legislator Resource Center to view our latest fact sheets on the 2023 legislative session.
We thank the General Assembly, advocates, providers and other stakeholders for partnering to advance bills that support the 1.79 million Coloradans who we cover and serve, provide added supports for Coloradans with disabilities or in need of behavioral health care, eliminate most co-pays for Health First Colorado (Colorado’s Medicaid program) and Save People Money on Health Care. We are also very thankful for new policies and funding that continue to support our health care providers who passionately care for our members every day. Below are key highlights of the legislative session.
Saving People Money on Health Care. SB23-222 eliminates co-pays in the Medicaid program, except for the inappropriate use of the emergency room. This bill saves Medicaid members money on health care, while also reducing administrative costs for providers and increasing their reimbursements equal to the value of the co-pay. HCPF also focused on prescription drug costs, the leading contributor to rising health care costs. We thank the General Assembly for passing HB23-1201 into law, effective Jan. 1, 2025, which eliminates the practice of “spread pricing,” or up-charging of prescription drugs by middlemen, negatively impacting Medicaid, insured individuals and group policies. The law also creates transparency into pricing and an opt-in provision so self-insured employers can benefit from this affordability law as well.
Two bills passed to increase hospital transparency and accountability. HB23-1226 and SB23-252 strengthen hospital financial transparency and price transparency, respectively, to help save Coloradans money on health care.
Gov. Polis signs HB23-1201 Prescription Drug Benefits Contract Term Requirements into law May 10 with bill sponsor Sen. Mullica (right) and Exec. Dir. Bimestefer (left) at Clinica Family Health, Thornton.
HB23-1243 builds upon existing legislation to further increase nonprofit, tax-exempt hospitals’ accountability to solicit, review and incorporate feedback from their communities in framing and executing their hospital community benefit investment plan. This will improve the impact and responsiveness of over $950 million in community benefit dollars spent by hospitals annually, in lieu of taxes not paid by tax exempt hospitals, to improve the health and well-being of communities across the state. SB23-298 will support rural hospitals in their efforts to collaborate, in lieu of merging, to improve access, affordability, quality and efficiency - all to the betterment of the communities they serve and their financial sustainability. These efforts will be supported by HCPF and the Attorney General’s Office. SB23-223 increases the frequency of targeted provider rate increases under the Medicaid program, changing the provider rate review cycle from 5 to every 3 years.
Other bills passed support Coloradans with disabilities such as nursing facility support, transformation and sustainability (HB23-1228) and expanding certain home and community-based services for eligible aging and older adults and people with disabilities (SB23-289).
HCPF’s fiscal year 2023-24 budget is $15.5 billion Total Fund and $4.5 billion General Fund – about one-third of the state’s budget. 96% of that budget goes to pay our valued health care providers caring for Health First Colorado and CHP+ members, including a 3% increase in provider reimbursement rates across the board on top of this year’s 2% increase, targeted provider rate increases, and a 16% increase in payments for those primary care providers participating in our Alternative Payment Model for Non-FQHC Providers (APM2).
In addition to our collaborative work this legislative session, thank you for your continued partnership in helping Keep Coloradans Covered as the federal COVID-19 PHE and continuous coverage provision end, and all states, including Colorado, must return to normal eligibility and enrollment operations. As the national press has recognized and as we have over the past few years, this is a massive effort and incredibly important. All of our 1.79 million members must go through the renewal process, which started in March with member notices about May renewal anniversary dates and will continue each month through April 2024. Members with June anniversary dates have already received their first round of noticing as well and will likely need to take action to maintain their health coverage.
Partners and providers, please help us Keep Coloradans Covered by continuing to educate staff and patients about the return-to-normal renewal process. Resources are available to help you achieve this shared goal, at the PHE Planning Resource Center and KeepCOCovered.com. HealthFirstColorado.com/renewals has plain language resources in English and Spanish with links to help members with what they need to know about the renewal process and where to find help completing a renewal. Members need to take action when they receive their renewal notice electronically or through the mail in an envelope with red lettering reading - “URGENT - PLEASE REPLY”.
Sample renewal notice envelopes to keep an eye out for.
Members can complete their renewal, including signing and returning their paperwork by the deadline listed on their renewal, in three ways: online at co.gov/PEAK, in the Health First Colorado app, or by mail.
Beyond the Medicaid continuous coverage requirement, the federal government ended the PHE on May 11, 2023. Colorado was prepared for this, and had already made positive policy changes, such as telehealth, permanent. Important, related changes are available in our May 2023 - End of the PHE special edition newsletter.
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. For more information, please visit our Legislator Resource Center. And please continue to join and support our efforts to Keep Coloradans Covered.
- May 2023
Redesigning care delivery for better outcomes
The Accountable Care Collaborative (ACC) is the Health First Colorado (Colorado’s Medicaid program) care delivery model, designed to cost-effectively provide access to quality health care services while improving member health. The model in place today, referred to as ACC Phase II, has been in effect since July 1, 2018, and was developed based on substantial stakeholder engagement. HCPF is now in the process of soliciting feedback from stakeholders to help frame the next generation of the ACC, Phase III, which will build on what works well today while making improvements to both modernize and address opportunities. The goals of Phase III, which will go into effect July 1, 2025, are to:
- Improve quality care for members
- Close health disparities and promote health equity
- Improve care access
- Improve the member and provider service experience
- Manage costs to protect member coverage and benefits, and provider reimbursements
We invite you to actively engage in the ACC Phase III stakeholder process by signing up for the newsletter, joining upcoming meetings and viewing our fact sheet as well as additional information on our ACC Phase III website. HCPF will also leverage the opportunity to better collaborate with the Behavioral Health Administration (BHA) and stakeholders to more thoughtfully align where appropriate the ACC Phase III and the emerging BHA’s Behavioral Health Administrative Service Organizations (BHASO) model, now that the BHASO’s implementation date is being moved from July 1, 2024, to July 1, 2025. This updated timeline, reflected in the revised House Bill 23-1236 Implementation Updates To Behavioral Health Administration as amended on April 26, amendment number L.028, which exactly aligns with Health First Colorado’s ACC Phase III timing.
To further advance our quest for better member health outcomes while reducing health disparities, last month, HCPF released our latest Maternal Health Equity Report. The report looks at maternal health during the pandemic, provides a window into the lived experience of members, and lays out HCPF’s roadmap to improve maternal health care and equity. In tandem with the release of this report, HCPF held an Advancing Maternal Health Equity for All Coloradans event, which included about 200 attendees. We invite you to review the report and watch the webinar recording by visiting our Publications page.
Thank you for your continued partnership in helping Keep Coloradans Covered as the COVID-19 public health emergency and the continuous coverage provision end. This month is the first renewal anniversary month in three years that may result in membership disenrollment from the Medicaid and CHP+ safety net coverage programs, as federally required. Partners and providers, please help us Keep Coloradans Covered by educating staff and patients about the renewal process. Resources are available to help you achieve this shared goal, at the PHE Planning Resource Center and KeepCOCovered.com. Also, HealthFirstColorado.com/renewals has plain language resources in English and Spanish with links to help members with what they need to know about their renewals. Members need to take action when they receive their renewal notice electronically or through the mail in an envelope with red lettering reading - “URGENT - PLEASE REPLY”. They can complete their renewal, including signing and returning their paperwork by the deadline listed on their renewal, in three ways: online at co.gov/PEAK, in the Health First Colorado app, or by mail.
Thank you for your partnership through this legislative session. We will include a summary of the key bills impacting HCPF and affordability in our June message as well as our final fiscal year 2023-24 budget. In the interim, we thank the General Assembly and our stakeholders for your valued input and collaboration on so many impactful legislative items, which are on our Legislator Resource Center.
Thank you for your collaborative efforts to improve our delivery system, better align our Phase III work with the BHA’s emerging BHASO work, reduce maternal health disparities, Keep Coloradans Covered, and drive meaningful legislation impacting Health First Colorado, CHP+ and health care outcomes and affordability for all Coloradans.
- April 2023
Policy priorities and partnerships past the pandemic
Thank you for your partnership in helping Keep Coloradans Covered as the state begins to act upon renewal determinations starting in May, after a pause of more than three years and in accordance with federal action mandating all states to do so. In March, HCPF, in collaboration with our county partners, began sending renewal notices to members whose renewal anniversary is in May; this process will continue month by month through April 2024 to re-determine the eligibility status of all 1.78 million Medicaid and CHP+ members. As of March 24, about 65,000 households were up for coverage renewal in May. Early reports show that our automation efforts over the last year resulted in about one-third, or 21,500 households, being auto-renewed (ex parte), meaning they do not need to complete a renewal packet to qualify for coverage. The remainder, around 43,500 households, will need to take action when they receive their renewal notice electronically or through the mail in an envelope with red lettering reading - “URGENT - PLEASE REPLY”. They will need to complete their renewal paperwork online at co.gov/PEAK, in the Health First Colorado app, or by mail. Members must sign and return their paperwork by the deadline listed on their renewal.
Partners, thank you for fulfilling your role to help Keep Coloradans Covered through this important chapter. Hundreds of providers and community organizations have aligned to increase member outreach, resulting in a 34% increase in members who signed up for emails and texts so we can reach them with important Medicaid and CHP+ renewal messages. We sincerely appreciate the collective, collaborative, united approach to executing on this important campaign to Keep Coloradans Covered. Please continue to help educate members by:
- Posting these flyers in your reception and public areas
- Attending our April 26 webinar
- Visiting KeepCOCovered.com to keep abreast of and leverage available tools
- Watching the recording of a panel of experts on this topic
This topic and more was featured at last month’s Health Cabinet Summit, which included 21 speakers sharing insights on prescription drug affordability, rural hospital investment opportunities, hospital affordability, value based payments and an update on the end of the federal public health emergency. We invite you to visit our website to review Summit materials or watch the recording.
Also at this Summit:
- We were joined by an expert panel to take a closer look at hospital affordability and community responsiveness. In 2020, hospitals invested 7% of their patient revenues ($965 million) in community benefits, which is significant, appreciated and valued. At the same time, opportunities remain to strengthen hospital accountability to engage, review and incorporate community input into how to invest their community benefit dollars. HB 23-1243 Hospital Community Benefit seeks to improve the alignment between community feedback and hospital spending.
- HCPF released hospital accountability and affordability resources, including the Hospital Insights Bulletin, the Breakeven Analysis tool and the Hospital Transparency Scorecard.
- This Hospital Insights Bulletin serves as an overarching summary of six recent releases on Colorado hospital financials. This consists of an analysis of the quality of hospitals’ Price Transparency postings; a new tool for and analysis of hospitals’ breakeven rates; a preview of profits and reserves information for Colorado’s major hospital systems in 2022; and three recently released financial reports on costs, prices, profits and community benefit, with links provided here: Colorado Healthcare Affordability and Sustainability Enterprise (CHASE) Annual Report, the Hospital Expenditure Report and the Hospital Community Benefit Accountability.
- The Breakeven Analysis tool provides better insights into what hospitals need to charge commercial carriers in order to offset the underpayments of public payers. Colorado ranks sixth in the nation for the highest hospital prices and fourth for both the highest patient services profits and total profits, which incorporate investment earnings. Both are indicators of price reduction opportunities. This tool allows carriers, employers, other payers and communities to negotiate price reductions with their hospital partners in a more informed way.
- The Hospital Transparency Scorecard shows 26.5% of Colorado hospitals have an overall quality rating of Good, while 47.0% ranked as Fair and 26.5% ranked Poor. Note that SB 23-252: Hospital Price Transparency strengthens hospital compliance incentives with the federal requirement to post hospital prices by health plan, which is critical to improving these compliance statistics and ultimately achieving the goals and outcomes of price transparency.
Related, HB 23-1226: Hospital Transparency And Reporting Requirements seeks to advance hospital financial transparency by enabling access to quarterly - or more timely and therefore meaningful - financial information which will also facilitate earlier engagement to support struggling hospitals; evaluation of the affordability impact of physician acquisitions; insights into profits and reserves leaving the state; executive compensation; improved Board-CEO alignment with community interests, and more.
Additionally at the summit, our session on prescription drug affordability highlighted that in 2021, nearly 10% of Coloradans were unable to fill prescriptions due to cost, and that prescription drug costs are the leading contributor to rising health care costs. HB 23-1201 Prescription Drug Benefits Contract Term Requirements seeks to address this by requiring pharmacy benefit managers and insurance carrier middlemen to only charge consumers the amount they paid or less, thereby eliminating spread pricing, or up-charging. Attendees polled at the summit indicated they were most excited about spread pricing policy as a way to save money on prescription drugs. For more on HCPF’s legislative agenda, please visit our Legislator Resource Center.
We also held a HCPF Maternal Health Equity Webinar on April 12. At this webinar, we reviewed our recently released Maternal Health Equity Report on maternal health during the COVID-19 pandemic, the lived experience of members and HCPF’s roadmap to improve maternal health care and equity. The event included remarks by U.S. Health & Human Services Regional Director Lily Griego, member and provider experiences, and thoughts from community partners. You can find more about this important conversation on improving health outcomes and care for the 43% of Colorado births we cover at our website.
In other developments at the Capitol, HCPF is very appreciative of Governor Polis’ budget, the difficult decisions made by the Joint Budget Committee, and the legislature’s work to finalize the budget including continued investments in health care. Some of the highlights from HCPF’s FY 2023-24 budget, awaiting General Assembly approval, include:
- 3% across-the-board provider rate increase, on top of this year’s 2% increase
- 16% rate increase to primary care medical providers participating in alternative payment models to reward better care, healthier outcomes and affordability
- Continued increased wages for providers caring for people with disabilities
- Incentive payments for rural providers
- $21 million for counties to support coverage continuity through the end of the public health emergency
- Authority to eliminate co-pays for most Medicaid benefits
We thank you and our many partners for all you do every day to care for and support our Medicaid and CHP+ members, to Keep Coloradans Covered, for collaborating to drive health care affordability, for increasing Medicaid member access to care, and saving Coloradans and our employers money on health care.
- March 2023
We look forward to seeing you at the March 15, 7:30-10 a.m., free, virtual Health Cabinet Summit. The agenda includes 21 speakers sharing insights through five short sessions: prescription drug affordability, rural hospital investment opportunities, hospital affordability, value based payments and an update on the end of the public health emergency.
HCPF has been working tirelessly across many stakeholders, readying the state for the end of the public health emergency, and especially the end of continuous coverage. This month, HCPF, in collaboration with our county partners, will begin sending renewal notices and related information to all Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+) members scheduled for renewal in May. The renewal redetermination process will continue month by month, for the next 14 months through April 2024 for all 1.75 million members.
Work with our federal partners at the Centers for Medicare and Medicaid Services (CMS) has intensified in tandem for HCPF and for all state Medicaid programs nationally. Notably, CMS has established criteria that states must meet to continue to be eligible for enhanced federal matching funds through the end of December 2023. This enhanced match follows the 6.2% enhanced match in place from January 2020 through March 1, 2023, and includes 5.0% for calendar year Q2, 2.5% for Q3 and 1.5% for Q4 2023. CMS confirmed this week that HCPF is indeed fully compliant, that we do not have to implement mitigation steps as other states do, and that we are eligible for continued 2023 enhanced federal matching funds.
We invite you to take comfort in the fact that Colorado continues to lead other states in our readiness for this transition in coverage, estimated at more than 325,000 Coloradans. Our primary goal is to Keep Coloradans Covered through a two-pronged approach: (1) helping members who continue to be eligible for our programs stay enrolled, while (2) connecting disenrolling members to affordable coverage. Thank you in advance for being a part of our collaborative, united effort to achieve this shared goal across state agencies, health care providers, contracted partners, community partners, counties, regional accountable entities (RAEs), Connect for Health Colorado, consumer advocates, health plans and more.
As part of this effort to Keep Coloradans Covered, we ask for your active engagement:
- At every touchpoint and opportunity, please remind Health First Colorado and CHP+ members to take action. Please display this flyer (in English and Spanish) in areas of your organization frequented by members, patients or the public. The flyer includes what members need to do and how to do it. This link also includes KeepCOCovered awareness posters, social media images, virtual backgrounds and signature tags to assist in your organization’s engagement efforts. Find more at KeepCOCovered.com.
- Please help connect those Coloradans who no longer qualify for our programs to alternative, affordable forms of health coverage such as employer-sponsored, Medicare, individual or family coverage and subsidies through Connect for Health Colorado, a spouse's coverage, or parental coverage for those up to age 26. Find tools to accomplish this shared goal and more at KeepCOCovered.com.
As you converse with members/patients, please communicate that the most important thing members can do right now is to update their mailing address, email and phone numbers and sign up for electronic notifications by visiting CO.gov/PEAK. Members who are having trouble accessing PEAK can call the PEAK Help Desk (800-250-7741). County human services departments can also help members update their information; however, members are likely to experience extended hold times, which is why we are recommending the use of PEAK.
Second, remind members/patients to look for, complete and sign their Medicaid and CHP+ renewal packets. Members who receive a renewal packet must return it by the deadlines listed within this important renewal communication. The renewal packet will be sent electronically or through the mail in an envelope with red lettering reading - “URGENT - PLEASE REPLY” - to indicate the importance of the required, time-sensitive member action. For more information and videos in English and Spanish about the renewal process, please visit HealthFirstColorado.com/renewals. While about 70% of our members will need to take these actions, about 30% of our members will be automatically renewed without action due to our automation enhancements completed in the last year.
Last, please remind your members/patients to start exploring alternative coverage courses early if they think they will no longer qualify for our safety net coverages, and not to leave this exploration to the last minute.
We appreciate your continued partnership in helping Keep Coloradans Covered as the public health emergency and the continuous coverage provision come to an end. For more information about the renewal process and frequently asked questions visit KeepCOCovered.com. The website includes information and links to numerous resources for stakeholders and community partners to help our members, and a virtual background and email signature to help get out the message. Additionally:
- Here is a recording of our Feb. 24 Keep Coloradans Covered news conference
- Here is the related news release
- At HealthFirstColorado.com/renewals are plain language resources and links to help members with what they need to know about their renewals.
- For more information about health insurance coverage types visit the Colorado Division of Insurance Types of Health Insurance Information page.
- February 2023
As the PHE comes to an end, please help us Keep Coloradans Covered
Health First Colorado (Colorado’s Medicaid program) has grown by about 500,000 members since the beginning of the COVID-19 pandemic. That’s the largest increase in Health First Colorado membership since Medicaid expansion, which helped connect an additional 600,000 Coloradans to affordable coverage. In accordance with federal directives, and in collaboration with our county partners, the Department will resume the standard eligibility renewal and disenrollment process beginning this May for Health First Colorado and Child Health Plan Plus (CHP+), after more than a three-year pause. The Department will take 12 months (14 months including member noticing, which begins in March) to complete the renewal process for all 1.75 million Coloradans currently covered under Health First Colorado and CHP+.
As we return to normal operations, the Department is estimating that more than 325,000 Coloradans (about 20% of current members) may no longer qualify for our safety net coverage programs, and will therefore be disenrolled beginning in May and over the 12 months that follow. Given the magnitude of this transition of Coloradans from Medicaid to commercial coverage, we are asking all stakeholders to join the Department and the Polis-Primavera Administration in a shared effort to Keep Coloradans Covered through two main pathways.
First, we invite you to help us ensure effective member awareness and engagement through the renewal process. For more information about the renewal process, videos in English and Spanish, and frequently asked questions, please visit HealthFirstColorado.com/renewals.
Second, we invite you to help us connect disenrolling Coloradans to other sources of affordable coverage to Keep Coloradans Covered. For more information about health insurance coverage types, please visit the Colorado Division of Insurance Types of Health Insurance Information page.
- Health care providers, advocates, counties/MA sites, Case Management Agencies (CMAs), Regional Accountable Agencies (RAEs) and others who provide support services to Medicaid members, please remind your Medicaid members to update their contact information with the state, to look for and complete their Medicaid renewals, and to seek other coverage options if they no longer qualify for their current coverage.
- Employers, brokers and consultants, please recognize that some employees now covered through Medicaid need to be enrolled in your employer-sponsored health plans beginning in May and over the 12 months to follow. Please proactively remind your employees how to do that, recognizing the magnitude of this coverage shift.
The Department is also partnering with Connect for Health Colorado to ensure disenrolling members know how to apply for individual and family coverage and how to secure the financial subsidies that make that coverage more affordable. Connect for Health’s network of certified assisters can help. Coloradans can also apply and enroll in a plan during their special enrollment period by calling the Customer Service Center at 855-752-6749.
Due to the tremendous advances in our eligibility processes over the last few years, some members will be automatically renewed and will not need to take any action to remain covered (about 30% and growing). Others will receive a renewal packet and will need to take action (about 70%) to stay covered by the deadlines listed within this important renewal communication. We have also made significant investments in PEAK, member correspondence, our monitoring systems and our eligibility system to further the important work ahead of us. We have further worked with our county partners, sister agencies and the Joint Budget Committee to secure additional funding to assist them through this unique chapter. Last, to ensure broad alignment and communications, for many months now, the Department has been hosting stakeholder meetings. The week of Jan. 23, we met with approximately 800 county and community partners on our plans to return to normal eligibility operations. To get connected to these meetings, please visit our PHE Planning website.
Through the Affordable Care Act’s Medicaid expansion and collaboration across the state, between 2014 through 2016, Colorado’s uninsured rate decreased from 15.8% to about 6.6% (Colorado Health Access survey results). By continuing to work together, we have been able to maintain that 6.6% uninsured rate through the COVID-19-induced economic downturn by moving hundreds of thousands of Coloradans from commercial coverage to Medicaid - a spectacular achievement to the betterment of the health and well-being of Coloradans, employers, our providers and our state. Now, we need to partner again to reconnect what is estimated to be more than 325,000 Coloradans back to affordable commercial coverage. Our Department is stepping up to lead that industry effort, in collaboration with our sister agencies, counties, providers, advocates and a cross section of industry leaders. Our shared goal through these efforts under the Polis-Primavera Administration is clear: Keep Coloradans Covered. Look for more resources and tools in the months ahead to help us achieve our shared goal. Thank you in advance for your engagement to Keep Coloradans Covered.
Separately, on Jan. 31, the federal government announced May 11 as the end date for the public health emergency. Colorado has been preparing for this, and has already made positive policy changes, such as telehealth, permanent. Please visit our PHE Planning website to stay updated.
Given the increasing number of Coloradans who will be covered by commercial programs in the months to come, health care affordability is even more important. In that spirit, the Department will continue to pursue our mission to Save People Money On Health Care through thought leadership and advances in prescription drug, hospital and value based payment (VBP) policies as well as innovations that improve care affordability, access, equity and quality. In that quest, last month, the Department released three hospital transparency reports to help policymakers and communities drive solutions that save Coloradans and employers money on health care. We will be hosting a Health Cabinet Affordability Summit on March 15, 7:30-10 a.m. on affordability solutions, VBPs, rural hospital supports and shared efforts to Keep Coloradans Covered.
Also, we invite you to keep abreast of our budget and legislative agendas in support of this important work and more.
We appreciate your continued partnership in helping Keep Coloradans Covered as the public health emergency and the continuous coverage provision come to an end. And we thank you for your leadership in driving affordable access to care and coverage for all Coloradans.
- January 2023
PHE Coverage Update, Legislative and Affordability Priorities
Thank you for your partnership in another unprecedented year for health care. Together, we are now successfully serving 1.74 million Coloradans, representing an additional 490,000 people — an increase of 39% since the start of the pandemic. Related, H.R.2617, the federal budget signed into law on Dec. 29, 2022, indicates that beginning April 1, 2023, states can start disenrolling individuals who no longer qualify for Medicaid through the eligibility redetermination process. In partnership with the counties, and after many months of planning and preparation, Colorado will take 12 months (14 months including noticing) to complete this process, leveraging the member’s annual renewal date and our modernized, member-centric processes. We are analyzing the related guidance from CMS received on Jan. 5 and will make any refinements to our plans, accordingly. With continuity of coverage top of mind, we are collaborating with Connect for Health Colorado and others to connect members who are no longer eligible for our programs to other affordable health coverage. Please join us at our Jan. 25 Community Partner webinar to learn more, and please visit our website to help us achieve our shared goal of keeping Coloradans covered through this transition.
We also invite you to join us at our Jan. 12 SMART Act hearing to learn more about HCPF priorities, our legislative agenda, performance against published goals and more. The hearing will begin upon adjournment of the Joint Health Committees. We also welcome your review of our FY 2021-22 annual report. Amidst the unprecedented growth in membership during the COVID-19 Public Health Emergency (PHE), we kept Health First Colorado per member per month cost trends flat while evolving innovations that drive industry transformation, improve quality, reduce disparities and improve the health of our members. Our leadership in driving affordability will continue to help us manage our own budget (about 30% of the state’s overall budget), while helping save Coloradans and employers money on health care as well.
As we begin the legislative session, feel free to visit our 2023 Legislative Agenda Overview to learn more about our emerging legislative agenda, which currently includes:
- Nursing Facility Sustainability and Transformation to implement the 2022 Nursing Facility Reimbursement Recommendations and ensure the industry continues to transform and innovate to meet the needs of Colorado’s growing older adult population and individuals with disabilities, while ensuring industry fiscal stability.
- Removal of Most Medicaid Co-Pays consistent with our R-7 Provider Rate Adjustments budget request. This would help us make care more accessible to members, reduce health disparities, improve provider reimbursements while lowering provider administrative burden.
- Public Health Emergency (PHE) Unwind Alignment to ensure the necessary state authority to continue to access federal COVID-19 funding while mitigating future federal non-compliance clawbacks of the $1.5 billion received from the 6.2 points of added FMAP to date and related funding still to come.
- Medicaid Provider Rate Review Advisory Committee (MPRRAC) which supports the JBC in enabling targeted Medicaid provider rate adjustments more frequently - every 3 years instead of every 5.
To save Coloradans, the state and our employers money on health care, on Dec. 5, the Polis-Primavera administration and HCPF submitted Colorado’s proposal to the U.S. Food and Drug Administration (FDA) to import prescription drugs from Canada. The plan identifies 112 drugs with an average savings of over 60% that could be available through this program, once approved by the FDA. Additionally, Colorado Medicaid executed its third pharmaceutical value-based contract. These contracts will help deliver savings to taxpayers, state and federal budgets in the form of manufacturer refunds if the respective drug does not meet expected health outcomes for Medicaid members who are taking them. Last, a huge thank you to the more than 10,000 Health First Colorado prescribers (44%) who are using the affordability module of our prescriber tool. Through emerging value-based payment methodologies, we are taking the necessary steps now to share the millions in savings generated through the tool with providers starting next fiscal year.
Thank you for your continued partnership, and best wishes for a healthy, rewarding, transformational 2023!