Medicaid Sustainability and Colorado's LTSS System
LTSS Medicaid Sustainability Framework Long-Term Goals Our Commitment Current Projects and Resources HCPF Medicaid Sustainability Page
Colorado’s long-term services and supports (LTSS) system plays a critical role in ensuring that older adults and individuals with disabilities have access to care in the setting of their choice. Over the last several years, strategic investments have expanded access, improved equity, and strengthened the direct care workforce.
However, ongoing fiscal constraints—including new federal mandates and limits on state revenue growth—require the Department of Health Care Policy and Financing (HCPF) to reassess and align its policies to ensure long-term sustainability.
Current Fiscal Environment
- Federal Policy Changes: New federal legislation, H.R.1 (One Big Beautiful Bill Act), significantly alters Medicaid financing, administrative requirements, and eligibility processes, which increases state-level financial obligations.
- State Budget Constraints: Medicaid comprises over one-third of Colorado’s state budget. The growth of LTSS expenditures—driven by increasing utilization, demographic shifts, and rising labor costs—has outpaced available revenue.
As a result, the Governor’s Executive Order issued August 28, 2025, initiated $252 million in budget reductions across state agencies—including approximately $79 million in reductions to HCPF, reflective of the Department’s share of the state budget and its recent cost trends.
View HCPF Overview of Budget Cuts Fact Sheet
LTSS Medicaid Sustainability Framework
The Office of Community Living (OCL) is working on a plan to make sure LTSS Medicaid services remain strong, fair, and financially sustainable. Instead of making across-the-board cuts, the focus is on targeted changes guided by data. The approach includes four main parts:
- Policy and Program Review - OCL will take a close look at current policies to make sure they match what the law requires, meet real health needs, and use funds responsibly.
- Payment Reform - The way providers are paid will be reviewed to ensure payments are fair, but also affordable for the program in the long run.
- Utilization Management - Tools will be used to make sure services are provided only when needed and in the most efficient way possible.
- Collaboration with Stakeholders - OCL will keep working with providers, case managers, advocacy groups, Medicaid members, and other partners to guide the changes and look for ways to improve.
Long-Term Goals
The overarching objective of these efforts is to ensure that:
- Individuals continue to receive high-quality care in the most appropriate settings;
- Provider networks remain strong and sustainable;
- Program operations align with national standards and best practices; and
- Public resources are managed responsibly to support long-term system viability.
Our Commitment
OCL remains committed to transparency, accountability, and partnership throughout this process. Sustainability is not a one-time goal but an ongoing responsibility—to the individuals served by the Medicaid program, to the providers who deliver care, and to the taxpayers who fund it.
Visit our Understanding the Impact of Federal Changes webpage for real-time updates, member messaging resources, and policy implementation timelines.
Stakeholders are encouraged to sign up for the At A Glance Newsletter for HCPF-wide updates and the OCL Digest for LTSS-specific updates.
Questions can be submitted to HCPF_HR1@state.co.us
Current Projects and Resources
Current opportunities for stakeholder engagement for each of these projects can be found in the OCL Digest Newsletter and on the OCL Stakeholder Engagement Calendar. As new opportunities are announced, stakeholders will be informed through the OCL Digest Newsletter.
Community Connector: Rate Reduction
Rates for Community Connector services will be reduced by 15% starting January 1, 2026, pending federal approval. This change aligns rates with similar adult services, supports Medicaid sustainability, and is part of statewide budget-balancing efforts in response to a significant revenue shortfall.
Eliminating the Nursing Facility Minimum Wage Payments
The Nursing Facility Minimum Wage Supplemental Payment will end one year earlier than expected, starting in FY 2025–26. This change avoids duplicative spending, saves $4.4 million from the General Fund, and does not affect nursing facility base rates.
Home and Community Based Services Provider Rate Reduction
The Home and Community-Based Services (HCBS) Provider Rate Reduction rolls back the 1.6% provider rate increase that took effect in July 2025, effective October 1, 2025, to address the state’s budget shortfall. While provider rates will decrease, member services and direct care worker base wages are not expected to be impacted.
Updated 9.9.2025
Individual Residential Services and Supports: Rate Alignment
The Individual Residential Services and Supports (IRSS) Rate Alignment will clarify definitions and billing requirements for IRSS in the Developmental Disabilities (DD) Waiver. This proposal establishes that Host Homes, Family Homes, and Member Homes will bill at a single standard rate, while only Staffed Homes — provider-owned homes with rotating agency staff — will qualify for the higher rate.
This change promotes accurate billing, aligns reimbursement with the operational and administrative costs of each setting, and supports program sustainability. The proposal is projected to generate $1.45 million in General Fund savings in FY 2025–26 to help maintain all waiver services.
Acknowledgment and Next Steps on IRSS Rate Alignment
HCPF sincerely thanks stakeholders for sharing questions and feedback about the recently announced Individual Residential Services and Supports (IRSS) Rate Alignment proposal. We recognize that unclear guidance about IRSS setting types and rates has created confusion and inconsistent billing practices, and we sincerely thank stakeholders for raising these concerns.
Our goal through the IRSS Rate Alignment effort is to clarify requirements by setting and ensure rates are appropriately aligned to account for the operational and administrative costs for each setting. Specifically, we are working to ensure that rates align with the staffing, oversight, and operational responsibilities associated with each model of service delivery.
The inclusion of family caregivers within the host home rate is part of this proposal because these settings share comparable costs and responsibilities. We recognize, however, that each family and provider situation is unique, and we want to ensure those nuances are appropriately reflected in rule language and billing guidance.
To reduce confusion, we have updated our fact sheets and other informational resources. In the short term, we will remove outdated communications that may have caused further uncertainty. Looking forward, we are committed to developing clear, consistent, and transparent rules and guidance with stakeholder input at every step.
We invite stakeholders to participate in upcoming opportunities to provide feedback on draft rule language, billing guidance, and other clarifications needed to support providers, families, and individuals who rely on this critical service. Your feedback is vital to ensuring that rules are workable, equitable, and responsive to the needs of the community.
Thank you again for your partnership and continued engagement as we work together to strengthen and clarify the IRSS framework.
Opportunities for Engagement:
Tuesday, October 14, 2025 from 10 to 11a.m.
Thursday, November 20, 2025 from 11 a.m. to 12 p.m.
Visit the OCL Stakeholder calendar webpage for more information about these opportunities.