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Medicaid Sustainability Updates

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Information & Resources

Medicaid Sustainability & CO LTSS System Update- 4.27.2026

On April 1st, the Joint Budget Committee (JBC) made their last decisions to finalize the long bill. The long bill is the state’s operating budget. The long bill is then considered in the House (which passed) and the Seante (which also passed). In these phases, there are usually no changes made; however, amendments could be made during this process. Those amendments could change what was in the long bill on April 1st. The long bill is now in conference committee to review the amendments. The final step is when the long bill is signed into law by the Governor in May. This is then when things are finalized. Until the Governor has signed the long bill into law, there could be changes and nothing is concrete until that time.

Below are the items that the JBC heard related to HCBS-DD waiver services. These are not all the Medicaid sustainability efforts; these are the ones impacting the HCBS-DD waiver.

  1. Across the board decrease
    1. The JBC approved a 2% across-the-board rate reduction. This rate reduction would go into effect July 1st 2026.
    2. The state continues to try to explore the sale of Pinnacol (Colorado’s Worker’s Compensation Insurance) which could reduce the amount of decrease we have this year. This is contingent on the passing of the bill to sell Pinnacol.
  2. IRSS rate alignment
    1. IRSS alignment would clarify the types of individual residential settings in HCBS services. Specifically defining these settings as settings in which there are rotating staff who come into a waiver members home but do not live in the home. This setting would be billed at the higher rate. The second setting would be defined as a setting where the caregiver(host homes and family caregivers) lives in the same home as the member. This setting would be billed at the lower rate.
    2. IRSS rate alignment failed to pass with the JBC and is not expected to be put into effect on July 1st.
    3. The state however is concerned about having different rates between settings where the only difference is the type of caregiver. This concern comes from increased federal scrutiny in this area as the Feds are focused on fraud waste and abuse.
  1. PETI applied to the DD waiver
    1. The JBC approved implementing post-eligibility treatment of income (PETI) in the DD waiver.
    2. PETI requires people on the DD waiver who have income (including social security) to pay for a portion of their residential services.
    3. Waiver members who are working and are enrolled in the Medicaid Buy-In program are exempt from PETI.
  1. DD Waiver enrollment changes
    1. The JBC approved ending the automatic youth (age 18) to DD waiver enrollment except under specific circumstances.
    2. The JBC approved to reduce the churn by half. The churn is the process in which when someone leaves the DD waiver, a new person can be added. Currently, the churn is 1:1 meaning for every one person who leaves the waiver, one more person can get onto the waiver. The approved churn rate will now be 2:1 where for every two people to leave the waiver, one can be added.

Health Care Policy and Financing (HCPF) and Office of Community Living (OCL) hosted a long-term budget and sustainability webinar on Monday April 13th. You can watch the webinar recording by following this link or review the slide deck using this link.

 

If you have any questions, please don’t hesitate to reach out to info@supportinc.com