from the desk of Pamela Bisceglia, Executive Director
The September 11, 2026, Medical Services Board agenda includes Document 19, MSB 26-04-15-A, “Medical Assistance Rule Concerning LTHH & CFC Group Rates, Sections 8.520 & 8.7000,” All Caregivers are encouraged to sign up and provide testimony. The rule, fast tracked by Health Care Policy and Financing (HCPF), and without stakeholder feedback, would expect caregivers to be paid less to care for two people than they would be paid to care for one person.
The group rates for authorized CFC and LTHH services shall be set at 50 percent of the current individual rates. This is intended to allow providers to be paid the same as, or more than, they would be for the same service provided to an individual.
These rates were developed using the same rate methodology as similar services. The rule change is necessary to improve alignment between reimbursement and the manner in which services are delivered, reduce duplicative billing, strengthen program integrity, and support the long-term sustainability of the Medicaid program. The changes will allow reimbursement methodologies to more accurately reflect situations in which one caregiver provides services to multiple members at the same time
HCPF touts this as a significant savings going into 2026-2027 but turns a blind eye to the risk it presents to our children and adults with disabilities. Like the deep cuts made to date, this will disproportionally impact children and adults with intellectual and developmental disabilities. The Office of Community Living asserts that the Governor’s directive is to continue to cut in anticipation of HR1. HCPF is supervised by the Governor, but they also receive marching orders from the General Assembly, and the priorities are not always aligned. New initiatives and directives show a lack of good faith while the Medicaid Commission is still working. This is at odds with the role and authority of the Commission. Specifically, the representatives who serve on the Colorado Medicaid Commission.
The Colorado Medicaid Commission’s charge and purpose is to identify, consider, and evaluate legislative and executive branch action options to implement a sustainable Medicaid program. The commission must identify, consider, and evaluate recommendations regarding implementing federal Medicaid policy changes in 2026, 2027, and 2028, and appropriately supporting Coloradans impacted by those policy changes. The Commission must issue a report no later than December 11, 2026.
HCPF Interim Executive Director and members of her team meet with the Commission to answer a list of valid questions that speak to HCPF budget, spending, and accountability. ADVOCACYDENVER observes that each presentation results in Commission representatives sometimes voicing frustration because HCPF does not provide complete answers, or the want to take a deeper dive into the spending. The Interim Executive Director follows the order to provide additional or more complete information.
The Commission is still in the phase of gathering information and has not begun to formulate recommendations. ADVOCACYDENVER observed that under Kim Bimestefer’s leadership, HCPF tried to ignore misspending on their part and blame significant financial issues on family caregivers. To date we have learned that the overwhelming majority of fraud is by providers and misspending under the leadership of Kim Bimestefer.
The Arc of Denver doing business as ADVOCACYDENVER was founded in 1954 by parents who asked that their children have access to education and the community. Our founding parents refused recommendations to institutionalize their child and instead simply asked for support so that they could keep their child at home and in the community. The Arc chapters including ADVOCACYDENVER advocated for family caregivers because parents of young children (and young adults) wanted their child to live in grow in their home and community and because of the historical lack of providers to service children and adults in their home and community. HCPF blames caregivers for their budget woes and suggests that it was never their intention to pay family caregivers as the primary providers for their children or adults. We challenge HCPF to provide us with a list of providers who are waiting to step in and serve our children, our youth, and our adults. Truth be told our aging caregivers have been waiting for decades for HCPF to identify and offer appropriate support to their adult, it is always the hope that such will be in place before the caregiver passes. As a mom, my greatest fear is that my daughter will pass before me. As a mom, my greatest fear is that I will pass before my daughter and she will not receive appropriate supports and services to live in her community.
ADVOCACYDENVER stands beside parent caregivers of children and adults with intellectual and developmental disabilities. Parent caregivers understand that cuts need to be made, but NO ONE has asked them where the cuts could/should be made, where they would tighten their belts. Having said that, before any additional Medicaid cuts are made, we ask that the state audit HCPF; we ask for a transparent report of HCPF’s spending; we ask for transparency in terms of HCPF’s independent contracts for 100s of millions of dollars. Finally, it is important for HCPF to remember that the people of Colorado are their client, and they need to engage in the culture of listening and understanding different perspectives, and being transparent and accountable for one of the state’s largest budgets.