from the desk of Pamela Bisceglia, Executive Director
As I ready this E-Voice for print, Coloradoans are still sorting out the flurry of final changes made to the Long Bill by Colorado lawmakers. We live in one of the wealthiest states and yet we made profound cuts to Medicaid in order to balance the budget. The cuts to public benefits disproportionately impact children and adults with intellectual and developmental disabilities. Among the budget drivers that Colorado lawmakers and Joint Budget Committee point to each year are Colorado taxpayer policies (Tabor and Gallagher); opinion in relation to these policies will need to wait for another day—shared over dark chocolate outside of the workday.
I had an opportunity to reflect on different publications, letters, concerns, recommendations, writings that ADVOCACYDENVER has issued over the last decade in relation to Health Care Policy and Financing (HCPF), the state’s department that runs Medicaid. May 2023, we published an E-Voice that discussed HCPF’s launch of their new IT system and Care and Case Management System (CCMS). To date, the contractor for this project is still trying to correct the system. HCPF has paid between 20 and 30 million dollars for a system that is not yet completely functional. The contractor has not met their obligation, and HCPF does not demand a remedy.
Boots on the ground advocates, advocacy leaders and parents were not aware of many of the gross errors in HCPF spending until legislative hearings for this budget cycle. ADVOCACYDENVER was focused on a list of HCPF blunders that impact children and adults with disabilities. Among the items on our list:
- Phase I case management redesign in the metro area. Phase I rolled out with deep and broadly consequential flaws. HCPF forbid case management agencies from providing any written information to their clients. HCPF sent written information at the last minute. After assigning clients to the wrong case management agency HCPF realized that counties share zip codes, As a result, HCPF had assigned a significant number of children and adults to the wrong case management agencies.
- Beginning November 2023, HCPF inappropriately removed thousands of individuals from long term disability Medicaid rolls. This error resulted in a domino effect that led to asignificant backlog in case management and county intake, escalations and appeals.
Disability advocates asked HCPF to wait until the case management system was stable before introducing any further changes. After initially agreeing that they would not implement changes that would further destabilize the system, they continued to rush to implement additional changes.
October 22, 2024, AdvocacyDenver sent an email on behalf of a list of stakeholders to the Governor’s office and copied to the Joint Budget Committee “JBC” that outlined ongoing concerns with HCPF. Advocates, parents, and other disability agencies provided recommendations to resolve stated issues. First and foremost, the community asked that:
The Governor/Joint Budget Committee assign a Special Master to monitor HCPF and that that person(s) report to the Governor and the Joint Budget Committee. That person should have the authority to correct HCPF, and demand that HCPF provide a Corrective Action Plan and provide bi-weekly reports of progress in meeting the objectives defined in the plan. . .
The Governor’s office sang their praises of HCPF but encouraged ongoing discussion and collaboration. We saw little substantive difference as a result. What was different was that Kim Bimestefer, HCPF Executive Director, started to attend some meetings with parents and advocacy leaders with Bonnie Silva, Director, Office of Community Living.
On March 17, 2025, the Colorado chapters of The Arc issued the following statement:
We anticipate that Medicaid funding will be cut at a national as well as a state level. Members of the disability community, including persons with lived experience and boots on the ground advocates believe it is important that we have a voice at the table in terms of potential cuts/restructure. In addition, we want to identify the “nonnegotiable”, areas where we advocate that Medicaid funding remain constant. Recommendations speak to services for Medicaid eligible individuals’ birth through life.
- No caps on waivers
- Payment for medication, physical health services
- Home health services
- No cuts in provider rates
Kim Bimestefer was silent. Bonnie Silva asserted that the Governor provided their marching order. In JBC meetings HCPF asserted that children and adults with intellectual and developmental disabilities cost the most per client/member and consume the larger share of HCPF funds such was the reason that decisions disproportionately impact that community. Ms. Silva and other government leaders begin a narrative that families were misusing the system. The narrative that Ms. Silva and Ms. Bimestefer did not forward was the gross mismanagement under their leadership.
Starting July 1, HCPF will be instituting cuts that disproportionately impact members of the IDD community. At the time of this publication, the most painful cuts that have been approved include:
- A 56-hour weekly cap for family caregivers. HCPF will allow case management agencies to make limited exceptions. Other exceptions will have to be submitted and approved by HCPF. Word on the street is HCPF will not approve any exceptions.
- IDD waitlist “churn” slowdown. Two people will need to come off the IDD waiver (move to another state or die) before one person can move off the waitlist.
February 27, 2019, The Arc of Colorado and volunteers placed 2,900 flags on the grounds of Colorado Capitol to represent each adult with an intellectual and developmental disability on the waitlist. Today there are 2,800 on the waitlist with the potential to double due to the 2026 budget cuts.
ADVOCACYDENVER asserts that a constant issue in relation to HCPF leadership has been centered around transparency and accountability. These issues were prominent during the Joint Budget Committee special sessions beginning Spring 2025, to date. In past years HCPF leadership was able to shmooze their way through hearings and argue about the need for additional staff funding with the Joint Budget Committee. This year much of the discussions and questions pointed to the lack of accountability and multimillion dollar errors:
- Erroneous removal of 575,605 Coloradans from the state Medicaid system between May 2023-May 2024.
- Overpayment of hundreds of millions of dollars for non-emergency transportation between 2021 and 2024. HCPF reimbursed providers at10 times rates they should have paid out and ignored alerts from these same providers.
- Overpayment of non-wheelchair transportation providers at an additional cost of 33 million dollars in the 2025-2026 budget.
- An estimated 77.8 million improper payment for Applied Behavioral Analysis.
In April 2026, Kim Bimestefer resigned from HCPF under threat of a vote of “no confidence” by the legislature. The Governor names Gretchen Hammer as the interim executive director. Ms. Hammer will have her work cut out for her as she tries to turn the Titanic around. The Joint Budget Committee provided full time allocations so that HCPF can try to recover overspending/overpayment that was their making. In the meantime, our children and our adults will bear the fallout of HCPF’s overspending, lack of accountability and transparency.