Frustrated with prior management of Medicaid and bracing for more near-term cuts, Colorado lawmakers plan to do a \u201cdeep dive\u201d into the state\u2019s massive program.<\/p>\n
The bipartisan Joint Budget Committee set aside $500,000 to stand up a working group to lead the effort in the coming months, the details of which are still being sorted out. Lawmakers have grown increasingly frustrated with Medicaid as they have repeatedly discovered new multimillion-dollar payment errors within the service \u2014 as they simultaneously have struggled to make painful cuts to programs that serve immigrant children and people with disabilities<\/a>.<\/p>\n Those recurring errors have eroded trust between the Medicaid program and the lawmakers overseeing its ever-increasing costs.<\/p>\n \u201cAs the (budget-writing) process wore on, I think we all became less and less sure that the numbers we were looking at were an accurate reflection of what\u2019s happening in that agency,\u201d Sen. Judy Amabile, a Boulder Democrat, told fellow lawmakers during a meeting Tuesday. \u201cThat is why, to a large extent, we are going to do a deep dive into what\u2019s happening there over the interim.\u201d<\/p>\n In Colorado, the Department of Health Care Policy and Financing<\/a>, or HCPF, oversees the Medicaid program; its budget last year was $18 billion, $4.2 billion of which came from the state\u2019s general fund. Lawmakers\u2019 frustration with the Medicaid program finally hit its limit last month, when nearly every senator signed on to a draft resolution calling for the top official overseeing Medicaid to be removed from office.<\/p>\n That official, HCPF executive director Kim Bimestefer, resigned shortly after Gov. Jared Polis\u2019 office was told about the resolution<\/a>. Polis is term-limited and will leave office early next year.<\/p>\n Colorado Medicaid serves more than 1.1 million people. The safety-net program\u2019s costs have surged: Over the past 10 years, HCPF\u2019s budget has doubled (more than half of that total comes from federal dollars). The increase in costs has strained the state\u2019s budgets and prompted difficult conversations about what to cut and what to save.<\/p>\n Lawmakers want the Medicaid working group to meet in the summer and fall, draft a report about the service and come up with recommendations for the next governor, along with the officials who will be appointed to oversee Medicaid under the new administration.<\/p>\n That\u2019s partly because Medicaid costs are expected to continue increasing and place a growing strain on the state\u2019s budget. New cuts and work requirements instituted by the massive tax-and-spending bill signed last summer by President Donald Trump will pile on more cost pressures<\/a>.<\/p>\n Lawmakers want to figure out how to bring down costs within Medicaid in the long term, rather than continuing to make yearly cuts, and to explore other ways to shore up its funding.<\/p>\n \u201cIf this seems bad,\u201d Amabile said of this year\u2019s reductions \u2014 which brought some lawmakers to tears \u2014 \u201cbuckle up.\u201d<\/p>\n Earlier this month, Polis announced former state Medicaid director Gretchen Hammer would serve as HCPF\u2019s new executive director. The agency did not respond to an email seeking comment on the new review on Wednesday.<\/p>\n In a statement, Polis spokesman Eric Maruyama said the legislative working group would build upon a project the governor\u2019s office launched last year<\/a>, which will focus on \u201ccost drivers in the Medicaid program and opportunities to control those trends.\u201d<\/p>\n \u201cWe are doing a lot of good work with the (Joint Budget Committee) and General Assembly to begin to reduce costs within Medicaid, but there\u2019s much more work ahead to successfully sustain the important care Coloradans rely on,\u201d Maruyama wrote. He added, referring to the measure signed by Trump last year: \u201cThis is especially true as the massive pending cuts in federal Medicaid funding, thanks to the Republicans\u2019 H.R. 1, begin to take effect.\u201d<\/p>\n Amabile said in an interview that the working group would also look at where there have been errors in the past and how to prevent them. The group would likely involve representatives from nonprofits and others involved in Medicaid services, and lawmakers may also be involved.<\/p>\n She listed the array of problems identified within the state Medicaid program in recent months. A program that provides health care to children and pregnant women without legal status has cost far more than state officials first projected. Earlier this year, the budget committee learned that Medicaid was paying as much as 10 times the appropriate amount<\/a> to providers who picked up patients in extra-large wheelchairs.<\/p>\n The Denver Post then reported that the broader transportation program, which provides rides for Medicaid patients to and from medical appointments, was overpaying drivers generally. It did so based on an apparently faulty analysis<\/a> that compared sedans in Colorado to ambulances in other Western states.<\/p>\n That overpayment went unfixed for years, and a state advisory panel that reviewed payment rates in that period also did not identify the error. While the mistake went undetected, the transportation program was beset by fraud<\/a>, and its costs tripled to $303 million a year.<\/p>\n As lawmakers were learning about those problems, federal regulators announced that Colorado Medicaid overpaid nearly $78 million for autism services<\/a> in 2022 and 2023. The federal Office of the Inspector General recommended the state repay $42.6 million.<\/p>\n In addition to setting up the working group, the budget committee set aside money so that Medicaid staff could conduct a review of claims within the autism program, as well as the transportation service, with an eye toward clawing back money from providers who were overpaid. They also cleared the auditors to use a specific type of statistical analysis to analyze the claims and potential overpayments, and legislative staff projected<\/a> that the review would return at least $36.6 million over the next three years.<\/p>\n Rep. Emily Sirota, a Denver Democrat and the chair of the budget committee, said Wednesday that if the state has to repay autism service funding, \u201cproviders who were overpaid should be contributing to this payment.\u201d<\/p>\n Sirota said Medicaid and HCPF staff worked to give legislators information on where costs were increasing and how those costs could be curbed. But, she continued, if lawmakers were going to \u201ckeep coming back to this well of Medicaid, we should all be taking a deeper dive together.\u201d<\/p>\n \u201cClearly,\u201d she said, \u201cthings have gone on in this department that require a second look.\u201d<\/p>\n