July 6, 2026 · 20,074 words · 9 speakers · 239 segments
Okay, the Commission on Medicaid will come to order. Mr. Brown, please call the roll.
Senators and Representatives, Barron.
Presente.
Bridges.
Yep.
Rizell.
Excused.
Gilchrist.
Here.
Kirkmeyer.
Here.
Mullica.
Excused.
He is on his way, though, just for anyone who is wondering.
Sirota. Here. Taggart. Taggart. Here. Brown. Here. Madam Chair, Mobley. Here. Okay. We are going to get started, and I'm going to turn the meeting over to our facilitator. I just, because we have an agenda, we're going to work through that. But I also want to say that we are trying to look at ways to make this a little bit more of a conversation and a little bit less of what we have here, which I'm not really sure what it is. So we're going to be looking into maybe changing the location for the next meeting into a space that's a little bit more like a table where we can all sit around and actually be looking at each other and talking back and forth. So just know that we're working on that. And so we have Ms. Gaither Gathercole. I always do it wrong. Ms. Gathercole here, and she's been talking to all the members, and just sort of big picture today, we're going to talk about how we're going to get to an end of the rainbow, how we're going to make decisions, the themes, and we're going to also lay out a schedule for the future meetings, at least for the next couple of months, so that you all will know, you all in the audience and whoever might be listening, and so that we all can plan around that too. So I will turn it over to you.
Good morning and thank you Madam Chair and members of the Commission. My name is Summer Gathercole. I'll start off by saying I'm delighted to be working with all of you and looking forward to this. I'm not naive and understanding the very big lift that we have ahead of us and also confident that we can do it together. As Chair Mombele said, I do think going forward we're going to try to find some ways to make this a little less formal, per se, so we can have more of a conversation. I will admit that as a facilitator, I am not used to sitting behind a microphone, and I like to stand up. I like to get you all moving around a little bit. So hopefully, I think going forward, we will have this look a little bit different. I will also say like if the other room that we're looking at has air conditioning that is a huge plus too. And I will say I think this meeting today you know I think we're going to try to sort through kind of where we need to be formal where we can be a little less formal or whatnot together. I will also promise you that today is probably the shortest meeting that we will have together. After this, it will get a lot longer after this. You can expect to have some pre-reads, which will have some pretty kind of high-level overview and data that you have all asked for, requested, that will help do some level setting Those pre will have links to if you want to go dive deeper you have the opportunity to do that But at a minimum if you can read the high overview before the meetings that would be great But we will really get into the meat of everything after today. So what we're planning to hopefully do today is I know in the first meeting, you talked about the decision rule, quorum voting. So we're going to see if we can come to agreement on that. We're going to talk about the work plan, the calendar, see if we can get some dates set up, and then also talk a little bit about our scope. This is a situation where it's quite easy to kind of say, start going down this road and saying, like, oh, my gosh, we could do this, we could do this, we could do this. And what we really need to do is figure out how do we balance the needs of people with money and value at the same time. So we'll talk a little bit more about that in the framework. As a reminder, this is a commission, not a committee. So just asking you to adjust your hat a little bit so that we're all thinking about this again, maybe a little less formally than what we would normally have during a commission. Really want this to be more of dialogue and discussion and not so much formal presentations or me speaking formally to you.
we've already heard as chair mobile I said I've had a chance to start doing interviews I realized that I have not had a chance to finish all the interviews yet so those are still in process and I know some people didn't get the original email so I've been following up by text we'll make it happen but one of the things that has come out of the the interviews that I've had so far is that when we get to a point where we have a report or set of recommendations to meet with the next governor-elect to make that person aware of what came out of this commission, as well as making sure that we are being really clear on kind of what expectations and accountability looks like in that next administration. So let's jump into it.
Unless are there any comments or questions before we get going? Okay. So I think we already know why we are here. We saw in that first meeting that was presented by Mr. Kurtz, the big change that we have in terms of Medicaid spending and our state revenue cap, what does that look like? So we know that the funds are the cost is growing faster than we are able to keep up with. So our job is to figure out, you know, per the legislation, identify, consider and evaluate legislative and executive branch action options to implement a sustainable Medicaid program. It's really about how do we bend that curve and still make sure that we're reaching those most vulnerable people that really need to be reached. And as I said, this is the honey trap to kind of watch how do we make sure that we don't drift into things that we can spend more money on, which is a very easy thing to do in these types of conversations. So I will likely be the contrarian there and keep saying we've got to focus on how do we keep focused on financial sustainability, the budget, and the dollars, and what does that look like. so to jump right into it recommendation on the decision rule um i listened a couple of times to the first meeting that you all had i know there was some debate going back and forth between six or eight being a a passing kind of recommendation what my recommendation is and it multifold is one that maybe it the 7 out of 10 passes for recommendation But in the report, we make sure to acknowledge every person who is in support, every person who is not in support. We can make sure where there's broad consensus or where it's divided. And I also believe that it will be really important, I know this came up as kind of talking about a minority report or dissenting opinion. I actually think that's a great idea. We did that in the Behavioral Health Task Force. What I would recommend is that that is part of the appendix, as part of the report, and not a separate document, because I have found that when they are separate, they get lost, and they're not necessarily attached or coordinated to the main report that comes out. So I think that's probably our first discussion point today, to jump into that and see if that feels like a compromise that feels comfortable for everybody. Any comments?
Rep. Brown. Thank you, Madam Chair, and thank you for that recommendation. What are we going to call you, facilitator, gather call?
Just call me Summer, really.
Okay, Summer. Thank you very much, Ms. Gather call. I can't do it. I'm sorry. Maybe when we do our more informal. I guess the only question that I would have for you is what happens to an item that is considered that is maybe even supported by a majority of the commission but isn't supported by a full seven? I recognize that wouldn't rise to the level of a full recommendation from the committee, and that may be fine. But where would such an item be memorialized and the vote potentially memorialized? Does that make sense?
You guys can just go back and forth.
Thank you. Right. I think it would not be a minority report because it is not a minority of the committee, but it might be worth documenting majority votes that did not rise to the level of a recommendation. Does that make sense? Absolutely. And I fully agree. I think that would also be part of the appendix as well, not necessarily in the dissenting or minority vote. In full transparency, I would like to reflect as much as possible in the report with the main recommendations that has full consensus and support in the main body of the report, but then a lot in the appendix around things that were discussed, debates, votes, and so forth. So I would really like to see all of that in there if everyone is comfortable with that.
Thank you.
Does anybody else have any question about it or is there an objection to doing it this way? Rep Sirota.
Thank you, Madam Chair. I mean, I'm just curious. Maybe you're just very confident about your facilitation skills. What if we got to the place where we couldn't get seven votes for anything?
well we might have a very short report um no in all seriousness i think again that's all going to be reflected in the report right so like if we don't have we don't get to a point where we have seven votes for everything or anything then i think that would just be demonstrated in the report and we would just highlight where the vote counts were across every recommendation okay my goal uh i don't know that we'll get to consensus on everything my goal is to get to a point where we can all feel comfortable getting behind recommendations It might not be exactly what we want word for word but if we can get behind it that where I like to see us get to And we probably won always get there but that my goal I would just add that I think that should be all of our goal, is that we figure out how to move forward with as much consensus as we can get. And to me, this imposes some discipline on that by saying, hey, these aren't going to be official recommendations unless we can get at least seven out of the ten of us to agree. So I think it's – I strongly support doing it this way, and I don't want to – I don't think that's a big risk. I do think this group is going to be working together for, you know, to come up with ideas that are agreeable. And so I'm pretty optimistic about it. Any other? Okay, great. Do we need to, do we vote on these things or? We don't have to. Okay, let's move on. All right, great, thank you. And then I think the other thing that came up in the first meeting was just around quorums and voting. And so I think to meet, we want six out of 10 of the commission members present. So that would be a quorum. Again, this is my recommendation. Routine matters. It's just a majority of who is present. And then, again, to adopt a recommendation, it would be that seven out of 10, with, again, everything being documented in an appendix in some way. Gilchrist.
Thank you, Madam Chair. Sorry, just to clarify on the 7 out of 10 to adopt a recommendation, I just want to make sure I'm understanding that we would – the plan is to shoot for a 7 out of 10 at least to recommend the report, but everyone is in agreement and understanding that part of that report we could disagree and we would not have 7 out of 10, but you could still vote in support of the full report but be opposed to several of the recommendations.
So just to clarify, it's per recommendation. We want 7 out of 10 support. So I think there's going to be different recommendations in the report. for those that don't have seven out of ten will still capture them in the appendix for those where there's a dissenting opinion or minority opinion that want to include something in the appendix around that we can have that as well what we ultimately want because of all that is for the final report hopefully everyone will feel comfortable saying yes I get behind this but we would definitely want seven for the final report but we will break down the recommendations by recommendations separately. Let's move on. Okay, we'll make sure that all of this is documented. Okay, so I wanted to share with you the 10 meetings that we have left, the first one of course being today. After today, as I shared, this is going to get a lot more, a lot longer, a lot more complicated and a lot more intense. So you see, and these are illustrative dates only, so we have not picked the dates. We're going to try to do that here in a few minutes. What I have done and what you have. as part of your handouts is a coverage map. So I have gone through the first meeting and the second meeting that you have had already, laid out all the questions that have come up so far, and also said, here's which meeting we're going to address them in. Now, what I will say is this coverage map will likely change over time. So do not feel like this is set in stone. Even as I've had a couple of interviews, this has continued to change a little bit. So I think this will evolve, but I did want you to know that I am making sure to capture the questions and the comments and the things that you're raising to make sure that we can address them in the remaining meetings that we have left. Senator Kirkmeyer.
Thank you, Madam Chair. Meeting number nine in October, public and stakeholder input. I think we should move that up. And I think we should send out a survey or have like four or five questions that we send out to stakeholders, like the hospital association, like the family caregivers, like the disability community, with specific questions and ask them to answer the questions. Not just come here and give us a presentation about how we hate everything or how everything's wonderful, which I'm pretty sure it's going to be the first part of that. But really answer questions like, what are we missing out on as far as federal dollars that they're aware of? What rules, regulations are making it difficult to survive? And of course these are going to need a bit of a massage. But from their perspective, what operational efficiencies could we expect out of this department? Because they've been examining it a heck of a lot closer than all of us. And then also, why in their opinion have the cost grown so dramatically? I mean, and maybe there's more questions than that, but I think that would be helpful from the very beginning so that we can actually dig in early. I mean, all this history stuff, eligibility, enrollment, and benefits, we already had a bunch of that. And I know that maybe some of us on the JBC have gotten more of this information, more in-depth information than others on this committee. But I don't know what we're going to get out of that other than we're just getting a bunch of regurgitated history. I'd rather hear what we're going to do to move forward from people who are involved in it, implementing it, boots on the ground. Like we could ask the counties, the hospital association, family caregivers, other groups that people have mentioned that we could ask these questions of. And let's get that early because I'd like to dig into that.
Why don't you go ahead and then we'll go to Rep. Rom. I wholeheartedly agree. In a few minutes we're going to talk a little bit about stakeholder engagement and what that looks like, but I made a note to add a survey to that so we could include that as well. So the finding or the public and stakeholder input is more of a summary of what we've heard to date through a variety of mechanisms that we're going to try to make sure that we get that stakeholder engagement.
Brett Perron. Thank you, Madam Chair. I also agree with Senator Kirkmeyer on moving that one up forward for that reason. We can actually get more input on the boots on the ground. I've already gotten some input from some elderly housing and medical services that they're really struggling with Medicaid and helping their residents. And I think that getting that information up front before we tackle these other aspects that we're going to be tackling is going to go a long way if we get that information from stakeholders and we can actually do something about it.
Okay. Senator Mullica.
Thank you, Madam Chair. and I'm just going to kind of tack on a little bit. I view this process as kind of building a house a little bit And to me the foundation is going to be that that stakeholder is going to be that information And I think that for us as commission members when we engaging when we getting ready to ask questions of the department or folks who are coming in having that information from folks out in the community of what they're seeing and what they're needing, I think is going to be crucial. And so I think for us to really have a strong foundation to build the house, we have to have that engagement, I think, early on. And so I would agree with that. The sooner the better to really be able to start building that foundation so that when we start getting these presentations, we're able to have things to point to and really able to address things that we're hearing from the front lines in the community. And so I appreciate the recommendation from Senator Kirkmire because I think it's a good one. Thank you.
Okay, Mr. Vice Chair. Thank you, Madam Chair. Ms. Gather-Cole, I wonder if you might just go ahead and skip ahead to your slide that talks about stakeholder engagement so that we can talk about how you sort of envision us gathering that information along the way and whether or not that sort of meets our needs since that seems to be what we want to talk about at this point.
Thank you. Read my mind. I was just going to suggest that we skip up there. So this is slide 15 for those of you who are looking at the printout, so it's just towards the end. A couple different ways that we're thinking about hearing from stakeholders, and so we can certainly push this up as needed. One is having some stakeholder sessions. So this is kind of, to your point, Senator Kirkmeyer, around kind of, can we get some of the associations? Can we get some of the counties? Can we hear from specific stakeholders that we want to make sure that we are reaching? We have talked about, Chair Mabale and I have talked about having public comment at the end of each of these meetings, maybe limited to an hour, but give people a chance to come and speak as they would like. One of the other ideas that I would like to suggest is that we consider office hours. So what I was thinking is, you know, teaming up with a couple of you at a time. They're virtual. They could be in person. People can step in and kind of share their suggestions and ideas as another way to collect input. I'm sure all of you, I know some of you have already been inundated by requests and letters. I'm getting those same things, and so that could be a way to also continue to solicit feedback. Of course, we can accept written comment as well. Those have already started to come in. And then we can have some regional sessions as needed if we don't want to keep it just virtual so that we can get out of the Denver metro area. So I think we can add a survey to that for sure pretty easily, but these are some ideas that we had around stakeholder engagement, knowing that this is something that's really important to all of you.
Senator Kirkmeyer.
Thank you. In what ways could someone give us their ideas or their comments confidentially?
I think we could set up maybe something as simple as a Google form where they don't have to submit their name or email. and we could do that in order to solicit input. And I'm open to other recommendations too.
Senator Kirkmeyer.
I think that would be good. And then because I think there are people who would like to be able to give us confidential, be confidential in their comments to us. Just because that way they don't want to have to suffer maybe some retaliation someplace. And then public comment I mean here one of my beefs about public comment having been on the other side and having to make public comment Two minutes each I mean I don know what are we hoping to get out of that You know, seriously, I wouldn't drive an hour down here to give two minutes and then drive back when I can sit at home, I guess, and just listen. I mean, what are we expecting them to say in that two minutes? I mean, are we going to have, like, maybe, again, even for the public, maybe some specific questions that maybe they could answer? instead of just, you know, again, this is what happened to me and here's my story. Because I know, you know, at the Joint Budget Committee, we had, what was it, two years ago, three years ago maybe, somewhere in there during the summer, we held stakeholder meetings with people. And mostly they just wanted to come and complain, which I get, venting is good at times, but it doesn't help us move forward to get better operational efficiencies. And part of the reason I was saying this part about the stakeholder sessions is, as I was telling you earlier, just this morning at the Joint Budget Committee, and I was talking about House Bill 1328, 26-1328, which was Senator Malka and I had this bill, that we actually got put into law that we had to change from administrative services to medical services for non-emergent medical transport. And when I asked why the department hadn't told us about that earlier so that we could pull down more federal dollars, I mean, in 26, 27, we're looking at the possibility of $20 million that we should have been pulling down. And we all know of other cases where we should have been pulling down a hell of a lot more money that we didn't pull down. So the answer was, well, it was in statute. I'm like, well, why didn't you tell us three years ago? And we got nothing. So that's why I think there are people who want to tell us stuff confidentiality, but also I think it's important to have more structure on what we're getting from people. We've all heard the stories, and I'm not trying to minimize anyone's story because we've all felt it. We had a really bad year. I'm just saying on the Joint Budget Committee emotionally, and we all were traumatized, basically. We don't need to go there. We're trying to figure out how to fix the problem and how to pull down more money and what rules and regulations are causing an issue, and how do we get to better operational efficiency in a department that has really just gone off the rails. So, anyways.
Senator Mullica.
Thank you, Madam Chair. If this is out of turn, I apologize and just tell me to wait. But, you know, we're talking about public comment. We're talking about getting this information, talking about building a house, laying the foundation. And this might be a question for you, Summer, or it might be a question for Mr. Brown or staff, because I do think for us moving forward, we're going to start getting deep into these issues. And I know we made a number of requests for research requests. And I just wanted to see if maybe we can get an update or if we are going to get an update on kind of where those are in the process. Because I do think as we start getting deeper in, you know, into these conversations, that that information is going to be extremely important to those conversations. So I think, yes, we have to talk about that today. but let's finish this conversation about how we're going to.
Perfect. So, Rep Taggart.
Thank you, Madam Chair, and thank you, Ms. Devon Cole. I have the opportunity on an ongoing basis to teach various leaderships in business SWOT analysis, and I'm sure most of us are familiar with it. And I think the approach to SWOT analysis is appropriate on the stakeholder side in this sense And I think it addresses Senator Kirkmeyer concern One of the problems with traditional SWOT analysis is the weakness conversation overpowers a group to the point people get deflated And they don't know how to go about getting out of that negativity. And I just wonder whether when it comes to the stakeholder, whether we enable you to have the conversations with groups of stakeholders and allow them to prioritize with your help what the top five, top six issues are from their perspective. and then we attack those because I, for one, don't want to sit here for four hours and go through the weaknesses. I find that demoralizing, and that's why I teach folks, prioritize those. It doesn't have to be five. It could be seven. I don't know what the number is, but I'm comfortable with you having those conversations and then coming back to us and saying, these are the seven most important issues that our stakeholders are saying you folks need to address by way of these recommendations. Just food for thought.
Well, so I'll just jump in. And I'm movable on this point. But having been a person who came and testified before various commissions, if we filter stuff through Ms. Gather Cole or through somebody else or in some other way, people aren't going to feel like they never got to talk to the decision makers. And that's us. And I get that hearing people's stories is tough. and maybe sometimes repetitive. But at the end of the day, like we are here to serve the people. And I think one of the big frustrations that I've heard from patients, people who are Medicaid members, is that we say we're doing X, Y, and Z, but they're not getting that. They're not getting even A, B, and C. And the services that they're receiving are not meeting the moment. And I get why it's inconvenient to have to listen to that. But I also think we're not going to do a good job if we ourselves aren't hearing from the actual people who are impacted by the decisions we make. And I don't mean the providers. I mean the people who are Medicaid members. And I think that we could, if other people thought this was a good idea, maybe it's not. I just popped in my head that we can limit public testimony to Medicaid members to tell us, we're talking today about whatever the topic is for the day, and you are a person who receives that kind of care, and you want to come in and give us a couple of minutes of your story about why it's working or why it isn't working or how it could be made better. I think that's important for us to hear. And I think the proposal was that we would limit that to no more than an hour. And so, I don't know. And I also get, not everybody is game, but I'd like for us to at least... this idea of just saying we're going to limit the public testimony to Medicaid members. And then for other stakeholders, we will have them meeting one-on-one with each of us and one-on-one with Ms. Gathercole. And also, I envision that we will have breakout groups where the members here on this commission who are interested in a particular topic will have the opportunity to have meetings offline with stakeholders. I don't know. Does that make sense? Senator Kirkmeyer.
Yes, it does to a point to me. So what I would say is this. I'm not opposed to hearing people's stories. That was my comment. But they have, so for example, I'm just going to use family caregivers. They live by those rules. They know which rule specifically is killing them. That's where I was talking about maybe more structure. Maybe we give them a couple questions to answer, and then they can tell us their story. But, you know, if you could change one thing about this, what would you change? You know, what rule is hurting you the most and making it so you can't survive as a family kind of thing? Or what rule is basically, because of its implementation, may drive you to having to put your child into an institution instead of being able to take care of them in your home? That's the kind of stuff that I think we're trying to drive to. It's not just hearing their stories. we want to get to some resolve on some of these things. I mean, it's just like what we're hearing today with regard to rural providers for non-emergent medical transport at the JBC. And it's like, it's not necessarily the rate needs to increase, it's the distance and the deadhead stuff. Like, so how do we get to a resolve for those issues? So that's what I was saying.
Okay. Well, I think, would it be possible to structure the, like put something on the website along with how to sign up for public testimony that says, here's what we're wanting to hear from you, and give them a list of five things or whatever it is for them to respond to, and then give them the opportunity to come and tell us that. we could even we could limit it to the first you know 10 people to sign up or something like that
but senator bridges thank you madam chair speaking of the website um if this document is not posted um as it's legally required to be online at this point um i'm hoping maybe someone could just put it onto the like a google drive and we can tweet out the link it just seems so we're we're a little short staff today. And I've already sent it to our team to have them post it. I sent it to them
like two or so hours ago. We're just waiting on them to get that online because we don't have access to the webpage in that way. It's up now? Okay, I'm getting a thumbs up that it's up. Thank you. Just, Madam Chair. Senator Burgess. Thank you. Future reference. We know these meetings are
coming. We know we're going to have documents to present if legislative IT could just be ready to post those, that would be, I think, to the benefit of the people of Colorado.
Okay. So I think we have the beginning of a plan for the public comment, and that sounds like a really good step in the right direction so that we get the most out of it and also so that people who want to provide their input also have a mechanism for doing that. So is everybody good with that? Okay. Great thank you for that conversation So this schedule will probably change a little bit Mr Vice Chair Thank you. Thank you, Madam Chair. And Ms. Gathercole, maybe you can, the one thing that I think we do need to think about is the department is an important part of these conversations. And whether you want to call them a stakeholder or what, in terms of this commission, right, there's going to be a need for a lot of transparency and sort of shared decision-making tools that potentially are gonna, we're gonna need their help, right, from some data. So maybe, I'm not sure where that fits in your sort of plan, stakeholder or otherwise, but as you're going through this, maybe you can specifically address how you see the commission engaging with the department within these meetings as well as outside of it.
Yeah, go ahead. Actually, Director Haber and I just set up a meeting for later on this week to talk through that and make sure, I mean, obviously the department is a partner in this and has to be. I will share that one of the things that I think is going to be really important for the commission is to make sure that we are pressure testing whatever is going in front of all of you. And so that you're not having to pressure test that that's being done before the meeting. But Gretchen, Director Hammer and I will talk through some of those details and set expectations.
Senator Kerkmeyer.
This is kind of a one-off, but can we get a list of all the acronyms? I mean, I know I had it someplace, and I know a lot of them, but I don't even know all of them.
Yes. So it would be great to get a list of acronyms. and and even if you could start us a list on who you believe the stakeholders are that would be great as well you got it thank you
okay I think the other thing I'll just add in terms of the remaining meetings this schedule will change there's also once all the interviews are done I can send out to all of you and we can post it online the more deep like what the details are for each of those meetings based on the conversations and the questions that have come up so far so I've already started to draft that out I just want to wait to have all those conversations done before I share it with everybody so this is just a summary of the map that I shared with you all in terms of the questions that have come up and where we're gonna where we which meeting we will be addressing them again this is all subject to change but just confirming to let you all this is slide eight confirming to let you all know that this is something trying to map it all out to make sure we make good use of our time going forward and again this will also continue to evolve I wonder if this is where we should talk about Senator Mullica's question about the research requests and like how we're going to sort out who's doing what and how we then can add to the
list of questions that we all have. So I also have a tracker for all the requests that have been made so far from meetings one and two. So I'll be trying my best to make sure that we get all that information from the different sources that have that have offered to provide it. And we'll get that all to you as well. Senator Baca. Thank you, Madam Chair, if this is the appropriate time. I
think what I looking for though is specifically what that timeline looks like We obviously now getting hot and heavy and starting to have multiple meetings a month We going to have people in front of us And I think what I really looking and I know we put that in I really looking for what that timeline is so that we have that information. Because what we are going to have to do is we're going to have to digest that information so that when people are coming before us, we have that information, questions ready to go. And that doesn't kind of happen overnight. And so I'm just trying to figure out what does that look like for us? When are we going to have that information so that we can kind of start that process internally to best prepare us for these presentations that are going to come before us?
Okay, so Mr. Brown is saying he sent some responses to our initial set of questions today. So you all should have, is it a link or is it?
In your inbox.
In your inbox.
legislative emails?
I sent it to your
No, it's from
Hickpuff. I sent it to your
In your box.
No, no, no. I sent it to your
non-legislative email.
Senator Malta.
Okay. Because we're all having trouble with our email. I got it. Good. Okay. So some of that came out today, but we probably also need on the website to
have our questions and all the answers to those questions posted somewhere so that we can look at it and so that the people who are following along can look at it too. And Senator Mullica. Thank you, Madam Chair. And I think it's just an appropriate time to kind of talk about because I think we're going to be
getting information from these presentations. It's probably going to have more questions and more research requests. Summer, can you kind of talk to us of what you, how you envision that? because there's probably going to have to be quick turnaround times. Obviously, the vice chair spoke about the department. I think we all maybe have a history with the department and maybe not getting the information we always need or as quick as we need. Can you kind of just speak to your vision on that and making sure, like, how do you envision us getting the information maybe in quick turnaround times that we may need?
Yeah, I mean, my goal is to get you the information as quick as we possibly can. I also want to make sure that you, going forward, I will say that today snuck up pretty quickly. But going forward, that you have all of the pre-read materials at least five business days ahead of time, and that they're also posted on the website, and that gives you some time to review it. And then also if there's questions that come up between now and then, between when you get the information and when the meeting takes place, we can try to see if we can figure out how to address those questions in real time. We won't always be able to do that. But that's actually why I started a tracker. So I'm keeping good tabs on what we collect or what is being asked, what's being provided, and what's still missing.
Okay. So do we want right now, do people have other things that they've thought of that they would like to have some information about before we, that we could put on the table today so that we can start to gather that for the next meeting? Have people come up with more things that they're, Rep Taggart.
Thank you, Madam Chair. I went over my series of questions in our one-on-one interview. So I already turned mine in.
Okay. Okay. Whatever that's worth. All right. Got it. I'm all noted. Okay. And so we are going to talk about where we you know what everybody said to the extent that you talk to most people sorry and try to prioritize some of those things I think we going to try to do that today But one thing I think would be helpful, and maybe everybody else has this already, but I don't, I need the real basics. This is how many people are employed by the Department of Health Care policy and financing. This is what those, how many of those employees are involved in simply admin, how do we, what is admin, how many people are involved in delivery of care, how many people are doing contract, like I want an org chart with real numbers attached to it. And also what is the total dollars associated with the different parts of the organization and and also probably want that for the BHA as well
senator Mullica thank you madam chair I guess one piece or it's a question slash request I'm trying to find the slide but early on you in slide five you spoke about really kind of this isn't going to be a time where we're trying to add more money per se but there is I think some instances when we talk about Medicaid where adding more money actually brings in more money from the federal government so I think I'm interested in that you know I know we we've put a research request in of what dollars are we missing out on or have we maybe missed out on and what does that look like but also you know I think that there is an instance if if state dollars can maximize federal dollars coming in what does that look like and I think those opportunities and so I don't want to want to make sure that we're looking at that and not cutting it off if we can potentially maximize some state dollars as well and what
that what opportunities are out there. Senator Kirkmeyer. And then adding to what Senator Mobley was requesting I'd like to know how many offices were created without statutory authority or new programs created without any statutory authority because I know of at least one in HICPOC and then I'd also like to know their authority with regard to IT which IT programs like CBMS what other IT programs have they taken over at health care policy and finance
Senator Mullica. Sorry, and just a quick follow-up. And I'm not sure. I just saw the email come through on the state request, but we're not the only state going through this. You know, and so I'm curious of kind of what's working or what has worked in other states or whatnot. And I think that being able to kind of look at that and maybe not necessarily have to reinvent the wheel if we don't have to, and in some cases, Obviously, Colorado is unique. I get that. But that may be in some of the reports we already have. If not, I think it's a valuable piece of information.
Absolutely. And I think what I've been asking everyone, too, is that if there are specific states that you want me to look into, to let me know. Because I would say I have no idea. I don't know. Okay. I guess states that are similar in size to us or have a similar percent of their population that are Medicaid enrollees. I think other county-run states, too, are going to be important to look at. Yep. Okay. Yeah. Okay. Okay, Senator Mullica is asking if we've talked about managed care. So which states use 100% managed care, which states have sort of a hybrid like we have, and which states are purely, if there is such a thing, fee for service? Yep.
Rep Taggart. Thank you, Madam Chair. I just want to make sure whatever states we pull are recognized by many other states as having adopted best practices. I don't want to see us adopt states to analyze just for the sake of adopting states. I want to always come back to who is doing things right. and they may not be doing things right on every single subject, and that's why there's going to be multiple states, but I think best practices plays a large role in this analysis. And what I don't want is what happened this morning, is that we analyze just, and you've already said this, just against those states that are only fee-for-service. That, to me, is a mistake.
Reptogra, I totally agree. And I think what we're going to learn is that states have strong, there's some strengths that they have around their Medicaid system and there's other things that we wouldn't want to replicate. So that's what we'll really have to look at. Yeah. And maybe just to add to that, and then I'll go to you, is where is Colorado unique? Like where are we the only state that's doing a particular thing in a particular way? because that might be good, but it might also be not good.
Senator Kirkmeyer. Yes, thank you, Madam Chair. And then I'd also like to know, again, this is going to have to come from the department, all of the rate cuts that take effect on July 1 that weren't proposed either in the statute or in the long bill, that JBC wasn't made aware of. So they just found out about another one. So today we learned that they can't, they tried to tell us that they can't increase rates without going through the long bill process or through the Joint Budget Committee, but they certainly have figured out how to cut rates. So they can do both. So they should start telling us the full truth. And I'd like to know what the heck they're doing on July 1 as far as rates, how they're all being cut, which ones were actually in the long bill or in statute someplace, and which ones they just did on their own.
Okay, I don't see any other hands up. So if you think of more things that you want to know about, I think we'll just... Send them my way. Send them your way. I also, I just would like some clarity on this. People have been sending me information, which I've been sending to you. Yes. Would you like us to stop doing that or to keep doing that? Or how do you want to handle that? What I would suggest is keep sending it to me. I will compile. It sounds like you all are using Box. And so I can compile everything into a folder in Box. And then that way you all have easy access to everything that's been submitted. We can also create a summary of what's been submitted since the last meeting, for all the meetings going forward. So everyone knows what's. Okay. So is everybody hearing that to the extent that you getting forwarded white papers or that kind of thing to forward them on and then we will all be able to look at all of what everybody been getting because I imagine we all getting different things Okay. All right. So at least maybe we can, for July and August, see if we can figure out meeting dates so that we can get those on everyone's calendars. I just got Vice Chair Brown's availability right before our meeting today. So I want to check in and just see if July 29th works for the majority of folks. I see a thumbs up.
I think the question is, is it a morning meeting? July 29th.
I mean, I think we need to have at least six people. And I think that there is going to be very hard to find a time when everybody can come. So.
All right, so I'm free on July 29th.
Are other people free on July 29th, or is that nobody is free? He's not free. I don't know. Maybe that was a mistake.
I mean, look, if we have to meet that day, I'll cancel my tour. But I've been trying to go on the east-west northern water tour for probably three years. Oh, my God. Yeah. You don't need it. You don't need it. Jesus.
Okay. Do we want to read HR1? Okay. You don't want to do this right now?
because we could yeah well I think we have to nail down a couple of meetings
here and that's what we're trying to do so I could we maybe just to show of hands who can meet on the 29th okay and we also have remote option does that get anybody there look can we just pick another date or two in July to see if we can do better than we just did. Do you want me to just go ahead and send a doodle poll out after this? Is the 28th good?
28?
That's not good for you? Okay. What about you, Senator Korkmeyer?
Okay. The 28th looks good. I'm sorry,
Rep. Barone, but we'll get you the next meeting. We'll fill you in. Yes, you will get a calendar invite after this meeting. Okay, so we have July 28th. And do people care about what time Rep Taggart Thank you Madam Chair The time for me is really important because it saves the state money
If we start late in the morning, 11 o'clock, I can drive over in the morning and just stay one night. Okay. Is 11 o'clock good on the 28th? All right. That sounds good.
And I think we have to plan to be here until probably 4. Does that sound right? Okay. We got one. Do we want to try for August so we can get them on the calendars? Yes, because I think that will make it easier. Okay. Did we do something on the 23rd or we're just doing the 28th? That's the second person who's asked. I think we're just doing the – so these were all possible dates that we had put out and then Vice Chair Brown, we had heard that 23rd of July did not work for you, which is why we took that off the list. Okay. That's correct.
I'm in Chicago.
Okay. So the 28th, now we're into August. Okay. So August, we have the 5th, the 18th, and the 19th that work for the chair, the vice chair, and myself. OK, can you say those dates again?
August 5th, 18th, and 19th.
5th, 18th, 19th. OK, and which one didn't work for you? OK, so the 5th or the 18th. Can we have a show of hands for the fifth?
I shouldn't raise my hand before I go.
Okay. Yeah, that's fine. Okay, the fifth is good. Eighteenth or nineteenth? Okay, and I have one person that's saying, well, let's do a show of hands for the 18th?
18th, August.
Okay. The 18th is good, because I think we have somebody who can't do the 19th. Okay. And again, we're doing 11. Is that good for everybody, 11? To four. Yeah. Yeah, I mean, I think that's the request I heard from Rep Taggart,
and we maybe can't accommodate him every single time, but...
Yeah, okay. So we have the 5th and the 18th. All right, should we try for one more or is everybody sick of this? Okay. I think the only thing that I would say for September is maybe to lock in the 17th because that is the day before the JBC forecast. Yeah. Okay. That's a good call. Okay. Well, have we already missed you on a couple of these or not? Have we already missed you on a couple of these or not?
August.
Okay. okay but so we wanted to do it around the time of the forecast and Saturday not obviously feasible so did we look at the 16th Or you're still at a conference on the 16th?
Okay, I guess then the 17th.
September 17th at 11 a.m. Does that work for others? Okay. And then are we trying to have an earlier in September meeting also? Yeah.
I think that would be beneficial.
Okay. So what were the possible dates earlier? The second, the first, or the ninth?
And actually, per Vice Chair Brown,
I think it's only the first and the second.
Because the ninth is?
He's not available on the ninth. All right, what works for everybody else on the 1st or the 2nd or the 9th? Raise hands for the 1st. Maybe it is the 7th. Maybe it is the 7th. The 1st of September? Are you guys
Senator Kirkmeyer-Riperone?
Can't do the 1st.
So there's a bunch of people down there that can't do the 1st.
What about September 2nd? September 2nd.
Okay.
Senator Mullica, I'm not seeing you raising your hand at all.
Okay.
You don't already have something on the first or the second. What about the third? the third. Oh my god. This is why I'm single. Okay. The third. Okay. The third. Barb the
3rd. Can you do September 3rd?
Okay. On the 2nd? Okay, so the 2nd. The 2nd. Alright. Okay, I mean, I think we have three meetings scheduled. At the next meeting, can you please pre-approve with your spouses for those of you that have them. That's a good idea. Maybe we could send out, like, these are the possibilities. So everybody has that. Yeah.
But we had some people that couldn't commit to the third.
So we're just going to table the... We have the second meeting in September scheduled, but we'll wait to schedule the first meeting in September until... So keep an eye out for that doodle poll. I will send it by email and text as well, so everyone's got it. Okay. I think we've already talked about a lot of this already. Research and data, we have a lot of it. There's been some requests. We'll update this. We know that there's a lot of information that is already available, so my goal is to also synthesize it for all of you. Okay, there was a question in there for us. No, just letting you all know, synthesizing all the research and the data.
Okay, and how are we figuring out who's going to do this research for us?
Is that all happening seamlessly behind? I'm looking at Mr. Brown now.
So we've been working with HICPF, who sent you all those responses that I sent to you this morning.
And then we are also coordinating with Ms. Gather Cole.
So our job is kind of to be support for them, but you hired them to kind of take on the leadership role in that regard.
Okay. All right, great. again this I think is a lot of information we've already talked through requests can go through me so I can collect them and track them and make sure everything's kind of pressure tested before it goes in front of all of you doing the one-on-one interviews so I think there's just about two or three left that are to be completed and then all of those themes I'll be sharing at the next meeting so that you have them. Again, just want to make sure I get all of them complete, which we'll definitely do before the next meeting. And then defining success. I know this was talked a lot about at the last meeting, and I want to check in and see just as you all are thinking about success for this commission outside of an actionable report that really tries to balance people getting access to services and our budgetary constraints, what else do we need to, what else do you all consider a success that maybe you have not shared yet?
Senator Mullica. Thank you, Madam Chair. I think you kind of touched on it. I think it's really figuring out what the framework of a successful, sustainable Medicaid program is in Colorado with, you know, with the parameters that we have to work with within our state. I think that obviously at the federal level, some of those parameters are changing and we need to adapt. and I think what I'm hopeful for is that we figure out how we make sure that our Medicaid program is successful, sustainable, and that we are doing the most good for the people who need it in Colorado. And so I think that we have a lot of work ahead of us. And I think that at the crux of that too is making sure that that department is ran to the best of their ability. I think that there's been some failures there that we need to do better at as a state.
Okay, do other people want to weigh in on what they think success looks like?
I mean I just say I think we taking on just a gigantic amount of things And so for me even if we just really get to some recommendations that almost all of us can agree to that are meaningful in terms of access to care and quality of care and cost, that that would be huge success. You know, if we can come up with just even a handful of things that make this system work
better.
Rep Brown. Thank you, Madam Chair. If we're talking about what sort of success looks like for us, I just want to put out a call for, I think, I'd like to at least make one of the parts of this exercise better sort of decision, shared decision-making tools that we all have. I know we have spent a lot of time talking about how we need more transparency and trust with the department. And I think part of that comes from building that comes from having a shared understanding of what the world really looks like. Right. And what what the Medicaid program and all of its warts and successes looks like. And I think the better that we as a legislature can, the better tools we have as a legislature to understand exactly what's going on with expenditures, with enrollments. And I will just say from a JBC perspective, you know, I think this is something that I brought up on the dais. I think others brought up on the dais, but, you know, medical services premiums is a pretty black box to the extent to which we could break that down and understand more about what's driving things in any given year. I think that would be helpful. But I don't know what those decision-making tools look like exactly, but I do think that that is part of the sort of shared exercise that we should be looking for is how do we – kind of resources do we need on an ongoing basis to be able to make the decisions that we as a legislature are required to make? And how can we, even if we disagree with the department, how can we have a shared understanding of what's ultimately going on? If we can get one thing out of this commission, I think that would be a really important thing
to me. Okay. Anybody else want to add to that? All right, so you can turn that into something. Well, for Senator Mullica and Vice Chair Brown, what you see here on the screen is, and I know it's very hard to read, and it's okay, I actually don't want you to read it right now, but I am putting together a framework that shows us kind of for people and for money, what are the different components that we need to keep in mind so that as we're thinking about recommendations and we're thinking about people, we can think about does this improve access to care? Does this, you know, worsen quality of care? Does this improve health outcomes? Or is there no change? So this is a framework. Again, I'm not, I don't want to finish this until I have completed all of the interviews. But this is a tool that we can actually all use in real time so that as a recommendation comes up, each of you can go in and complete kind of on your own where you think this lands and then we be able to have a conversation about it in real time So it one of the tools I hoping that will help us kind of figure out and narrow in and think about what the balance between the money and the people and where do we see value intersect with that as well. So this is very small. I realize that, again, I'm not asking you to review it right now because it will be changed, but it will be something that I'll share with all of you publicly before the next meeting so you have a chance to review it so we can see if we're all comfortable using this type of framework. Okay. Okay. I'm going to skip to kind of talking a little bit about our scope and what's in scope, what's out of scope. We already know that this is an absolutely behemoth project. So I want to be really clear on where we can focus our efforts. And again, I think this will change a little bit as I finish up some of those remaining conversations. But, you know, I think the things that I've heard so far that we are in agreement in around what's in scope, eligibility and benefits, provider rates and payment, delivery and capitation, financing and federal funds, program integrity, the Medicaid, BHA, block grant overlap, and then I realized I also neglected to include waivers in here too, so that will be part of it. So that is the longest of things that I think are in scope. What's on the boundary? So it's real. I think it's something that we can include in the report, but not necessarily ours to fix, is HIPPF's culture. And again, I think that that's come up a lot. I know that we have a lot of concerns around that. I think there are ways that we can talk about accountability for HIPPF in the report. So again, we're kind of touching upon it. Whether the VHA should exist. I know that there's lots of questions around that. That is not something I think we necessarily are going to tackle in this conversation or in this commission, even though it could come up. But I also recognize that there is an intersection, right? so we can't just ignore the BHA completely. IT and cybersecurity. So I think there's some data and questions
that we can find out more around that, Senator Kirkmeyer,
but let's see what kind of control we have or what influence we have there. TABOR reform, again, we can name it, we can flag it. I don't know that this commission is going to put forward a recommendation around TABOR. Rev Taggart.
Thank you, Madam Chair. I guess I'm just concerned about the comment that's here on whether the BHA should exist or not. I know you and I talked about it from the standpoint of we did put this in place to centralize our services as it relates to behavioral health, yet we've not done it. and not having done that and still having behavioral health spotted in nine different departments is a cost. It's an administrative cost. And I don't view that as a boundary situation. I view that as we are wasting taxpayer money. If we want a BHA to manage all of behavioral health that what we need to be doing and not this hybrid that we have today that adding to our cost structure and potentially adding to a lack of quality service that we so desperately need in this particular area So I am a little worried about that statement.
Rep. Taggart, I don't disagree with you. There is that intersection, and it is going to have to be discussed. I think in the broader picture, I was thinking more of, I know that there has been lots of conversations over the last year about whether or not the BHA should exist. I don't know if that's the question for this commission, but I think the question for this commission is, does the BHA take on more of the behavioral health and take it out of HICPF, vice versa? I think those are the things that we're going to have to grapple with. I just think in the larger scheme of things, it may not be this commission that says this is, you know, the BHA should exist or not, but we can talk about what should exist within the BHA or not. Yeah, I'll just add, I think to the extent that we have HICPF is paying for almost all of behavioral health services for, well, for all of it for Medicaid recipients. And the BHA has a huge role in how that all got set up. I just don't think we can leave them out of the conversation, out of the Medicaid conversation. And so I agree. We have to talk about that. But I hear you. We don't have to talk about the other funding that BHA has, but I don't actually see how we talk about the raise without, at the same time, talking about the BHA, because we have to talk about the BASOs. We have to talk about whether that's duplicative or not duplicative. So I think that actually does go more into our scope than this might indicate. Okay. I totally agree. There's definitely an intersection. We're not going to be able to not talk about it. I just want to make sure we don't go down. I guess what I'm trying to say is I don't want to go down the rabbit hole of just focusing on the BHA when we know that we have a larger issue to take on. Rep Gilchrist.
Thank you, Madam Chair. Just a quick comment on the HICPF culture. I agree that we shouldn't, that's not something we can change in the legislature, but I would like to keep in mind HICPF's relationship with the legislature and how we can continue to strengthen that and information sharing and all the things that we've all talked about that, you know, I think will make the program better if we can work more collaboratively together.
Absolutely. I think we can put, I would imagine that the report will include expectations of HICPF going forward and more around accountability and relationship building. So, yes, I think in the broader scheme of things, I don't know that we're going to put together a change management plan for the HICPF culture. So that's really what I was getting at there. Okay. I agree, though, that this is why we're here, is this commission is born out of frustration with not feeling like we're getting what we need from this department in order to make good decisions and not trusting that they're making good decisions, whether they're telling us about that or not. Senator Kirkmeyer.
Thank you, Madam Chair. So a couple of questions. So do you see there's a difference between administrative efficiency and operational efficiencies as far as what we'll recommend on? And which of these things fall underneath either operational efficiencies? or administrative efficiencies?
I mean, I think there's a lot of similarities and overlap there. So I do think that those will probably be things that we'll recommend on. I think it's a question of how much detail will we get into. Yeah, because, I mean, the reason I'm asking is, I mean, I think we need to be recommending on the, on operational and administrative efficiencies.
I mean, this is a department that's grown pretty dramatically wild over the course of the last few years, eight years. and then their operations have changed as well. I mean, with the creation of the Rays and the Bossos, I mean, they're middlemen, essentially, right? We created a contracting and then at the same time increased the number of FTE at the department. So, I mean, we hired people to apparently watch over the people that are doing all the contracting with all the providers, which is what the department was supposed to be doing in the first place. So we created middlemen. So it's things like that that I guess to me, I don't know if those are all covered underneath what we'll recommend on, but I'm sure I'll bring them up as we get there.
I noted it. Thanks. Okay, any other? Okay. I think this goes actually into what we were already talking about just with that framework that I shared with you that, again, we'll share again before the next meeting. we've already talked about stakeholder input. So I think we made some pretty good progress today in terms of decision rules, quorum, information protocols, tracking, and so forth. We've got our work plan that I will adjust, and we've got some dates on the calendar. We'll get some more dates on the calendar. And I think we're pretty clear on where the scope falls in and things that are out of our scope, and also the in-between. Senator Kirkmeyer.
I'm sorry, I know you already moved on, but again, back to what we'll recommend. Will there be, do you think these things cover regulatory reform?
I think those are going to have to be in scope. Those are going to be in the scope that we would recommend on? Okay, great, thanks. Go ahead, Senator Kirkmeyer.
I just keep thinking of things here, sorry. One of the other things, a bill that Senator Mulliken and I had about stabilizing the safety net two years ago, I guess I'd like to know how we've stabilized the safety net. I mean, is that somewhere in this recommendation as well? Because that's a huge concern. Right? Do you see that in here, in the scope, for what we'll recommend on? I mean, the two years is basically up. And I don't know where we actually got to as far as stabilizing the safety net and stop having hospitals close certain services or clinics, you know, going out of business kind of thing. And it wasn't just in rural Colorado. Thanks.
Reparon, did you want to? Okay. I know that it's in here somewhere, but I do, when you said, well, we're going to also talk about the waivers, I want to just make sure that one of the things that I've asked for, and I don't, I haven't gotten it in a way that I can, that I, I haven been able to articulate exactly how I want that but I want to understand for long services and supports what are all of the different options that people have or you know things that are out there for people who are in that situation and how those things interact and how, you know, if you're on this thing, you know, you're on the IDD waiver, does that mean you also can't be on the LTSS waiver? And all of the things that we did last session, how those impact those people, so that we have a clearer understanding of what all of the different choices are that are being made made by HICPF and also all the different choices that people are different things that people are faced with when they're looking to get care. And so I just want to make sure that that's in the mix when we talk about long-term services and supports because I still don't know what that looks like for a patient. Senator Mullica. Thank you, Madam Chair. And I was going through the document that we got just a little bit ago from the research requests and appreciate it. But like, and hopefully summer,
I think you'll have it too. It's not nearly, I think the depth of information we need, you know, for asking about whether states are comparing ourselves to other states, you know, saying majority or, you know, like it's like, we need to see specific other states asking about what services were provided, you know, back in, in 2010 compared to, to 2026, you know, just going over mandatory and optional services is not kind of what we need. I think we need specifics. And I think we, you know, it'd probably be helpful too to talk about, you know, dollars next to those services as well. And I think that's going to be information we need. And so just glancing at it, not digging in deep yet, you know, to the 15-page document we got, we're going to have to have, I think, deeper information in my opinion. Thank you.
I've not had a chance to look at that yet, but we'll take a look and make sure we address some of that. Rep Taggart.
Thank you, Madam Chair. I know HR1 is on our next meeting. As a part of HR1, are we also going to go over the Rural Transformation Fund? Because I'm getting a number of questions from providers. that are asking about this August 1st deadline, and I have to tell you, I have no idea what the department, what they've put in it from a procedural standpoint as it relates to the Rural Transformation Fund, and it's awkward because I don't know how to answer these questions. I was just going to ask, knowing that our next meeting is not until late in the month, how do we want to make sure that you get answers to some of that well before August 1st?
Yeah, that's a great question. I think that should be part of what we talk about, because that was set up in H.R. 1, and we have to respond to it. But also we need to understand, like we heard, Rep Brown and I heard on a call that we actually
have to do cost sharing as part of HR1 for the expansion population.
So I want to make sure we talk about that What are the options for that What is that going to look like And then we have to talk about the provider fee and what are the plans that are currently being talked about to respond to that And I'm sure there are at least, you know, 10 more things that we all want to know about as part of what we're talking about with HR1. So I assume that our research team will be working on all of those things? Yeah. If you are receiving constituent requests in particular, send them to us and our team, and we will get our constituent services team working on that. And I would say that everybody here who asks specific questions, you know, like, what are we doing about the work requirement? Because that was in flux. I was on a, I wanted to call it an infomercial. a webinar about that, and it was like, oh, my God. And the webinar was before they changed all the rules. So do we know now what the rules are? Do we have a good idea of how we're going to meet the requirements? Do we understand what it means to be medically fragile? Do we, all of those things that were up in the air, those are things that we want to get answers about. Vice Chair.
Thank you, Madam Chair. And, yeah, the only thing I would add to that is I think it's – I anticipate that the department already has some – has been working on this, right? We're about a year into – since the passage of H.R. 1. So I would like to hear what the department has been working on and what their current plan is, especially given the rules that came out. But I would also like to hear from maybe them and from others what is actually possible, where we sort of have flexibility and where we might want to help to steer the department in a better direction, if that makes sense, or where they need feedback and direction from the legislature at this point. I think I think Rob Taggart's example of the rural health transformation that's a good example of like you know we've we've had a application approved by the feds it said we were going to do such and such things but if we don't do those things well in a subsequent round of funding or subsequent year they may take some of our money away and so I'd like to hear how that's going and how we can steer steer that money and steer the department in a good direction.
Yeah, Rep. Taggart.
Thank you, Madam Chair. I'm happy, by the way, Mr. Brown, to send individual questions, but I don't want to lose touch of the broader context of my, broader context of my question is what Representative Brown just spoke of, is we as a legislature don't have, I'll just speak for myself, As a legislator, I don't know what the department is doing with the rural health transformation funds. I have no idea. So to get to specific questions, it's hard for me to answer a specific question when I don't know the broader context of what's taking place. I didn't know until I got this phone call that applications for these dollars have to be in on August 1st. But I'm going, oh, okay. What's that all about?
I think we can ask the department to at least provide a summary to everyone hopefully as soon as possible in the next week or so so that you got at least some answers to those questions that are coming up Okay are there other questions that people are thinking about for this conversation about H Yeah, Senator Mullica. Thank you, Madam Chair. to the chair's question earlier in regards to staffing, I think getting information from the department around, I think the centralization of their redetermination process. I know the JVC ran a bill or there's some sort of commission or committee that's also looking at that as well. And so obviously I think that may have a staffing impact, but would like to have more information on that. Yeah, and also to the extent that there's some forecasting happening about what this means for the Medicaid enrollees, like you don't save any money if people don't get thrown off of care. So not that that saves you money either in the long run, but what does that look like? What are they anticipating? And you know, what can we expect? in the next year or two, three, four. I mean, we do have to be looking further ahead than, like say the Joint Budget Committee would normally look because the loss of the provider fees is, I just don't, I need to understand is there a plan and if there's not a plan, what is the plan for making a plan? So that's something else I think we have to talk about. Senator Kirkmeyer.
Thank you. I just want to make sure after all of this, my question though about what are all the rules, what's going in effect with the provider aides, we're still going to get that, correct? Yes.
As of July 1. Yes.
Because I want to know where they've changed things without any authority. Thanks.
Okay, and to the extent that you need more input from us before the next meeting, you'll reach out to us and, you know, if everybody could review whatever it was they were worried
about with H.R.1 and then respond to Ms. Gather Cole about that.
Yeah, Senator Kirkmeyer.
Thank you. I appreciate that. I think we also should be prepared to do more on our next July meeting than just HR1. So I don't know if we're going to try and follow money and eligibility enrollment benefits, because I think some of those, I mean, we're going to be here from 11 to 4, correct? I think we should be trying to figure out how to move some of these up so that we can move our stakeholder input up to the first meeting in August.
Okay. I will definitely be adjusting the schedule and we'll re-circulate it. Thank you. Okay, are there other questions or comments on what's in store for next week or about our priorities or other information requests that people are thinking about? I don't see anybody. Okay.
I think now, Madam Chair, if you want to move into public comment, there's an opportunity to do that.
Okay. And do we have people signed up? Yep. All right. So, you know, do whatever you were going to do today. But we will, for the next meetings, we will do a better definition of what we think will be the best way to use your time and put whatever it is you guys want to talk about into a context. but I'm going to call people up and we'll just do it the old-fashioned way today and you will have two minutes or so to testify and we'll start with Ms. Gibson, Mr. Luez, Ms. Welch, Ms. Fieber. Let's just start with that. Are they online? Okay. All right. Is there anybody online? All right. Well, maybe I'll keep reading until we get a few more people up. Mr. Limbaugh, Ms. Lehman. Come on up. Okay, and Mr. Gaines. You can all sit. You can all sit at the dice. Yeah, if I called your name, you sit up here where the microphones are. All right. Well, did I call anybody who was online? No? Okay. Well, let's keep going. Mr. Rose is remote. Ms. Aragon. And Mr. Raley. All right. Well, we'll start at this end of the table. And if you put the microphone a little, yep, and then it turns on and off on this bottom of the stem. And you tell us your name and who you're with, and then you have two minutes to testify.
All right. I'm Betty Lehman. I don't know if I can do it in two minutes, but I'm going to try.
All right. Well, we'll give you a little leeway.
So I wanted to just start and tell you what the beginning of the waivers were in the early 80s. There was a family that were upper middle income earners. They had a daughter who was living in the hospital named Katie Beckett. And Katie, the private insurance would not pay anymore. The hospital couldn't keep her anymore. But the family was over income for Medicaid. So the TEFRA Act in 1982 with Ronald Reagan, they created the waivers, meaning they were waiving the family's income and basing Katie's ability to access Medicaid home health on her income and assets. And that was the beginning of all of these waivers. But it's based on the child's income and assets and not on the family's. I've been working with families doing planning for when they die and they have severely disabled children, what's going to happen with them. So I work collaboratively with financial advisors. My background is I'm a CPA and I work with attorneys on this future planning. Some of my clients are billionaires. They too can have children with severe disabilities. They pay nothing. They pay zero. And so I sent to each one of you an executive summary of an idea There three pieces of legislation federally right now that are being introduced that could any of them could be amended for this idea. In 2014, we had the ABLE Act, Achieving a Better Life Experience Act, that was signed into law by President Obama. And currently it allows $20,000 a year. It's tied to the gift tax exclusion. And I propose that it be tied for those families who would like to contribute to their direct service provider costs to Medicaid, that they be able to voluntarily put up to the estate plan, estate tax limit, which is $15 million, that they be allowed to put in a couple million dollars into a child's ABLE account, voluntarily agreeing that then Medicaid, third-party Medicaid recovery, can then bill that ABLE account for the direct services provider costs. And I put on here, if there was only 1% of the people enrolled in waivers contributed, that would start out with $18 million a year. And if 5%, it would be $90 million a year. My clients would give anything if they could put their money in a tax-free account. And they would certainly allow Medicaid third party to bill them for the direct service provider costs of Medicaid, which I think is a solution to keeping the Medicaid program alive, is allowing for the first time that people who have the wherewithal to be able to contribute to that program through means that we already have. We already have ABLE account. We already have third-party Medicaid recovery. It's simply at the federal level creating an amendment, not bringing a new statute, changing from the gift tax exclusion to the estate tax exclusion for those who voluntarily agree to allow third-party Medicaid to bill their account, their child's account, for their direct services providers. So it's a new idea. I've conferred with a couple of billionaire people. They can't wait. They just can't wait because you don't have to put much in to cover the Colorado match. If I put a million dollars into that ABLE account, they could draw off at least $40,000 a year. That covers my son's waiver, direct service providers, the Colorado share. So I'm trying to give you guys an idea that I think would be any congressional leader could bring this forward. So that's my two minutes are up. But I'd be happy to answer any questions about this. It's what I do for a living.
So questions yet? Okay. You know, typically we ask the questions of the whole panel at the end, but if people have, this seems quite unique. So we'll Senator Kirkmeyer.
Thank you, Madam Chair. So do we need a federal fix before we can do the state?
Yes. Yes. Has to be a federal fix. But it would be an amendment rather than a brand new piece of legislation. And there's currently three ABLE statutes that are being brought forward right now. They're all bipartisan. It's Tom Tillis.
And then do we have to do a state fix after the federal fix?
All you have to do at the state level is just allow third party recovery to build the ABLE account for those who have volunteered to do that They can get the upper limit unless they volunteer to let Medicaid bill I think that that would save the waiver programs.
Senator Bridges.
Thank you, Madam Chair. So is the idea that the reason they do this is they're able then to gift the estate tax exclusion to their kids? No, the reason that they are interested in this is that cable accounts grow tax-free.
And pardon me for not being formal. No, you're good. Madam Chair and members of the committee and Senator Bridges. So the reason that they enjoy this is because it grows tax-free. So it's a tax shelter, essentially, that they could set up for long-term care provision for their loved one, their family member for their lifetime through this ABLE program, and they want to. And they would keep maybe 2% into the ABLE account so that it would continue to grow to continue to pay. Senator Bridges.
Thank you, Madam Chair. And the reason that they would want to do it through the ABLE account, and the reason we would want that federal change to allow them to do it into the ABLE account, would be that otherwise those dollars would count against the income for that person.
No, no, because the parent's income doesn't count. But if it's gifted, though, so if they just straight up give these... Oh, yeah, no, no, they can't because then they would... That person doesn't qualify for Medicaid anymore. This allows them to ensure that their kids continue to have care in the long term and have access to the funds that the parents would otherwise just give to them if they didn't have these Medicaid needs, but that Medicaid would be able to go in and use the interest that is generated from that to offset the Medicaid costs. So in other words, it gives them the ability to hand down money that they wouldn't otherwise have without having their kids kicked off of Medicaid. And it allows the state to lower its costs for Medicaid if this change were to be made. I'd like to think of it as it's saving Medicaid, but it is a win-win. I mean, it is a win for those people that have the resources to put that money aside for their children, and it doesn't have to only pay for Medicaid waiver costs. I mean, currently, it doesn't pay for any Medicaid waiver costs, but that's already allowed in the ABLE account. You can pay for medical expenses, so there's no other changes that would need to be made. at the federal level, they amended it, then the state can start billing. Okay.
All right. Thank you. We're going to move on. Oh, Rep Taggart.
Thank you, Madam Chair, and thank you. I think it's an excellent idea. If it's possible, we're not putting a lot of work on your shoulders. Could you get us a little bit of information about Senator Tillis's proposed amendment? Because I know I can make a phone call, many of us can, to our congressional delegation and say, we need you to get behind this if you haven't already.
Yes, Representative Taggart, absolutely.
That's all it would take. The two of you making that phone call could probably amend this, and it could save the waiver programs nationally by people being able to contribute to them. Right now you can And if you give money to your child that counted as income to them so that would throw them off the waiver This is an assurance that I mean it family contribution to long care and people that have the wherewithal they chomping at the bit to be able to do this But their benefit, of course, is that it grows tax-free. Okay, thank you.
Europe and just tell us your name and who you're with and begin your testimony. Thank you, Madam
Chair and committee members. My name is Maureen Welch. I live in Littleton, Colorado. I'm the parent of a 19-year-old son with intellectual and developmental disabilities, and he's on the DD waiver, and I'm here today because he's in a day program. I only have coverage two or three days a week, and I'm glad it happened on a Monday so I could be here. I am a small business owner. I own Navigating Disability Colorado, which I created to educate our community about this absolutely overwhelming system of navigating disability in Colorado. I'm a recovering special ed teacher. I pivoted to serve the community through an online educational resource. This system is extraordinary complicated. As Senator Amable mentioned, it's been a horrific year for us through rate cuts, caps, and limits. I feel grateful to be in Colorado, where we have a very approachable legislature thank you very much that we can come down here and we can testify we can do it online and there's also ways for us to engage with our department HICPUF if the committee and contractors can strategically figure out how to effectively engage us as members in this community it would be trail-breaking for this legislature and I love the idea of having some strategic questions put to our community focusing on Medicaid members would be helpful because industry lobbyists often get way more access to you than we do. And there's no advocacy group that can accurately represent all of the needs of our community. But even with our problems with Medicaid, Colorado is still the number one destination state for people moving here. I do private consults every week. This is a problem. We have to figure out a pipeline issue coming into Colorado. We can create all the changes, but if we have more people that keep coming, it's an issue. I had to wait two and a half years to get on the CES waiver that Ms. Lehman thank you very much for all of your work for that waiver when my son got on it. I appreciate her comments but my single moms who are losing 50% of their income and facing homelessness we need relief now. We are a few of us are millionaires or even billionaires and in fact the members have great lived experience and we want to contribute and we look forward to working with your committee and the contractor for this commission. Thank you very much.
Thank you. Okay.
Good morning, Madam Chair, members of the Commission. Thank you for the opportunity to be here today. My name is Yvonne Limbaugh, and I'm here today with my family, my wife, Michelle, my daughter, Bailey, in the back, and our youngest son, Andrew. Andrew is 24 years old, and he is on the DD waiver. We live in Aurora, Colorado, and we are Andrew's primary care team. Right now in the disability community, there's a lot of fear and confusion from our friends, and it's even more so than usual. Usual, we're used to trying to coordinate services and supports and administrative complexities of that. We have to deal with the Social Security Administration. We have to deal with HICPOP. We have to deal with the counties, the CCB, and then the various providers. Some days it's worse than hurting cats and it's almost like trying to paint a portrait, but the only tool you have is a kaleidoscope. You're just trying to always fit these pieces together and make at work and it's very difficult. To add to that stress now, we're dealing with HICPF telling us they could be taking up to 90% of a person's SSI benefits. And we're wondering how people are going to live on $90 a month. People are asking, can I afford haircuts anymore? Can I afford healthy food anymore? What's it going to be like for me when I only have $90 a month? I don't know anyone can possibly live on $90 a month in Colorado, but that's the fear. And dealing with HICPF and trying to get straight answers has been difficult. It seems to be a lot of confusion within that agency as to what's going to happen. But thankfully, they are participating. I don't want to come down on them because they are participating with meetings for us. I do appreciate their time. At the same time, though, we see HIPAA spending millions and millions and millions and millions of dollars on consultants, and nothing ever gets better. We see them spending millions and millions and millions of dollars on waste, fraud, and abuse. And those are things that none of us in our community had anything to do with. but we're the ones who pay the price for that. We'd like to see a system that's focused on the members, not the bureaucracy. We'd like to see a system that's easy to navigate, easy to understand, and that's predictable. As a parent, we'd like to be able to plan and know that our children are gonna be okay when we're not here anymore. That our children are gonna have the supports and services they need to live a full life. So thank you for your time and your attention to these matters.
Okay, thank you. And next we'll go online and...
Hi, are you able to hear me?
Okay, Ms. Haney. Sorry. Go ahead.
It's okay.
Tell us your name and who you're with and you can begin your testimony.
Sure thing. Thank you. And good afternoon, Madam Chair and members of the committee and commission. My name is Hany Raley. I'm the executive director of the Arc of Aurora. We serve people with intellectual and developmental disabilities and their families in Aurora and beyond. As you begin this important work, I'm really encouraged by your desire to lean heavily on the people who know Medicaid the best. Those are the individuals who rely on it every day, their families and their caregivers. You know that no report, fiscal model, or policy analysis can fully capture what Medicaid means to the people whose independence and health depend on it every day. And frankly, as you've already heard here today, those within the systems not only have feedback, but they have real ideas and paths forward that are often overlooked by surely well-meaning administrators and policymakers. You're charged, while it's to evaluate funding, systems, and sustainability, we know that those conversations are essential. But Medicaid is more than a budget or a delivery system. It's the difference between living safely at home or not, accessing healthcare or going without, working, learning, and participating in our communities. When we don't engage users, Colorado risks escalating and repeating problems it has spent decades and so much money trying to solve. While staff and directors come and go, families and individuals hold the institutional knowledge that should inform your path forward. Our organization and the Colorado Arc Network stands ready to support you, to share what we are hearing locally and across Colorado, but mostly to connect you directly with the people whose lives will be impacted and affected by your decisions. I thank you for your time. I'll see you soon, but appreciate your commitment to Colorado's Medicaid members.
OK.
Commission members questions Yes Senator Bridges Thank you Madam Chair Ms Welch you said we the number one destination Can you elaborate on that I think we had a sense of that from the testimony but I think there were other folks insisting, no, that is not the case. That's not what's causing these rates to rise. But it really clearly seemed to me like a huge number of the folks who testified told us they moved to this state for the benefits that we provide. So is that your sense as well? and could you have anything to back that up? Ms. Welch.
Thank you very much, Senator. Yes, I do private consults as part of my services and I get calls every week from people saying, I have researched all the states in the country and Colorado's the best for me. And they move here and they can get eligibility. I'm okay, what do I want to say? I floated this by a few of you legislators in the past, but I'm okay with someone moving here and qualifying for Medicaid if they're low income and they qualify through the MAGI program. My issue is when people move here and they do the waiver and they go through the HCBS, which basically only looks at the income and assets of the member. So also we have waiting periods in other states. I think Colorado should look at that, a waiting period for enrollment for HCBS services. When I got on the CES waiver, I waited two and a half years for my son to be enrolled because we had a wait list on every single waiver in 2012 except for the EBD because by statute we can't have a wait list. Perhaps it's time, instead of watering down the waivers to the point that they're no help for us families because the rates are too low, it's too hard to get services, and companies are closing. Many companies closed in the last three weeks that I heard about. It's very, very sad. I think we need to start looking at some waiting periods for the HCBS enrollment. Texas has one month to get on any Medicaid. Arizona, I think, has six months. Don't quote me on that. But there's a couple states and they all make you wait certain periods in order to enroll in Medicaid. And like I said, if somebody is low income, I don't have a problem with them accessing the services that they can. But when we're talking about weaving or not looking at the household income, I think we may need to do a wait list for those people. Because otherwise, services like my son, if we water down the day program rate anymore, there will not be day programs. My son is a level three autistic son. He is non-speaking. He has behaviors and they're getting paid $22 an hour net after they take their cut for those services. That is not feasible. And what's happening is the high behavior people like my son aren't able to access state program because they can't provide the ratios that they need. So, yeah, I think Colorado and it's terrible. I mean, here I was sitting on a wait list myself, but we need to serve the people that are already in Colorado and make sure that we protect those services. I have other ideas of why numbers have climbed, but that's maybe another question.
Senator Bridges and then Senator Mullica.
Thank you, Madam Chair. This was, as I said, a matter of great debate in the JBC. And we were told by folks in Medicaid that we can't have a waiting period for folks who move here, that that's against federal law. It sounds to me that maybe other states have decided that violating federal law is just what they're going to do, which seems to be what everyone involved with federal law is doing these days. But we, I think in this state, need to really focus again on serving the folks we have. I love that our benefits are such that folks from around the country want to come here. I think that that speaks well of us but especially given the restrictions we have on our budget we just can be the place that people from around the country come for services We have even more restrictions on our ability to fund than just about anywhere else really than anywhere else in the country And getting a hold on that, getting some sort of way to stem that tide of folks coming in, I think we have to do, and I think needs to be on the table. Per the discussion we were having about what are the things we need to look at here, I think that definitely needs to be part of what we look at here on this commission. Thank you.
Ms. Welch.
Yeah, I was just going to have a quick comeback. I'm not sure the other states are violating federal law. I'm just not sure HICPF is interpreting it in the same way, or maybe they have it set up a different way than HICPF is thinking. I do always, when I speak to these families, just to cover myself, I am very blunt with them and say we have a capped budget here, and these services are getting diluted by the day. Literally every month they're getting diluted. So I'm pretty honest with them and I don't sugarcoat anything, but it still is, I hear this from people, the best state to move to because you can get services right away.
Senator Malaka.
Thank you, Madam Chair. And thank you, Ms. Welch. I really appreciate every time we get to hear from you and, you know, real world experience and lived experience. And I'm not sure if this question is for you or maybe for summer or whatnot. but and you touched on this a little bit but I would be curious to see what other states are doing in specific policy that they've implemented in regards to kind of a waiting period and then I think this probably is more for summer I would be interested to hear from the department as well what the data is on that destination and what impacts it's had on our waiting list and what that what that means I'm sure they have that information on folks who who have moved here recently, but I think that could be a valuable piece of information as well for us moving forward. I don't know why.
Mr. Vice Chair. Thank you, Madam Chair.
In response to your comments and also to Senator Bridges' comments, I think this is sort of an action item, I think, for our facilitator, Ms. Gathercole, which is just that we, it It sounds to me like federal law does not prohibit the kinds of waiting periods that you're talking about, but we have been given direction from the department previously. My guess is that the actual waivers are written in such a way that does not allow that, and that HICPF has been reluctant to reopen those waivers. But I would love to get clarification on what the exact reason, because sometimes the reason that the federal government won't allow us is sort of because of an agreement that we currently have, and sometimes it is actually written into regs or statute. So I would just like to have more clarification on that particular item.
Rep Taggart.
Thank you, Madam Chair. I think my colleagues might have already covered everything on this, but I was one of those individuals that asked that question, and because what didn't make sense to me from a data standpoint was that the numbers of children, and I'm just speaking about the two children's waivers right now, were growing exponentially when, in fact, in the state as a whole, our numbers are dropping when it comes to children, And we see that by way of public education And when I asked the question about eligibility we were told very matter that that was not an issue that we could explore without getting in trouble with CMS And so it's troubling to hear that other states have already addressed this issue, and again, we're sitting here wondering. I come from your same school, Ms. Welch, that our first and foremost responsibility are to the citizens of Colorado. And we need to get to the bottom of this.
Ms. Welch.
Thank you. I was taking a couple notes here. So, Senator Mullica, actually, I don't think HICPAF has that data that you want because they don't track where people come from. When people apply, they don't ask, did you move here from another state? They also don't ask me as a family caregiver when I have residential services on the waiver if it's me personally delivering it or if it's a host home. It's the same code. So I would really caution this body and all legislators to highly question what you get from HICPF because what they're telling you isn't actually driven by billable code level data. And a lot of it is what we would call it anecdotal or what they think. And then the waivers are 300 pages each. I have read most of them, not every single letter, but I'm going to go home and do a little control F function and see about waiting periods. I do not recall out of the nine waivers that I read regularly, there's anything about enrollment restrictions anywhere in those waivers. But now I'm challenged to go back. So I will do that and get back to you.
Okay. Senator Mullica and then Senator Kirkmeyer.
Thank you, ma'am. Just, I guess, a response to that then, Ms. Welch. So, if, I guess, is it just anecdotal, is it just, is this just coming from conversations you're having, you're saying that we are the number one destination in the country. and so what what makes you say that what what what data do you have to show that and then if you do have data to show that then where are you getting it if if if not from the department miss welch thank you i know that we were listed in the usa today as the number one autism destination state a few years ago in an actual publication and that's still circulating in reddit and all the online discussion boards as to the new data all i can tell you is i did hear a number floating i can't source it that we have 300 new enrollments a month coming from out of state now i don't know exactly the source of that we don't track where they come from so this is very concerning uh i don't know how to get down to it i just know that when i get my private consults booked through my county app and they pay me to come and talk to me about my expertise and how you get enrolled in medicaid i'm getting so many inquiries because every other state is cutting like i said i warn them Colorado's not Nirvana and to come here with eyes wide open but I also know that we have to look at the big picture and we cannot handle the whole nation's level of disability needs on our state capitated budget it's just not possible I just want to follow up on that so you're saying that we can't have this data and yet somebody has this data and and you're basing it on people calling you to ask about Colorado, but are those people calling around to other states too? And so how do you know that all those people are then landing on Colorado? And what is the impact? Because I think one of the questions we had, just a waiting list, if you don't know that somebody's come from out of state, then you're suggesting that everyone has to be on a waiting period, even if they have a kid that was born here. and they've lived here however long, so everyone would be under this waiting period. Well, I thought you said we don't know where they came from and we don't ask. Yeah, Ms. Welch.
Okay, good question.
So we have two different topics. One is coming from out-of-state waiting periods, and that's what the other states have, Texas and Arizona, I know for sure. Then we have separate waiting periods like we do for the DD waiver, which is atrocious that we have that long a waiting list here in Colorado. So I think we're talking about apples and oranges. So when I'm talking about a waiting period, I'm looking at waiting periods for people moving here from out of state. And then, of course, we have gone to wait lists in the past for more waivers than the DD when we've had financial challenges in the state. So that would be another question to look at. I would hope that we could maybe look at the out of state folks before we start putting on our residents on wait lists everywhere. But I run a program to educate people. I'm not a data wonk. I just know what people call me, and I know that HICPUF does not track the types of caregivers that I am versus a host home because it's the same billing code. So I just am very – I don't know where we can get that data from unless there's some directive from the legislature to have them start collecting that data for are you moving here from out of state.
Senator Kirkmeyer.
Thank you, Madam Chair. So is there an issue, though? there may be waiting periods that are allowed within the waivers, but we were told specifically that you can't have a wait list in community first choice. And now my understanding is they've attached community first choice to the waivers, which is saying you can't have a wait list.
Ms. Welch. Actually, community first choice is a separate bucket. I like to look at it as three buckets. You have state Medicaid for health first Colorado. The middle bucket is CFC, community first choice. and then you have the third bucket which is hcbs the middle bucket you do not need to be on a waiver to access so you could move to colorado qualify as disabled either through social security or the hiccup contractor process and once they designate you as having a disability you can do the care calculator and see if you qualify for the cfc services so it's a different three different buckets okay i just want to put a flag for miss gather coal that this is exactly the thing I was talking about What are all these things and how do they intersect Go ahead Senator Kirkmeyer
But if they're attaching everything to community first choice, they meaning HickPuff here,
that's where we got the answer that you could not have a waiting list. So a waiting period is the same as a wait list, essentially, correct? No.
Ms. Welch. So a waiting period would be you move here from another state that you have to wait a certain period of time to apply for Medicaid. So that's different than a wait list, which is for everybody that's applying for a specific waiver. And the community first choice option is actually under the Affordable Care Act. It has nothing to do with HCBS. It's a freestanding benefit that our state has chosen to launch, I think, at a very questionable period of time in history, given our budget right now. but it is completely separate from Medicaid. Now, the eligibility may be the same because you have to do disability determination and meet financial eligibility, but you do not have to be on a waiver to access CFC.
Rep Brown.
No.
Okay. Rep Taggart, did you have a question?
No.
Okay. Are there any other questions? You ask. All right. Seeing none, thank you all for coming today and testifying, we really appreciate it. Let's just circle back and see if anybody else is online or if anybody else is here in the room. Is there anybody in the room who wished to testify today? And is there anybody online? Okay. Come on up. Is there anybody else? So if you want to testify and you're sitting in the audience, please come on up and have a seat at the table. Okay. You're up. Tell us your name and who you're with of anybody and you have two minutes.
Hello. Good morning, Madam Chair and members of the Commission. My name is Matt Lopez. I the founder and CEO of Continuum Recovery Colorado a behavioral health provider serving Medicaid members with substance use mental health disorders in the Denver metro area I appreciate the opportunity to speak today and also want to express my support for the recommendations submitted by the combine for Colorado Medicaid behavioral health specifically provider credentialing, continuity of care, reimbursement rates, MCO accountability, and how they impact patient care and providers. Colorado's made significant investments in behavioral health. My concern is that administrative barriers within the managed care system are preventing those investments from translating to access for patients. Our organization is fully licensed, Medicaid enrolled, and Joint Commission accredited, yet Colorado Access denied contracting with us, citing network adequacy. CCHA denied allowing us to relocate our office less than five miles away for network adequate reasons as well. We have also had clients whose rate change in the middle of treatment and requests for single case agreements were denied, disrupting medically necessary care. Rocky Mountain Health Plan took more than a year to associate our clinical director with our facility, delaying our ability to serve the Medicaid members. We're also seeing reimbursement policies that discourage providers from offering higher levels of care. Intensive outpatient reimbursement rates are being significantly reduced, while partial hospitalization rates are also being reduced to reimburse at nearly the same rate despite requiring additional clinical hours, staffing and medical oversight. Both PHP and IOP require prior authorizations, meaning that managed care organizations have already determined the medical necessity of these services. rates should support providers ability to deliver the care that they have approved. This commission was created to ensure Colorado's Medicaid program is sustainable and sustainability means that controlling more than just cost means that ensuring qualified providers can participate, patients can maintain continuity of care and medically necessary behavioral health services remain available in every community. Thank you for your time and your commitment to improving Colorado Medicaid system. I'm happy to answer any questions and provide any additional documentation regarding our experiences.
Okay. Thank you for being here. I've certainly heard exactly this from other providers, so appreciate you coming and sharing that. Does anybody have any questions? I don't see any, so thank you. All right. We will limit you this time to two minutes, though. Thank you Senator Mobley So I mentioned that I was a CPA and that did corporate etc
I, a couple years ago, a few years ago, caught the Office of Community Living in a massive fraud. I have it here. I presented it to Kim Bimfester, who was angry at me, although it wasn't me that did it. But I caught them. And it was horrific. And I just want to say, this is an us and them office. The Office of Community Living is they think that they're us and I'm them. And the rules don't apply. They have no oversight. The fact that me, that I could catch them in this major fraud and brought it to their attention, took two and a half years before I could get it to Kim. and they just said, hey, if we quit doing it, is that okay? I mean, what am I going to do? You know, yeah, that's okay if you quit doing it. But I just want you guys to know that on the receiving end, and I've been on the receiving end of Medicaid for 35 years with my disabled child, it's horrific right now. They have no morals anymore. It's terrible. They lie. They cheat. It's terrible. and I'm disgusted so that was I needed to say that to you guys because you're you know you have power and they need somebody with power to start looking at what they're doing and how they're doing it and how they're you know handling the community and the fact that they have this group think about us and them and it's
just a horrible situation to be in if you're on the receiving end of it so thank you okay thank you All right, and I think with that, we are done for today, and the Medicaid Commission is adjourned.
Thanks.