Current �Long-Term Services and Supports (LTSS) Challenges and Strategies

November 4, 2025

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Closed Captions

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• Captions can be translated into different languages by clicking on the up arrow next to the Closed Captions button and then selecting your preferred language.

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Welcome and �Meeting Logistics Reminders

• There are a lot of folks on the call please:
• Use raise hand feature to ask questions
• Be on mute when not speaking
• Use the Q&A feature to pose questions or raise hand
• Reminder: Keep out the PHI, PII, bring individual issues through our escalation process, follow up outside larger meeting
• Keep your comments about broader not case-specific issues or one-time events
• Meeting materials will be posted on the Stabilizing Long Term Services and Supports webpage

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Agenda

• Federal and State Budget Update and Questions
• Protecting Coverage for LTSS Members
• Paying Providers Timely to Protect Access to Services
• CCM Updates
• Reducing Case Management and County Backlog
• LTSS Questions

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Federal and Budget Updates on Medicaid in Colorado

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Unsustainable Medicaid trends due to increases in medical inflation, increases in our benefits, expansion of our coverage programs, outlier trends in certain areas, and outlier increases to our provider reimbursement rates.

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Medicaid General Fund cost trends averaged +5% annually (0-11% range) from FY 2015-2016 to FY 2019-2020, and averaged +19% (12%-26% range) from FY 2021-2022 to FY 2024-2025.

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Long Term Services and Supports

LTSS ~5% of members: 42% of spend at higher trend of 9-12%

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Non-LTSS ~95% of members: 56% of spend at a lower trend of 8-9%

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Taking care of people with disabilities is core to Medicaid programs.

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LTSS Members

Non-LTSS Members

Medicaid Sustainability Framework helps us

better manage Medicaid trends and avoid draconian cuts

1. Address Drivers of Trend: Better address all the controllable factors that drive Medicaid cost trends
2. Maximize Federal Funding: Leverage and maximize HCPF’s ability to draw down additional federal dollars
3. Invest in Coloradans: Continue investing in initiatives to drive a Colorado economy and educational system to reduce the demand for Medicaid over the long term as Coloradans rise and thrive
4. Make Reasonable Medicaid Cuts or Adjustments: Identify where programs, benefits, and reimbursements are comparative outliers or designed in such a way that we are seeing - or will experience - higher than intended trends or unintended consequences
5. Reassess New Policies: Consider pausing or adjusting recently passed policies not yet implemented
6. Exercise Caution in Crafting Increases to the Medicaid program going forward

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HCPF’s FY26/27 Budget

• HCPF’s proposed annual budget for FY 2026-27 is $20.6 billion in total funds (TF), including $5.99 billion General Fund (GF).
• Representing an increase of $2.3 billion TF including a $413 million increase GF
• About 96% of total funds allocated to HCPF go to providers to care for members
• The funding allocated to HCPF in the Governor’s FY 2026-27 budget request represents 32% of available General Fund for the entire state budget.
• The HCPF budget also includes a reduction of $537 million TF, including $217 million GF (the $20.6 billion TF is net of the $537 million TF reductions)

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Resources: HCPF FY 2026-27 Budget Agenda Summary and FY 2025-26 HCPF Budget Reductions Fact Sheet

• FY26/27 Budget Requests

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Governor’s Budget released on October 31, 2025

LTSS Medicaid Sustainability Actions

We recognize the significant impact the Sustainability Actions will have on Long-Term Services and Supports (LTSS) members, families, and providers, and that news of benefit changes and reductions is difficult.

• 18 new Sustainability Actions announced related to LTSS; in addition to the 4 announced in the August Executive Order
• We encourage stakeholders to visit the Office of Community Living’s (OCL’s) LTSS Medicaid Sustainability website for more information on these actions.
• Sign up for the OCL Digest Newsletter for additional updates as they become available and visit the OCL Stakeholder Engagement website for information on the upcoming informational webinar on the Governor’s budget on November 10th 10:30 a.m. - 11:30 a.m.
• Send us your comments through the HCPF Office of Community Living - Governor’s Budget Announcement - Stakeholder Comment Form

Robust HCPF Plan to help navigate our realities

• Discipline to Medicaid Sustainability Framework
• Grounded in facts/insights and alignment around shared goals
• State budget challenges, Medicaid trend drivers, solutions
• Understanding H.R.1 impacts and aligned goals: North Star - prevent inappropriate loss of coverage and no draconian cuts to Medicaid
• System builds and investments and eligibility processor investments
• Leverage ACC Phase III and Innovations (eConsults, Prescriber Tools, Value Based Payments, etc.) to control trends and improve quality
• Leverage third-party insights, state comparisons, learnings
• Prioritize engagement, transparency, partnership, leadership

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H.R.1 Medicaid Coverage Threats

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Medicaid Expansion population - 375,000 Medicaid members:

• Federal CHASE Funding Reductions funds expansion, Buy-Ins, CHP+ October 2027
• Eligibility redeterminations increased from every 12 months to every 6, starting Jan. 1, 2027
• Work requirements for most “able-bodied adults”, starting Jan. 1, 2027
• Working, job training, going to school, or volunteering at least 80 hrs/mo to qualify
• Coloradans may lose coverage because they don’t meet the new requirements or because of administrative complications
• Increased clawback risks - Payment Error Rate Measurement (PERM)

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North Star: Mitigate coverage losses and its catastrophic consequences to Coloradans, providers, economy

County Administration Changes: Shared Services

• Shared Services as a way to drive efficiencies in benefit service delivery for public and medical assistance programs (HCPF & DHS joint proposal).
• Shared Services centralize, in one county, various administrative functions that support eligibility determination and optimize requirements and best practices across all counties (ex: Returned Mail Center model in Prowers county).
• Shared Services will allow counties to focus on the core duty of determining eligibility.
• Proposal includes 4 Shared Services (working with counties to hear their ideas of additional services): Tier 1 Call Center, Central Document Scanning, Member Case Integrity (HCPF only) and Quality Assurance (QA) as shared services (HCPF only).

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H.R.1: Work Requirements

Working with CMS on Flexibilities

1. “Minimum Viable Product” or MVP to be in compliance with H.R.1 Medicaid Expansion Work Requirements effective January 2027 versus completing all the IT work and connectivity required in H.R.1.
1. Track II additional IT connectivity to follow
2. Ability to potentially leverage member “self-attestation” of exemptions and compliance with Work Requirements, including some of the required 80 hours of volunteering and potentially school. Additional federal guidance is expected before the end of the year.
3. Allowing states to define Medically Frail - that might include such attributes as homelessness, active chemotherapy treatment, inpatient substance abuse disorder treatment, and more.

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MVP Engagement Timeline

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Ongoing collaboration with SNAP/TANF and other programs with work requirements.

Updated H.R.1 Resources

• New web page specific to H.R.1, which provides information on the federally mandated changes to Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+) and their impact on our programs in Colorado.
• Also highlights educational resources, including an updated fact sheet on work requirements the FAQ page with key information.
• Launched Colorado's Medicaid Sustainability Framework webpage that outlines our plans to manage Medicaid trends and avoid draconian cuts in the face of state budget challenges and decreased federal funding due to H.R.1.
• Adding a calendar of events for stakeholders to engage with us on this important work as well as additional videos and adding to FAQs to keep you updated on all things H.R.1.
• Created an online form and inbox hcpf_HR1@state.co.us to submit a question or comment related to H.R.1.

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HR 1 Engagement Survey

We value your partnership in navigating this challenging time together.

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Please complete this survey to help us understand:

• Your concerns about H.R.1
• Where you go for trusted information
• How we can best share information with you



To submit a question or comment related to H.R.1, please use our online form. You can also email us at hcpf_HR1@state.co.us.

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Rural Health Transformation Program (RHTP)

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• Application: One-time state submission due Nov. 5, 2025, with a Rural Health Transformation Plan (8 required topics) + certification no dollars will fund the state match.
• Implementation Date: Disbursements to approved states expected early 2026.
• Estimated Impact: Increased federal funding of 50% “base” dollars divided equally among all approved states, while the other 50% is targeted toward “not less than ¼ of approved states”.
• Colorado’s award expected to be $100M/year minimum for 5 years. May be up to $200M/year.
• Next steps: Awaiting CMS approval Dec. 31, 2025.

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$50B in Federal Funding Available

$10B/yr over 5 FFYs 2026-2030

For more, visit the HCPF Colorado Rural Health Transformation Program webpage.

Colorado’s RHTP Application Overview

Through collaboration and innovation, Colorado’s RHTP will transform how care is delivered, driving accessibility, quality, and affordability for rural communities.

Colorado’s application approach:

• Health care is local and unique based on each region’s needs and capabilities
• Food is medicine
• Home-grown workforce focus: training, recruitment, and retention support
• Cross-sector partnerships and strategic collaborations
• Transforming rural health care with innovative approaches to care
• Technology innovation to promote care coordination and data sharing capabilities amongst providers

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Questions?

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Protecting Coverage for LTSS Members

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Disability Determinations

Where We Started

• Action Review Group (ARG) manually requesting records for providers, causing extreme delays in disability determinations
• No clear process for languishing applications
• No clear communication for follow up on applications
• Sparse data available
• Application processing time exceeding 120+ days

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Where We Are At Now

• 45% of records needed are accessed in Contexture, and 90% of those are enough to make determination
• Standards established for applications that are waiting medical records
• Improved communication between ARG and counties for status updates
• New ARG Dashboard for accurate data monitoring
• Application processing time between 30-60 days

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Disability Determinations (1)

This graph shows the disability applications received since January 2024 until September 2025.

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The average is around 1250 applications per month, with the lowest amount in March 2024 of 927, up to 1,428 in March 2025.

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This data shows us that we are seeing a consistently high amount of disability applications.

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Disability Determinations 2

This graph shows the disability applications completed since January 2024.

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It shows us that before HCPF intervened, less than 1,000 applications were closing each month. With new processes and tracking mechanisms in place, between 1,100 and 1,300 applications are being completed each month.

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Escalations Process

• Review of HCPF Member Escalations Process
• Had an average turnaround time of 1 day across the two tiers for the month of Sept.
• This is down from over 12 days on average back in 2023.
• Were averaging as high as 1500 tickets a month in 2023, but have reduced to an average of 600-800.
• County and CMA Partner Integration into Salesforce has begun and we have started the process of integrating the first round of partners.

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Eligibility LTSS Path to Stabilization

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Emerging Issues

Stabilization Actions

Sunsetting Flexibilities

February 2024, member eligibility for those receiving Long Term Services and Supports was impacted.

Fast tracked temporary eligibility system (CBMS) changes to mitigate LTSS member impacts. Obtained federal approval.

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• February 2024 - Temporarily paused terminations for most LTSS reason codes (i.e. Reinstated & Pend HDT feature)
• March 2024 - Applied the 12 month extension to Level of Care (LOC) end dates for active LTSS members without an active LOC
• May 2024 - Expedited backlog & manual processing of LOCs not previously sent from CCM to CBMS
• August 2024 - Implementation of the 60-day extension to mitigate terminations

End temporary eligibility protections. Return to normal eligibility processing guidelines.

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• January 2025 - Removed the temporary pause on terminations at renewal. Implemented a 60-day extension at renewal for LTSS members.
• January 2025 - Initiated outreach to procedurally terminated members with an auto dialer campaign, text/email campaign and with returned mail
• December 2025 - End the 60-day extension at renewal for LTSS Members.
• March 2026 - End the 12 month extension to LOC end dates

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Long Term Care 60-Day Eligibility Extension Sunset

1. Federal partners allowed for a flexibility (waiver) to allow the 60-day extension for Long Term Services and Supports, Adult and Children’s Buy-In and Program of All-Inclusive Care for the Elderly (PACE) members. However, this has an expiration date of Dec. 31, 2025, and HCPF must comply with this change.
2. The extension of the Level of Care for 12 months will continue until March 2026. Additional information will be provided soon on the upcoming changes for the ending of that waiver.
3. HCPF has established internal processes to continue to monitor and support stability of the programs from a policy, operations, and systems perspective.

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Special THANK YOU to everyone that has partnered and collaborated with the goal of supporting applicants and members, improving their experience, and gaining access to important health benefits.

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Long Term Care 60-Day Eligibility Extension Sunset Plan

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• Project CPPM-10684 MA LTC and Buy-In Eligibility Extension Sunset will be implemented 12/14/2025 to no longer grant eligibility extensions to eligibility determinations made on or after 1/1/2026 for the LTC and Buy-In aid codes.
• Eligibility extensions will continue to be applied on eligibility determinations made on or prior to 12/31/2025. 
• Anyone approved for an extension on or prior to 12/31/2025 may have an extension applied to months into the calendar year 2026.
• The last approved eligibility extensions should end by 4/30/2026. 
• No further eligibility extensions should be seen in CBMS after 4/30/2026.

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The COGNOS reports (MA LTC and Buy-In Eligibility Extension) created in 2024 with the original project will continue to be available for the eligibility sites and case management agencies through June 2026.

Current Process�Scenario

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September 9, 2025

November 5, 2025

September 10, 2025

Implementation of eligibility extension sunset

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December 30, 2025

March 5, 2026

Implementation of eligibility extension sunset 2

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January 15, 2026

Paying Providers Timely to Protect Access to Services

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PAR Edits

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• Reminder: Providers are required to verify that a member is eligible to receive a HCBS service prior to providing services — those services should be authorized with a prior authorization request (PAR).

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• By January 2026, the system edits temporarily paused for stabilization will be reinstated to deny claims without a PAR.

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CCM Updates

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Care and Case Management System

Where We Started

• 188 items identified during the stabilization planning process needed to resolve
• Phase 1 and Streamlined Eligibility
• Quality concerns with vendor performance with testing and releases
• Small Department team supporting the LTSS modules
• Call Center vendor turnover caused support issues for Case Managers

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Where We Are At Now

• 29 items remain, but 19 are specific to the Colorado Single Assessment tool
• Increased vendor oversight, including governance, process improvements, and quality releases, at each phase of the change management process
• HCPF facilitated monthly CCM support meeting with CMAs to receive the latest status and ask questions
• CMA specific meetings with the CCM Customer Experience Center to address agency specific trends, open tickets, questions or training opportunities

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LTSS Care and Case Management (CCM) System Stabilization and Enhancement Dashboard

The LTSS Care and Case Management (CCM) System Stabilization & Enhancement Dashboard is posted to HCPF website https://hcpf.colorado.gov/ltss-ccm-system-stabilization-dashboard

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LOC Transmission Alerts

On September 7th, there was a CCM release to provide case managers feedback for Level of Care (LOC) transmissions:

There are now 3 types of alerts that are LIVE in the CCM for completed 100.2 Assessments:

1. The LOC Certification has been successfully sent

2. LOC Certification was not sent

3. LOC Certification Rejection Notification

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Data quality metrics for the month of September 2025

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Introduction to PAR Interface

Improve Workflow Efficiencies for the Case Manager

• Goals will no longer be required in the Bridge
• Approved Pre-Prior Authorizations(PPA) information is sent from the Bridge to CCM hourly (instead of overnight)
• PPAs will be matched to service plans on a variety of criteria to minimize mismatch errors
• Fewer errors means fewer Notifications/Tasks to case managers will be created alleviating frustration

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PAR Interface Timeline

October to December 2025: Vendor AC/GW E2E Testing, HCPF Testing and Training Documents Delivery

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January 2026: Estimated Go Live

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Reducing Case Management and County Backlog

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Case Management Agency Performance

Pending Referrals

755 statewide in Sept ’25

June ‘24 to Sept ‘25: 80% Reduction

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Past Due CSRs

55 statewide in Sept ’25

June ‘24 to Sept ‘25: 93% Reduction

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Past Due Initials

158 statewide in Sept ’25

June ‘24 to Sept ‘25:

78% Reduction

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Case Management

Backlog Update

Ongoing Oversight

• Monthly data submission from all CMAs, including any case management activities occurring outside of required timelines
• Ongoing individual stabilization meetings with CMAs
• Performance and Quality Reviews Completed

Key takeaway: Agencies are not experiencing high impact to stabilization with the launch of Community First Choice. Referrals are occurring but are not higher than average/normal.

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County New Application Information

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The Total Application Backlog has Decreased 90% since May 2024.

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Application Timeliness

• Non-LTSS (goal to process in 45 days): 98% for the last 4 consecutive months
• LTSS: (goal to process in 90 days): 98% for the last 4 consecutive months

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Backlog is defined as “Exceeding Processing Guidelines”

County Renewal Information

The Total Renewal Member Backlog Decreased 89% since November of 2024. Most of the decrease was due to project implementation.

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Renewal Timeliness

• Non-LTSS: 98% for the last 3 consecutive months
• For June and August 2025, both LTSS and Non-LTSS above 95%

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Questions?2

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Thank You!

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