HCPF's 2022-23 Budget: Investing in Member Access, Quality, Equity & Affordability

The Governor’s balanced budget for fiscal year (FY) 2023-24 doubles down on the work to make our state more affordable, safer, cleaner and prepared for a natural disaster or financial rainy day. The state operating budget is $40.5 billion total funds, including $14.7 billion General Fund. Of that, HCPF’s proposed budget is $14.9 billion in total funds, including $4.43 billion General Fund, which is 30% of the total state General Fund operating budget. HCPF’s General Fund budget proposal reflects an increase of $346 million, the majority of which is to account for utilization and provider rate increases. 

Of our funding, 96% continues to go to providers, with only 4% allocated to cover administrative expenses such as HCPF staff and contracted partners. We continue to be the most efficiently run health plan in the state, with an administrative allocation nearly 10 points lower than commercial plans.  

The Department's discretionary requests total $207 million total funds and $73 million General Funds. Thank you to our valued and engaged stakeholder for voicing your priorities for our work over the next fiscal year. Based on our strategic priorities and stakeholder input, our budget requests focus on these shared goals: increasing provider reimbursement funding, improving health equity, access and outcomes for our members, enhancing our stakeholder engagement approach, resources to improve compliance, supporting children and youth with complex needs, supporting future Behavioral Health Administration (BHA) operations and aligning case management with federal and state requirements. 

Increasing reimbursement to providers is one of the most important actions the Department can take to help address health care workforce shortages and increase member access to health care. Accordingly, the budget includes: an across-the-board provider rate increase of 0.5%; targeted rate adjustments and rate balancing recommended by the Medicaid Provider Rate Review Advisory Committee (MPRRAC); a base wage increase for Home and Community-Based Services (HCBS) workers statewide from $15 per hour to $15.75 per hour and to $17.29 per hour for workers in Denver; and a 16% increase to reimbursements for Medicaid PCPs by enrolling in our Alternate Payment Methodology Two (APM2) value-based payment program. To further address health equity, the budget includes funding to cover birthing doulas intended to reduce maternity disparities, financial support to help rural providers stay connected to the Health Information Exchange (HIE), and the elimination of all member co-pays apart from emergency room co-pays. This latter budget request further increases provider reimbursements and reduces provider administrative burden. 

The budget also significantly increases nursing home reimbursements, tiered based on Medicaid utilization, to address emerging solvency issues in this industry while providing $1.13 billion in funding for Medicaid behavioral health programs, up more than $500 million since FY 2018-19.  

This fiscal year, the TABOR limit reduced available state funding by $1.9 billion. For FY 2023-24, OSPB’s September forecast highlights revenues at $685 million over the TABOR cap. Given TABOR challenges, HCPF is very appreciative and supportive of the Governor’s budget. As we navigate TABOR challenges going forward, the Department's top priorities remain protecting member benefits and provider reimbursements through cost control and trend management innovations that improve quality care, close disparities, and drive affordability. That includes requested funding to develop mission-critical cost and quality indicators and propel value-based payment adoption. 

We appreciate your partnership to support and advance this budget and our shared priorities. For more information, please read the Department’s FY 2023-24 Budget Agenda Summary, posted on our Legislative Resource Center. We also invite your engagement beginning this month in the design of our next generation Accountable Care Collaborative (ACC Phase III), which incorporates these and many other shared goals and priorities into our future Medicaid care delivery model. For more information, please visit hcpf.colorado.gov/accphase3.

HCPF in the Community:

HCPF leadership has truly enjoyed the many recent face-to-face meetings we have had with stakeholders and partners across throughout the state. We appreciate seeing you in person, expressing our appreciation for our partnership, and hearing about your successes, priorities, concerns and challenges. Recent visits included Southwest Colorado, Eastern Plains, Western Slope, Northern Colorado and greater Denver.

Learn more about the visits and see the photos! 

Free Educational Opportunities for Coloradans:

Please help us grow the health care workforce as well as the child care workforce. Please print and display these time-limited training opportunity communications in your patient waiting rooms, exam rooms, staff break rooms and other related areas. The links below include a poster that can be printed and a digital display that can go on TV screens in patient or staff areas. Print and digital resources are here: hfcgo.com/assistance. 

The first poster communicates free, short-term training for in-demand health care professions (i.e. CNA, EMT, MA, pharm tech, etc). The second poster also communicates free early childhood education courses to become a certified child care professional. Both of these free education opportunities are essential to revitalizing the health care workforce, while offering upward mobility for low-income Coloradans seeking new career paths. If these communications get to the right people - specifically Medicaid members - they can be life-changing, giving people a once-in-a-life-time opportunity for free certifications that create a meaningfully different income trajectory, while helping grow the workforce. 

Please help fully leverage these unique educational and career advancement opportunities by displaying these important communications today! 

New Tools - Preparing for Renewals Partner Kit:

The Department has launched a partner communications toolkit to aid in preparing for the end of the PHE - Preparing for Renewals. This new toolkit includes a section on renewal process education that explains key terms and provides sample notices so partners can see exactly what the member will see when they go through the renewal process. In addition, both partners and members can view short videos in English and Spanish on key actions: updating an address, completing the renewal process, and transitioning to other coverage if a member no longer qualifies.

Upcoming Webinar:

The Department will be hosting an informational session on preparing for the end of the Public Health Emergency. This webinar is geared toward community partners such as advocacy organizations, providers, and community organizations who may provide other assistance to Health First Colorado or CHP+ members (housing, social services, etc). The content includes an overview of communication resources for partners to assist members in preparing for and taking part in the renewal process. We’ll also discuss transitions in coverage for members who may no longer qualify for state-administered programs.

When: Nov. 17, 2022, 12:30 - 2 p.m. Mountain Time

Topic: PHE Unwind Webinar | Community Partners & Advocates

Register in advance for this webinar: Zoom Registration

After registering, you will receive a confirmation email containing information about joining the webinar.

Community Ambassador Program:

The Department is working with Colorado communities to start an Ambassador Program. The goal of the Ambassador Program is to work with Health First Colorado members and people who might be eligible for services to improve the letters and other written information the Department uses to communicate with Coloradans about Health First Colorado. The Department is focusing first on Spanish- and Vietnamese-speaking communities.

Ambassadors are people who will help us understand the needs of the communities they live in. They will partner with community organizations that work with Health First Colorado members to help make the information members and people who may be eligible get easy to understand in their native languages and in culturally responsive ways. 

Ambassadors will help Health First Colorado with: 

• Leading interviews, focus groups, and listening sessions 
• Getting feedback about the best ways to communicate with members

and potential members

• Sharing guidance for policies and programs
• Providing important information to Health First Colorado members and

potential members

Ambassadors will be paid an hourly wage and get training and support from

the Department.

We are asking for trusted community organizations to contact our subcontractor, Health Management Associates (HMA), if they are interested in supporting the Ambassador Program. This could include hosting an Ambassador or providing information about potential Ambassadors in their community. The program will be run by the Department’s Member Experience team.

Please contact Lee Repasch or Kelsey Moore for more information about the program and how to participate.

eConsult Platform Informational Update:

The Department is implementing a statewide Medicaid electronic consultation platform called the eConsult Platform. This platform will promote the Department's mission to improve health care equity, access and outcomes for the people served.

The eConsult platform will enable asynchronous (store and forward) clinical communications between a Primary Care Medical Provider (PCMP) and a specialist provider. The PCMP will be able to transmit an electronic clinical question to a specialist and medical information will be reviewed by the specialist provider. The specialist provider will be able to review the case without the member being present. The specialist provider then provides electronic medical consultative guidance that

assists the PCMP in the diagnosis or management of the member’s health care needs or facilitates the appropriate referral for a face-to-face visit with a specialist provider when clinically appropriate.

The Department is currently in the evaluation and negotiation phase of the procurement and expects to have an eConsult vendor selected by the end of 2022.

Anticipated Timeline

• Mid-spring/summer 2022 - Invitation to Negotiate (ITN) Posted and Vendor Selection
• Fall/winter 2022 - Contract Negotiations
• Winter 2023 – Centers for Medicare and Medicaid Services (CMS) Review of Contract
• Spring/summer 2023 - Implementation Activities
• Late summer/early fall 2023 - eConsult Platform Go Live

Note that the timeline is subject to change without prior notice and is only provided as a reference.

For more information, visit the eConsult Platform webpage or email HCPF_econsult@state.co.us.

Pharmacy & Therapeutics Committee Openings

The Department has nine open positions for the P&T Committee members. 

The Pharmacy and Therapeutics (P&T) Committee is an advisory board established pursuant to Executive Order D004-07. The committee performs clinical reviews of drug classes and makes recommendations which help the Department develop and manage the Medicaid Preferred Drug List (PDL).

The P&T Committee is required to consider clinical criteria such as drug safety and efficacy when making its recommendations. The committee also considers public comments and testimony related to the drug classes being reviewed or other PDL-related agenda items.

More information on the Committee and its meetings is on our website.

Applicants are being accepted for the following two open positions for the P&T Committee member term ending in December 2023:

• One physician with any specialty
• One member representative 

Applicants are being accepted for the following seven open positions for the P&T Committee member terms January 2023 - December 2024:

• Pharmacist (2 positions)
• One physician who specializes in the practice of psychiatry
• One physician who specializes in the practice of pediatrics
• One physician who specializes in the practice of treating patients with disabilities
• One physician with any specialty
• One member representative 

We are accepting CVs for open positions and plan to notify new members in December. The first upcoming meeting for new members is Tuesday, Jan. 10, from 1-5 p.m. (planned to be virtual).

If you are interested in serving or know someone who would be qualified, please submit a CV along with a completed Conflict of Interest form to:

Colorado Department of Health Care Policy & Financing

Attn: Brittany Schock, PharmD

Fax to 303-866-3590, Attn: Brittany Schock, PharmD.

• A CV is not required for the member representative position. A resume (or similar document) is acceptable.
• Duties, membership and other term details are in the P&T Committee Policies and Procedures.
• Encourage those located anywhere in the state to consider joining since these meetings are being held virtually, and we are looking to have a diverse committee.

Open Enrollment Has Begun

Open Enrollment for health insurance has begun! This year’s Open Enrollment

period began on Nov. 1, 2022, and ends on Jan. 15, 2023. Thanks to the

Inflation Reduction Act, there continue to be more savings for more people. Folks

can see how much financial help they qualify for and review plans before enrolling by

using our Quick Cost Plan Finder Tool.

Exciting New Health Insurance Option for Coloradans who are Undocumented

OmniSalud is a new health insurance program that provides Coloradans who are

undocumented with a safe way to compare affordable health insurance plans and sign

up on a secure online platform. Thanks to a new Colorado law passed in 2021, every

company that sells health insurance in the state has to offer plans with a specific set of

lower, fixed costs and make them available to everyone – no matter their

documentation status. We strongly encourage folks to sign up with the help a certified

expert who can walk them through the application and help them understand

how to use their health insurance, all free of charge. To learn more about OmniSalud

visit our website. You can also find an OmniSalud expert and make an appointment.

Web and print versions of our resources on Connect for Health Colorado and

OmniSalud are available to you free of charge through our Open Enrollment

Online Toolkit and our Online Print Materials Store.