What’s wrong with Colorado Medicaid and disability services?
This is the worst I have ever seen Medicaid in Colorado. I’ve been the badass of Colorado’s disability benefits system for over 15 years, so I speak from experience when I say that our state Medicaid system is in worse shape today than I’ve ever seen it before.
Case management redesign: Colorado’s process full of problems.
One of the biggest sources of chaos is the rollout of case management redesign (CMRD). CMRD was federally mandated in 2014 but Colorado waited until the last minute to implement it. Also, the manner in which they ‘designed’ conflict-free case management was mired with issues. I served on the 2014 HCP workgroup to help work on that, but the problems are still on-going today.
The end of COVID PHE means thousands lose their Medicaid.
The federal Public Health Emergency (PHE) was launched in early 2020 to deal with the COVID emergency. States were forbidden to kick people off medicaid during the Pandemic. The PHE ended in May 2023 and recertifications to check on Medicaid eligibility were reinstated. This scenario illustrates the negative impact:
Many people lost jobs during the pandemic, and qualified for Medicaid coverage. Even as their income increased, they were ‘protected’ and continued to receive needs-based Medicaid medical coverage. Then the emergency officially ended in May 2023, and since then, two in five Coloradans have lost their Medicaid coverage. Many were wrongfully terminated and appealed.
Learn more in this article:
More than 2 in 5 Coloradans who had eligibility reviewed lost Medicaid in first assessment since COVID
Tech turbulence: multiple disparate data systems cause downtime, wrongful terminations and delays.
HCPF calls this hot mess ‘IT innovations.’ There are currently four different information systems involved in managing disability services in Colorado: Benefits Utilization System (BUS), The Bridge, DDD Web and Care and Case Management System (CCM).
Per the HCPF website, The Care and Case Management System (CCM) is intended to be an electronic case management system maintained by a third-party vendor. The system was supposed to integrate and replace the functions supported by the Benefits Utilization System (BUS, an electronic case management system where HCBS waiver service plans are contained), the Bridge (Prior Authorizations PAR for medical medicaid services), and the DDD Web (info for direct care providers). But ask anyone who has worked with it over the last months: it’s making things worse.
HCPF claims the CCM will eventually integrate with the interChange and the Colorado Benefits Management System (CBMS). These are often down or offline for days at a time! Or when one entity uploads a document, the other entity on the same platform can’t access it due to platform issues.
Shenanigans in rule making and interpretation.
There are suspicious things happening in rule making and interpretation of current rules for home health and access to medically necessary services in school settings.
Colorado has a history of contracting out government services, which seems like it would be more efficient. However, separate contractors are limited by the scope of their contract and often are not integrated with other contractors. The state Medicaid agency contracts, or outsources, work to the counties and case management agencies too. However, the state Medicaid agency is the provider of last resort, per federal contract, meaning the buck stops with them.
Legal action pending due to complaints about our system.
Also according to a reliable source, the Department of Justice is investigating multiple civil rights complaints that came through the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR). There are many more individual complaints filed including this large organizational complaint.
Many want Governor Polis to take immediate and decisive action on the multiple embarrassing and very serious federal civil rights complaints. He could change HCPF leadership (I have suggested a replacement, if he wants my input). Instead his office, as well as Attorney General Phil Weiser, have declined to take action when many families have stated their concerns. It’s incredibly disappointing, however, the federal financial match of state Medicaid expenditure allows for the federal level to get involved in the process. So, I believe it is time for more people to continue to escalate their complaints to the feds.
Where does the buck stop? In my opinion, it stops at the top of the Medicaid agency, Health Care Policy and Finance (HCPF), with Director Kim Bimestefer. She was appointed originally by Governor Hickenlooper and Governor Polis kept her on; she serves at the Governor’s pleasure. She comes from a 15-year career at Cigna commercial healthcare. All decisions, work at HCPF and subcontractors fall under her leadership.
What is our state doing to remedy the Medicaid situation? Not enough.
HCPF went to the joint budget committee at the Legislature and received $27 million in extra funding. HCPF said they would get funds to the Case Management Agencies ‘without metrics.’ Colorado cannot spend its way out of these complex problems, which are the result of poor management, planning and overall leadership at HCPF.
Maureen’s solution in hindsight: Colorado never should have agreed to only one type of ‘Walmart’ case management agency.
Although it’s too late to change now, I want it to be known that I opposed the current environment of only having one kind of case management agency, which I call ‘choice of Walmarts.’ In 2014, I was the minority opinion on the State HCPF conflict-free case management workgroup. I advocated for member choice of small niche, medium and large agencies from which to choose.
These are my five badass fixes for our current situation:
Create and require a state case manager certification for those processing HCBS waivers. This would level the basic training that currently is mired by big variations in quality. In 2014, I suggested this, but there was push back.
Double the pay of case managers, who have the most member interaction. Due to high turnover and low retention, the workload for many case managers has tripled. Triple the workload means they are generating triple the monthly billable case management income for CMAs, so CMAs can afford to pay them better!
Cross-train all CMA staff, even the leadership in the C-Suite, to focus on intake and case management. All hands on deck, this is a crisis! With proper training and staff willingness, there is no excuse for leaving so many families waiting for responses or resolutions.
Prioritize hiring CMA staff with lived experience! If CMAs want the smartest people in this area, they should consider hiring veteran expert consumers of LTSS services to work as case managers and or consultants (with double the current pay, of course). Hire family members and people who manage their own service plans and have mastered the process with years of experience. CMAs should be granted flexible work schedules due to caregiving, so agencies should allow part-timers, and creative proposals for work arrangements outside the normal nine-to-five.
Raise medicaid rates for direct service providers. There is a crisis of workforce capacity. Make accepting Medicaid a better experience. Pay providers on time. And show appreciation that they choose to serve our community.
Ok, now what CAN YOU do?
Be informed, know your rights. Be kind, appreciative and firm. Escalate issues to supervisors at your Case Management agency (CMA). You can call the main phone number to ask, if the supervisor’s name isn’t under the signature line on the email.
Not happy with your CMA? If another CMA is willing to accept you (and has the ability to bill monthly for Medicaid case management services), you can transfer. Money talks, and you can walk.
If you get denied or terminated, ask for the denial in writing (including HCBS Waiver services). Then scan, organize, save and read all official letters carefully, and follow directions for an appeal. You do not need an attorney to appeal a medicaid decision.
Escalate issues with County Human Services and Case Management Agencies to the State. They are subcontractors for State Medicaid HCPF. Get to the front of the line by completing these complaint forms at HCPF. It has helped many families get a faster response.
County complaint form https://bit.ly/41Wjgms
CMA complaint form https://bit.ly/3Q4f0gM
File a federal discrimination complaint, at no cost, no attorney required: https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf.Then a federal review can trigger investigation. There is apparently an independent investigator already looking into the many complaints against HCPF.
In summary: It’s a mess, so become your own BADASS!
Yes, Medicaid in Colorado is a mess. You can advocate for your disabled loved one using the five suggestions above. Also, if you haven’t yet, join the free online Navigating Disability Community to get the monthly Badass Newsflash newsletter as well as timely announcements into your inbox. Channel your inner Badass: take action, get to the front of the line and get your needs met! Share your thoughts on the system, and how YOU intend to become your own badass!
Check out my video on this topic!