Medicaid Funding - Protect Colorado Home Care

Medicaid Funding

Keep Home-Based Care Accessible

High-quality home and personal care is at risk for many Coloradans because government reimbursements set by the state aren’t keeping pace with the cost of recruiting and retaining care providers.

In-home providers who serve Medicaid patients in particular rely on government reimbursement to cover the cost for those services. In 2015, Colorado’s Medicaid Provider Rate Review Advisory Committee recommended home health rates increase over three years to reach 90 percent of Medicare LUPA (Low Utilization Payment Adjustment) rates. This was never realized, and rates are critically low at 75 percent of LUPA.

That concern has been compounded with the state’s recent minimum wage increases — and Denver’s additional minimum wage increase — as well as the rising cost of recruiting and retaining workers in a tight labor market. The state legislature in 2019 passed into law Senate Bill 238 to direct 85 percent of increases in reimbursement rates to caregivers, which is critical to sustaining a desperately needed workforce. However, that goal cannot be realized without an increase in reimbursement rates.

Home care is a more affordable way to deliver care. Reimbursements must keep pace with ongoing cost increases to ensure Colorado has a robust home care provider network to meet the needs of our communities.

Operating costs for home care agencies are currently rising faster than government reimbursement rates. These services are only possible with proper staffing and administration. However, the cost of staffing, transportation, administering health insurance benefits, conducting background checks and complying with additional federal and state regulations have been on the rise while reimbursement rates have remained stagnant.

In-Home Care is at Risk in Colorado

Already since Jan. 2020, consumers are feeling the effects of current policies that fail to provide home and personal care businesses adequate reimbursements to cover the costs of providing care. Some home care agencies are being forced to decline care services for Medicaid consumers. Other Medicaid providers are putting their agencies up for sale or shutting down entirely.

Home care providers cannot competitively recruit and pay workers without a substantial increase in Medicaid reimbursements, at least not without being forced out of serving the state’s Medicaid population.

If home and personal care providers are no longer able to accept Medicaid patients, the cost of caring for these patients will rise as they seek care in other, more expensive health care settings such as hospitals. In-home care will also become less accessible across the state to others in need of these services.

Increased Medicaid reimbursements in Colorado are necessary to reflect the growing cost of home and personal care services so providers can continue to offer care in Colorado.

Support Colorado’s Private Duty Nursing Program

The Private Duty Nursing (PDN) program provides skilled nursing services on an intermittent basis in the home for complex medical and developmental conditions within Colorado’s Medicaid population.

The current LPN reimbursement rate is far below what licensed practical nurses can earn in other settings, making it difficult to recruit and retain these professionals. A shortage of LPNs in home care is limiting access to these services and driving up health care costs. Raising LPN reimbursement rates and making this program more accessible would allow more children and vulnerable Coloradans to receive this vital care without unnecessary hospitalization.