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Who’s guiding Colorado’s Medicaid Commission? A closer look at the panel shaping future policy
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Colorado Accountability Project, Approved, Commentary, State

Who’s guiding Colorado’s Medicaid Commission? A closer look at the panel shaping future policy

By Cory Gaines | Commentary, Colorado Accountability Project Meet the Medicaid Commission and their newly-hired advisor. Medicaid is a big line item in the state’s budget. It’s gotten so big, and eaten up so much of our state’s money, that our legislature has gathered up a commission. SB26-187 (linked first below) creates a (quoting from the bill summary): “… commission on Medicaid (commission) to develop recommendations regarding implementation of new federal Medicaid policy changes that go into effect in 2026, 2027, and 2028 and to support Coloradans impacted by those policy changes.” This commission will meet a few times and prepare a report to be used by the legislature in the 2027 session. Quoting from the bill’s fiscal note: “Between May 13, 2026, and December...
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Colorado Medicaid Freezes Payments to Home Health Agency Facing Fraud Investigation
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Colorado Politics, Approved, State

Colorado Medicaid Freezes Payments to Home Health Agency Facing Fraud Investigation

By: David Migoya | Colorado Politics The agency overseeing Colorado’s federal Medicaid program has suspended an Aurora home-health agency that is the focus of an investigation into an enterprise that lured dozens of homeless people with promises of free housing and cash and reaped tens of millions of dollars in Medicaid reimbursements. Officials said it has stopped paying Medicaid claims filed by On Going Home Health Care pending the outcome of its inquiry into “The Program,” an elaborate and intertwined confederation of businesses that provided shelter, money and prescriptions to homeless participants in return for billing the federal program for administering the drugs. The Program was the center of a Denver Gazette investigation last month that exposed how On Going ...
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Colorado Probes Claims of Cash Incentives Linked to Medicaid Services for Homeless Residents
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Colorado Politics, Approved, Local

Colorado Probes Claims of Cash Incentives Linked to Medicaid Services for Homeless Residents

By: David Migoya | Colorado Politics Editor’s Note: This story is part of a series. Read about how home health in Colorado is a complex setupand about the group On Going HHC. They call it “the program.” For the past four years, dozens of homeless people in the Denver metro area have been recruited to live rent-free in suburban houses sprinkled across Aurora — not the stereotypical homeless shelter-type housing one might think, but rather neat homes in middle-class communities with mortgages. But living there comes with a hitch: a requirement that participants be on Medicaid and have at least one prescribed medication — all must first visit the same doctor to get a cursory exam and a prescription — administered by a home health company for which the doctor ...
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Colorado saw red flags in autism therapy billing and approved higher rates anyway
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Rocky Mountain Voice, State, Top Stories

Colorado saw red flags in autism therapy billing and approved higher rates anyway

By Jen Schumann | Rocky Mountain Voice Federal auditors documented convicted staff working with autistic children. Colorado had no system to catch it. Every week, parents of autistic children in Colorado dropped their kids off with behavior therapists they trusted. What they didn't know—what the state never required anyone to verify—was whether those therapists had passed a background check. Many hadn't. Not because anyone failed a background check. Because Colorado never required one. HHS Office of Inspector General audit highlights—February 2026. Source: https://oig.hhs.gov/documents/audit/11494/A-09-24-02004-highlights.pdf The findings from federal auditors came out in February. At least $77.8 million in improper Medicaid payments for autism therapy in 20...
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From $8 Billion to $16 Billion: How Colorado’s Medicaid Budget Doubled in a Decade
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Rocky Mountain Voice, State, Top Stories

From $8 Billion to $16 Billion: How Colorado’s Medicaid Budget Doubled in a Decade

By Shaina Cole | Contributing Writer, Rocky Mountain Voice If you ask most Colorado families how they feel about health care right now, the answers aren’t complicated. It’s expensive.It’s confusing.It keeps going up. And for taxpayers helping fund Colorado’s Medicaid program — known as Health First Colorado — another question has started to surface: If enrollment has come back down, why hasn’t spending followed? Ten years ago, Colorado’s Medicaid agency operated on roughly $8 billion. Today it’s closer to $16 billion. The Common Sense Institute (CSI) calculates that as 101 percent growth over the decade. CSI reports that the rest of the state operating budget grew 64 percent during that same period. The story of enrollment is different. ...
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$4 million-plus in alleged Medicaid ride billing draws federal fraud charges in Colorado
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Rocky Mountain Voice, State, Top Stories

$4 million-plus in alleged Medicaid ride billing draws federal fraud charges in Colorado

By Shaina Cole | Contributing Writer, Rocky Mountain Voice Colorado’s Medicaid transportation system operates on a straightforward premise. A ride is provided to a qualified Medicaid recipient. Documentation is submitted. The state reimburses the provider. For thousands of Coloradans, particularly those in rural communities or without reliable transportation — that structure makes routine medical care possible. But federal prosecutors now allege that in two separate cases, the reimbursement model itself was manipulated. Non-emergent medical transportation billing is the focus in the cases that have been filed in U.S. District Court this month regarding providers in Mesa and Douglas counties. The cases involve more than $4 million. On Feb. 10, the U...
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Medicaid billing error cost Colorado tens of millions, officials acknowledge
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Approved, Colorado Accountability Project, Commentary, Red State

Medicaid billing error cost Colorado tens of millions, officials acknowledge

By Cory Gaines | Commentary, Colorado Accountability Project HCPF really did accidentally pay millions in Medicaid claims. In an earlier op ed about Colorado's Medicaid expansion (see the first link below) and how that puts our state at higher risk of fraud, waste, and/or abuse, I asked the Colorado Division of Healthcare Policy and Financing, HCPF, the state unit which adminsiters Medicaid, about what they do to prevent or stop such problems.Their spokesperson responded with:“We constantly look out for fraud, waste and abuse (FWA) across all services & programs, but some programs or services are more susceptible to FWA than others. We have various processes/procedures in place for ‘high risk’ services to prevent inappropriate payments from going out the door. Tho...
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How Medicaid growth is crowding Colorado’s budget priorities
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Colorado Accountability Project, Commentary, State, Top Stories

How Medicaid growth is crowding Colorado’s budget priorities

By Cory Gaines | Commentary, Colorado Accountability Project Medicaid and Colorado’s Spending on Same I wanted to share Nash Herman’s op ed from Complete Colorado with you. I will leave it to you to read it in full, but there are a couple of pertinent things to share. The op ed does a good job of providing an overview of what will likely be a big issue this legislative session: Colorado’s Medicaid spending, a largely self-caused injury. In typical government fashion, the relevant state department, the Department of Healthcare Policy and Financing, engaged a third party and paid them $600K to study the issue. The contractor came back and recommended that, quoting the op ed, “... the state should prioritize reductions in behavioral health, long-term...
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Colorado Budget Strain Deepens as Autism Therapy Audit Threatens $60 Million Medicaid Repayment
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The Colorado Sun, Approved, State

Colorado Budget Strain Deepens as Autism Therapy Audit Threatens $60 Million Medicaid Repayment

By Jennifer Brown | The Colorado Sun Therapy centers countered that an abrupt rule change could result in long-term harm for children with autism. Colorado may have to repay the federal government from $60 million to $150 million after auditors found the state Medicaid program has been covering care by uncredentialed behavioral technicians for children with autism.  The financial hit comes as the state is already dealing with a $1 billion budget shortfall and cuts to Medicaid benefits that have affected multiple programs for people with low incomes and disabilities.  Colorado is among several states whose programs were audited by the Office of the Inspector General. The audit is not final and the results are not yet public, but officials at the ...
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Gaines: Medicaid bloat is eating Colorado’s budget after a decade of federal expansion
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Colorado Accountability Project, Approved, Commentary, State, Top Stories

Gaines: Medicaid bloat is eating Colorado’s budget after a decade of federal expansion

By Cory Gaines | Commentary, Colorado Accountability Project Colorado's Medicaid bloat under Obamacare In the first post of this series, I briefly went over Colorado's Medicaid financing (how much and on what). If you want or need that context, it's the first link below. In the second part of the series, I want to talk about how Medicaid got expanded by the Feds--allowing more people to get on government-funded healthcare-- and how Colorado leapt at the expansion like a shot. There were two recent (and big) expansions of Medicaid: the first was the Affordable Care Act (Obamacare) which expanded Medicaid coverage to people (including those without any disability or children)making up to 138% of the Federal Poverty wage. Screenshot 1 is a summary of the changes, it comes from...
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