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Colorado’s Medicaid debate: Should lawmakers fix spending before seeking more federal dollars?
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Colorado Accountability Project, Approved, Commentary, State

Colorado’s Medicaid debate: Should lawmakers fix spending before seeking more federal dollars?

By Cory Gaines | Commentary, Colorado Accountability Project Drawing down more Federal money as the solution to Colorado’s Medicaid problem? Have you ever heard the saying, “the first step is admitting you have a problem”? Nash Herman’s piece on the Colorado Medicaid Commission (linked first below) made me think of that. The reason being that, per what he writes about their first meeting, the commission seems to largely be focused on wringing more money out of the Feds than dealing with the bloat that Colorado lawmakers have heaped upon the program since 2014 and Obamacare. Quoting from the piece with embedded links left intact: “The most recent Commission meeting raised questions about the government’s priorities in addressing Medicaid and the state budget. A re...
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Federal audit questions nearly $54 million in Colorado Medicaid home-care payments
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Rocky Mountain Voice, State, Top Stories

Federal audit questions nearly $54 million in Colorado Medicaid home-care payments

By Jen Schumann | Rocky Mountain Voice Colorado can’t fully document millions of dollars it billed for Medicaid home care. That’s the finding of a new federal audit. The Office of Inspector General wants Colorado to return $8.07 million in federal money it says the state was not entitled to claim for personal care in a single budget year, the one ending June 30, 2024. Auditors questioned another $45.69 million and told the state to work it out with CMS. The $8.07 million is a recommended refund. The $45.69 million is a different story. It’s still under review, and CMS could recover all of it, some of it or none. Either way, nobody has ordered Colorado to repay the full $53.8 million. In the sample, auditors kept hitting records that didn’t add up. Where the care happened. H...
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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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