Colorado agency that administers Medicaid will make big changes under new federal law

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3 hours ago

Agency that administers Medicaid will make big changes under new federal law, state official says
Agency that administers Medicaid will make big changes under new federal law, state official says
Agency that administers Medicaid will make big changes under new federal law, state official says
As executive director of the Colorado Department of Health Care Policy and Financing, Kim Bimestefer oversees the state's largest health insurance program.
Kim Bimestefer, executive director of the Colorado Department of Health Care Policy and Financing
CBS
Medicaid covers 1.2 million Coloradans, or one in five residents. Verifying the eligibility of so many people each year is already a colossal task. Bimestefer says, under President Donald Trump's new tax and spending law, it will become far more challenging.
"We've got to set up an entire industry in 18 months," Bimestefer said.
Bimestefer says the state has sophisticated software that can automatically check things such as age, income, address and citizenship. But the new law creates new requirements, including 80 hours of work, school or community service each month for people between the ages 19 and 64 who aren't pregnant, disabled or have kids under age 14. There is no automated system for that or a master list to know who's in school and who's volunteering to verify eligibility.
And Bimestefer notes the state now must do that verification twice a year.
"We have to build the entirety of the infrastructure to capture and automate and to make sure that we don't have people impeded of getting through the eligibility process and therefore losing coverage," Bimestefer said. "Because the down-streaming impacts of people losing coverage are absolutely catastrophic."
Bimestefer says up to 377,000 Coloradans could be impacted by the new eligibility requirements. It's estimated about 56% of them are already working, but Bimestefer says verifying that will be the challenge.
Bimestefer worries thousands of Coloradans will lose coverage.
"They'll move. They'll change their email address. They won't realize have to do it," Bimestefer explained.
That will lead to more uninsured patients, Bimestefer says, and more uncompensated care, which will increase costs for everyone.
"The north star is to have people covered but, again, this is going to be part of many difficult decisions that this state is going to have to step up and make," Bimestefer said.
While most of the changes to Medicaid -- including the new eligibility requirements -- don't take effect for at least a year and a half. Bimestefer says she needs to start preparing now, which takes money.
Bimestefer says lawmakers -- who decide what services are covered -- will have to make tough decisions soon. Gov. Jared Polis is expected to call them back to work next month.
The new law provides $200 million to help with implementation, but the money will be shared among all states. The state of Kentucky alone spent about $270 million on a work requirement only before a court blocked it.
"Are we going to lower provider reimbursements? Are we going to change benefits? All those are very difficult decisions," Bimestefer said. "But were going to have to move some of those levers in order to deal with the fiscal realities that the costs will continue to go up, and the revenues available will continued to be strained."
Bimestefer says, not only will Colorado have to spend millions of dollars on new hires and new systems to implement the law, it will have to do so as it loses millions of dollars.
Starting in 2027, the law limits federal matching funds that Colorado has used to increase provider reimbursements. The state budget is already expected to take a billion-dollar hit from other provisions in the law, so the legislature won't be able to backfill the lost revenue, which Bimestefer says could be as much as $2.5 billion. She says the money has helped double the number of providers that accept Medicaid over the last 5 years. If reimbursement drops, providers may limit how many Medicaid patients they see.
The law provides $50 billion to help offset the loss of funds for rural hospitals, which see the most Medicaid patients. Bimestefer says the state should know in the next few months how much of that money Colorado will receive.
The original bill included a provision that cut additional federal funding to states like Colorado that pay for health care for undocumented immigrants, but that was dropped from the final bill.
Bimestefer says that doesn't mean the Cover All Coloradans program won't face cuts. It was expected to serve about 3,600 people this year at a cost of $27 million, but it serves nearly six times that -- 21,000 -- at a cost of more than $50 million.