Medicaid: Big Impacts You Need to Know for 2025

As we detailed in our December 2024 blog, 2025 may bring large-scale Colorado Medicaid changes if the state Medicaid agency moves forward with the planned launch of Community First Colorado (CFC). This would open access to In-home Support Services to Medicaid members though the state Medicaid medical plan without the requirement to enroll in a waiver. This allows more access to services without being forced to use a case management agency! The state also gets an increased federal match of 9 cents, so the state gets 59 cents from the federal government for every 50 cents allocated in our state budget for related services (this assumes the federal match, which is not to be taken for granted with White House change of Administration.
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2025 also brings the controversial Colorado Medicaid agency (HCPF) relaunch of prior approval requests, or PAR, which will start up again for home health occupational therapy, physical therapy, speech therapy and Certified Nursing Aide (CNA). The last time they ‘turned PAR on,’ it was a complete mess and they turned it back off.

Tabled for now by Colorado, is the ever-discussed revision/update to the Person Centered Support Plan and decommissioning of the Support Intensity Scale (SIS) assessment which was never intended to be used to allocate funding. Believe it or not, this process started in 2016!
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The new Colorado Nursing Acuity Tool will likely be problematic, and unfortunately, the department will not accept public comments about it because they claim that any changes would ‘no longer make it a valid tool.’ It is not yet available for public view, and the state has not issued a release date.
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Two children’s waivers will merge into one: the Children’s Life Limited Illness waiver (CLLI) and the Children’s Home and Community Services (C-HCBS) will combine and become the Children with Complex Health Needs (CwCHN).
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The Children's Habilitation Residential Waiver will expand to encompass an additional group of youth under the age of 20: those with Serious Emotional Disturbance (SED). This and the development of better intensive treatment options is due to the legal settlement agreement, which addressed the negligence of Colorado and forced the state to provide appropriate medically necessary treatment options for youth with behavioral health needs.
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Concerns about the Colorado Development Disability Waitlist

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Colorado has a serious issue with a reported waitlist for the 24/7 Developmental Disability (DD) waiver which currently contains at least 3,000 people, creating an alarmingly long potential wait of ten or more years for enrollment.
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A recent memo released by Colorado HCPF raised serious concerns due to its implications that policy changes may negatively affect the priority level of waiver members who need to enroll in the DD waiver after transitioning to adult age, thus needing to enroll in a waiver to ‘replace’ their former child-age CES or CHRP waiver.

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During yesterday's January 22 meeting of the Joint Health committee at the state capitol, I advocated by offering public testimony, stating my concern about the long DD waiver waitlist and encouraging the committee to reserve earlier waitlist spots for youth who are aging out of the CES and CHRP waivers. For detailed policy updates, join the free NDC Community!

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State Budget Cuts on the Horizon

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The forecasted 2025 Colorado state budget is expected to be tight due to Tabor - a bit under $1B to trim – here’s a good article. Tabor was approved by a statewide initiative in 1992. It requires a refund to taxpayers, which restricts state general fund allocation.
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This is an over-simplified snapshot of the state budget:

● One third goes to PK-12 education

● One third goes to the Medicaid department

● One third goes to everything else (higher ed, dept. of local affairs, dept. of labor employment, judicial, public health)
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Unfortunately, the state is anticipating education funding cuts. Here’s a good article. Here’s how to follow education during this Colorado Legislative session: Chalkbeat article​
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Federal Budget Cuts Expected

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Vigilance and emails to federal representatives will be needed with new leadership in Washington. The new White House administration has had some information leak, with a potential plan for cuts in Medicaid. Join the NDC Community for updates on my state and federal advocacy, and to learn how you can become an advocate too.

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If you’ve been considering getting your disabled loved one on a Colorado Medicaid waiver, or you have concerns about changes to your existing waiver, consider joining Roadmap for the Waiver Journey. In our program, you’ll get help applying for a waiver, understanding how 2025 changes will impact you, and updates on all the changes coming down the road over the lifetime of your disabled loved one.
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Learn more about waivers and ask questions about 2025 changes by attending one of my upcoming Live Info Sessions!

Discover Roadmap for the Waiver Journey:
​Get your disabled loved enrolled so you can potentially gain up to $100K each year in services and caregiver income!

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If you have a disabled family member. Medicaid waivers provide peace of mind and up to $100K annually in disability services and potential family caregiver income. ​
But the Colorado disability benefits system is hard to navigate. That's why we created Roadmap for the Waiver Journey, the only membership program that teaches you how to successfully apply for and maximize a waiver through all the ages and stages of your loved one's life. Get on this special email list for program info!

ASK THE BADASS QUESTIONS ABOUT WAIVERS! FEBRUARY 5TH AT 7PM

Maureen hosts a FREE live info session to give you the inside scoop on the life-changing benefits of Colorado Medicaid waivers. After the session, participants get the first spots to enroll in the next cohort of our program, Roadmap for the Waiver Journey, which teaches EVERYTHING you need to successfully apply for, or maximize, a waiver over the entire lifetime of your disabled loved one. Don't miss out - waivers offer up to $100K annually in potential caregiver income and the value of services you can use!

Already have a Medicaid waiver and just want to improve your plan? Purchase a Service Plan Audit!

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• Are you fully utilizing all the funding provided by your Medicaid waiver?
• Do you know how to get paid income for the care you're already providing?
• Are you hiring all of the services you need to support your disabled loved one?
• Are you taking advantage of respite care providers so YOU can get a break?
• Do you know how to submit modification requests to improve your plan?
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If you can't confidently answer all of these questions, you are probably underutilizing your Medicaid waiver -- that's like leaving YOUR FREE MONEY on the table! Your disabled loved one deserves to get everything the waiver offers! If you don't have time for a program but you need more than a consultation, book a Service Plan Audit - spots are limited! You'll submit your plan to Maureen, then enjoy a one-hour video conference with the Badass herself as she helps you update your plan to maximize it's value!