Health Care for Poorest Coloradans is at Risk as Medicaid Costs Dominate Budget Debate in Legislature

The Denver Post | By Nick Coltrain and Seth Klamann

 In October, a group of Medicaid providers warned Colorado lawmakers that they were in trouble.

One after another, the providers — from hospitals, mental health clinics and community health centers — described a budgetary collision that’s played out for more than a year: Hundreds of thousands of Coloradans lost Medicaid coverage after the pandemic ebbed, resulting in less money for the clinics’ already-thin operations. Though those patients’ health insurance disappeared, they still needed care — but it’s no longer been reimbursed by the state. 

The results, the providers said, have been layoffs, hiring freezes, reduced hours and anxious number crunching.

“This is very serious,” said Devra Fregin, the executive director of Clinica Colorado, whose clinics treat low-income patients. “Something needs to change, or we’re not going to be able to serve our state to the best of our ability.”

The providers’ pleas found a legislature — and a Medicaid system — at a crossroads. As clinics ask for help, lawmakers convening this week for the 2025 legislative session are bracing to cut hundreds of millions of dollars from the state budget.

Legislators have said they’re loath to cut Medicaid and further strain a sagging system. But the program takes up roughly a third of the state’s general fund budget, and K-12 schools — which lawmakers recently celebrated funding fully after decades of exploiting legal loopholes — account for another third.

That reality may force legislators to spread the pain to the most critical parts of the budget. It also may spark a deeper examination of Medicaid, the safety-net system that provides coverage for roughly a quarter of the state’s residents. On Monday, budget-writers are set to hold a daylong hearing combing through the spending of the Department of Health Care Policy and Financing, which manages Medicaid. 

Citing that coming hearing, department officials declined an interview request last week. In emailed responses to written questions, executive director Kim Bimestefer said HCPF was “very concerned about state budget constraints and the impact on Medicaid over the short and long term. Despite some recent fluctuation, medical inflation continues to outpace growth in other goods and services.”

She said the agency also planned to discuss potential cuts during the Monday meeting with lawmakers.

The fiscal debate is set to dominate the legislature, which meets for four months beginning Wednesday, as lawmakers jockey for sparse funding for new programs — while also fighting to protect their priorities in a budget that must be balanced.

“I don’t want to cut Medicaid, and I don’t think there’s huge political appetite to cut Medicaid,” said Sen.-elect Judy Amabile, a Boulder Democrat who sits on the Joint Budget Committee and previously served in the House. “I think there’s political appetite to try to fix what is going wrong.”…

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From Immortality to Ugly People: 100-Year-Old Predictions About 2025

Akron Beacon Journal | By Mark J. Price

Nearly 100 years ago, a group of deep thinkers dared to imagine what life would be like in 2025. Some of their prophecies were completely off target, while others proved to be weirdly accurate. [Including:]

  • The future looked ugly to Albert E. Wiggam, an American psychologist. According to his calculations, homely, dull people were having more children than beautiful, intelligent people. “If we keep progressing in the wrong direction, as we have been doing, American beauty is bound to decline and there won’t be a good-looking girl to be found 100 years from now,” he told an audience in Brooklyn, New York. Looking around the auditorium, he added: “However, this lack is not apparent yet, especially here in Brooklyn.”
  • Thanks to science, people would live to be 150 years old... The advances of medicine and surgery will have been such that most of the ailments and limitations of old age will have been eliminated. Life will be prolonged at its maximum of efficiency until death comes like sunset, and is met without pain and without reluctance. There will be no death from disease, and almost any sort of injury will be curable.
  • In a hundred years, there will not be numerous nations, but only three great masses of people — the United States of America, the United States of Europe and China.
  • The earth will be under one government, and one language will be written and understood, or even spoken, all over the globe.
  • People would use a pocket-sized apparatus for communications to see and hear each other without being in the same room.
  • Horse-drawn vehicles are fast disappearing from our streets, but jackass-driven automobiles will still be with us 100 years from now.

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Thinking of our Members, Colleagues, Patients, Loved Ones, and First Responders Affected by the SoCal Fires

Coalition for Compassionate Care of California | By Moore Ballentine

The staff of CCCC are watching as the Palisades, Eaton, Hurst, and other fires ravage Southern California. Our hearts and thoughts are with all affected. Here are a few tangible ways you can help, even at this early stage.

Donate to:

As always, in the early stages of a disaster, cash donations are more helpful than supplies or efforts to volunteer. That said, Pasadena Humane is asking for both donations (give at pasadenahumane.org/wildfirerelief) and specific supplies to help shelter animals displaced by the fire: pet food and water bowls, extra large crates, and blankets. Drop off supplies at 361 S. Raymond Avenue, Pasadena.

For information and updates, here are some helpful links, courtesy of the California Department of Aging:

Editor's note: Thank you, Coalition for Compassionate Care of California for equipping so many with this crucial information! Readers of our newsletter, please distribute and encourage your networks to support these relief efforts. Ongoing, our newsletter will be posting ways you can specifically help hospice and palliative care in these tragically impacted service areas. Please email relevant stories with URL links to [email protected]. We send support to all persons affected! 
 

Biden Signs Dole Act, Expanding Access And Funding For Vets’ At-Home Care

Home Health Care News | By Audrie Martin
 
Veterans will have expanded access to at-home care under a new law signed on Thursday by President Joe Biden.
 
The National PACE Association (NPA) on Friday applauded Biden’s signing of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, which will enhance veterans’ access to the Program of All-Inclusive Care for the Elderly (PACE) nationwide. 
 
“This bill will dramatically expand the options available to our veterans who want to age in place,” President and CEO of NPA Shawn Bloom said in a press release. “Moving forward, there are a myriad of additional actions that Congress can take to easily implement PACE for hundreds of thousands of additional seniors and their families who would benefit from PACE.” 
 
But expanded PACE access is just one component of the new law. Among its other provisions related to at-home care, the law allows the Department of Veterans Affairs to increase funding for home- and community-based care. Previously, the VA could only allocate 65% of the cost of nursing home care to a veteran receiving HCBS.
 
“This landmark legislation includes a provision that increases the amount of VA funding for in-home care to match 100% of the cost of nursing home care for veterans, a crucial victory for both veterans and their caregivers,” the Home Care Association of America (HCAOA) stated Friday in a LinkedIn post.
 
“This adjustment enables veterans to receive comprehensive home-based care equivalent in cost to institutional care, promoting veteran independence,” HCAOA said in a statement. “Notably, the Secretary of Veterans Affairs is authorized to approve expenditures exceeding 100% for veterans with conditions such as amyotrophic lateral sclerosis (ALS) or spinal cord injuries, ensuring that those with the most significant needs receive the support they deserve.” 
 
HCAOA, LeadingAge and several other advocacy organizations applauded Congressional lawmakers after the U.S. Senate passed the Dole Act on Dec. 13.
 
Among other points, they noted that providing care at home and in the community greatly improves the quality of life for veterans and their caregivers while also reducing health care costs for the VA. Generally, home- and community-based services (HCBS) are significantly less expensive than institutional care. 
 
Additionally, the VA has found that using HCBS not only delays the need for nursing home admission but can also help avoid such admissions altogether. This approach also reduces the risk of preventable hospitalizations.
 

Home Health OASIS Submission Requirements for All Patients, HHQRP Resources

Alliance Daily | Jan. 9, 2025

Effective January 1, 2025, home health agencies could voluntarily begin submitting OASIS data for all patients regardless of payer. The collection and submission of the OASIS for all patients becomes mandatory July 1, 2025.

The Centers for Medicare & Medicaid Services (CMS) removed the temporary suspension of the OASIS data collection on non-Medicare/non-Medicaid home health agency patients through the CY2023 Home Health Prospective Payment System Rate Update final rule and updated the removal in the CY2025 Home Health Prospective Payment System Rate Update final rule. With these changes, patients who have received home care services of more than one visit in a quality episode provided by all Medicare-certified home health agencies and Medicaid home health providers in states where those agencies are required to meet the Medicare Home Health Conditions of Participation, are eligible for OASIS data collection and submission. 

There are no changes to patients excluded which are those under the age of 18, those receiving only maternity services, and those receiving only chore, housekeeping or personal care services. As stated above, there is a voluntary period prior to the mandatory implementation date of July 1, 2025.

There are many questions about the revised requirement which CMS has addressed in a Q&A document. CMS has also released a Fact Sheet and provided guidance on the provision of the OASIS privacy notice. Specifically, effective January 1, 2025 HHAs should only provide patients with the CMS Privacy Act Statement and Attachment A – Statement of Patient Privacy Rights.  Attachment C – Notice About Privacy for Patients Who Don’t Have Medicare or Medicaid should not be provided to patients. These forms are available on the Home Health Agency Center webpage in the OASIS section. Both documents are available in English and Spanish.

In addition to these OASIS resources, CMS has also posted updated introductory courses to the Home Health Quality Reporting Program (HHQRP). This series of courses is helpful for those new to the HHQRP as well as those interested in a refresher.
 
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