April 2024

At A Glance

At a Glance is a Department of Health Care Policy & Financing (HCPF) publication that provides information on major initiatives, policy changes and program updates. Feel free to share At a Glance with your colleagues. Find previous editions of At a Glance on our website. Thank you for your interest!

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A Message from the Executive Director

Social Determinants of Health System Transformation to Improve Whole Person Health

Thank you for partnering with the Department of Health Care Policy & Financing (HCPF) to evolve Colorado’s social determinants of health supports, improve whole person health, and reduce health disparities. Key HCPF initiatives include:

  • Working with the Office of eHealth Innovation (OeHI) to finance and build the Social Health Information Exchange (SHIE). The Social Health Information Exchange (SHIE) leads the next phase of evolving prescriber tools. It will enable providers, Regional Accountable Entities (RAEs) and community workers to better support individuals through payer programs, state programs, and community supports. Long term, the tool will help connect individuals to payer health improvement programs like prenatal and related maternity programs, diabetes management, cardiac or asthma programs; it will help refer individuals to state health related social needs (HRSNs) program such as Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants and Children (WIC), or Housing Vouchers; it will also aid provider care teams and community workers in connecting individuals to community food banks, homeless shelters and other related supports. The SHIE has been successfully financed through two sources. First with HCPF American Rescue Plan Act dollars, which need to be spent by September 2024 on designing and building the initial foundation for the tool. The second source is through a HCPF/OeHI budget request enabling a 90/10 federal match, with the 10% state funds approved by both the Joint Technology Committee (JTC) and the Joint Budget Committee (JBC) during this legislative session. The contract with Resultant, the state’s vendor partner, was executed in November of 2023.
  • Working with national experts and the Center for Improving Value in Health Care (CIVHC) leadership, who is the appointed administrator of the state’s All Payer Claims Database, and its Advisory Committee to determine how to code and capture payments related to social determinants of health for future analysis, tracking and reporting.
  • Collaborating to increase access to SNAP and WIC enrollment to improve food access and security.
  • Including member incentives in the Accountable Care Collaborative (ACC) Phase III that encourage engagement in health improvement programs as well as value-based payments that encourage provider care teams to connect patients to whole person care programs that improve Health First Colorado (Colorado’s Medicaid program) member health. 
  • Exploring permanent supportive housing benefits through an 1115 waiver. HCPF hosted our first stakeholder meeting in March to launch our work on the feasibility of leveraging Medicaid to help pay for food and housing. Over 200 participants attended to provide their thoughts and perspectives. The goal is to amend HCPF’s existing 1115 waiver to include HRSNs.
  • HCPF is engaged with the Colorado Food is Medicine Summit and evolving movement, along with more than 200 stakeholders from almost 80 organizations. Together we’re working to tackle the critical issue of how to increase health through access to essential nutrition programs. This is in complement to home delivered meals HCPF already provides for older adults and people with disabilities discharged from inpatient hospital care and through community-based services available through Long-Term Services and Supports (LTSS) services. 
  • Pursuing authority to expand coverage to certain populations through an 1115 waiver. HCPF submitted an amendment to our 1115 waiver on April 1, 2024, seeking: 
  • Criminal justice reentry services effective July 2025
  • Serious mental illness and serious emotional disturbance (SMI & SED) inpatient care effective July 2025
  • Continuous eligibility coverage for children 0-3 years effective January 2026
  • Continuous eligibility coverage for adults released from Colorado Department of Corrections facilities effective January 2026

The ACC is the primary vehicle for delivering health care to Health First Colorado members, with RAEs as the central component responsible for propelling members’ physical and behavioral care coordination, case management and overall health. As such, Phase III of the ACC, scheduled to begin July 1, 2025, is designed to incorporate HRSNs support and advance whole person care to improve member health and reduce health disparities. This is one of the most important advances in the ACC Phase III Draft Contract, which outlines the RAE contractual requirements for prospective bidders. The Draft Contract is based on the policy and programmatic recommendations outlined in the ACC Phase III Concept Paper, which leveraged the tremendous feedback received from about 1,000 stakeholders across 20 stakeholder meetings. 

April is the twelfth month of Colorado’s public health emergency (PHE) unwind process, reflecting the state’s and the nation’s return to business as usual eligibility processing, post the Continuous Coverage PHE chapter. All members can still leverage the 90-day reconsideration period to submit their renewal information late, or after that, submit new applications for coverage. More information is on our updated website, reporting webpage and in our newsletters. Please help members and partners complete the renewal process: Update Your Address, Understanding the Renewal Process and Take Action on Your Renewal (available in the top 11 languages spoken by our members). Flyers have been developed for employers to distribute to employees to remind them to look for their Health First Colorado renewal packet and where appropriate, how to transition to employer-sponsored coverage, and the importance of doing so in a timely manner. We ask that all stakeholders leverage these tools.

We are also continuing to implement supports and flexibilities for counties, Case Management Agencies (CMAs) and Health First Colorado members with disabilities who are eligible for LTSS. This is in response to concurrent challenges impacting the LTSS system, including: 

  • System issues with the implementation of the new Care and Case Management IT platform that are causing work-arounds and longer processing time for case managers; 
  • Unforeseen complications with the transition of members to new CMAs to achieve the federally required conflict-free case management; 
  • A backlog of requests for medical records acquired from hospitals and other providers by industry vendors, providing critical information necessary for the federal disability determination required for long-term care eligibility; 
  • Increased county workload due to the end of the PHE combined with a record number of Health First Colorado and SNAP renewals.

In the coming months, the IT innovations and case management redesign modernizations will create a better system for members, providers and CMAs. But the unintended impact of all three occurring at once has caused short-term challenges to member program eligibility, provider reimbursement, CMAs processing and member service response time.

HCPF has been pursuing a number of solutions to address these issues and protect coverage for LTSS members through system and process changes, mitigating payment delays for providers to ensure care access, resourcing escalation processes for members struggling to navigate the renewal process, supporting counties and CMAs, and working with providers and vendors to address unprecedented backlogs in securing medical records necessary for disability determinations. Please visit CO.gov/HCPF/stabilizing-LTSS for more information. 

Thank you for engaging to propel system transformation that improves whole person health, for your continued engagement to Keep Coloradans Covered, and for your partnership to navigate and address LTSS system transformation challenges.


Public Meeting to Gauge Community Interest in Potential Application to Federal Transforming Maternal Health (TMaH) Model:

HCPF invites organizations and individuals to attend a public meeting that will present information about the possible HCPF application to a federal Transforming Maternal Health (TMaH) Model from the Centers for Medicare and Medicaid Services (CMS). The model focuses on improving maternal health care for people enrolled in Medicaid and Children's Health Insurance Program (CHIP). Learn more about the model at the CMS webpage

At the meeting, HCPF staff will first review what they know about the model so far. Next, attendees will be invited to provide feedback. HCPF staff are eager to gauge interest in the model and identify community preferences for what HCPF should prioritize in its application. 

Community feedback will inform HCPF's TMaH Model application and design.  

The meetings will be recorded, shared with attendees, and posted to HCPF’s TMaH webpage

Meeting date and time: Tuesday, April 16, 11 a.m. to 12 p.m.  

Registration and location: the meeting will be virtual via Zoom. Register in advance for the meetings

Meeting Accommodation and Language Access Notice: Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Please notify Patrick Potyondy at patrick.potyondy@state.co.us at least one week prior to the meeting to make arrangements. 

Las ayudas y servicios auxiliares para individuos con discapacidades y servicios de idiomas 

para individuos cuyo idioma materno no sea inglés pueden estar disponibles por solicitud. 

Comuníquese con Patrick Potyondy a patrick.potyondy@state.co.us al menos una semana antes de la reunión para hacer los arreglos necesarios.

For more information, please contact Anoushka Millear at anoushka.millear@state.co.us or Brooke Greenky at brooke.greenky@state.co.us

Recovery Audit Contractor (RAC) Provider Training:

Providers are strongly encouraged to register for training opportunities regarding the RAC program, including:

  • What to expect if audited by the Colorado RAC
  • Audit timelines
  • Usage of the Health Management Systems, Inc. (HMS) Colorado RAC provider portal for audit tracking, record uploads & transparent reporting
  • Information on provider rights & responsibilities

HMS and HCPF have created quarterly meetings for different audit types including:

  • Complex Audits, Medical Records Reviews
  • Hospice Specific Complex Audits, Medical Records Reviews
  • Automated Audits, Data & Claims Reviews

Colorado RAC 101: Complex, Medical Records Reviews Training

May 15, 2024, 11 a.m. to 12 p.m. MST Registration Link

Colorado RAC 101: Hospice, Medical Records Reviews Training

June 18, 2024, 2 to 3 p.m. MST Registration Link

Colorado RAC 101: Automated, Data & Claims Reviews Training

April 16, 2024, 10 to 11 a.m. MST Registration Link

Recorded training and presentations for the HMS Colorado RAC 101 and for the HMS Colorado RAC Provider Portal are on the HMS Colorado RAC website at under the tab on the left titled “Resources & Informational Documentation.”

Reminder: Resources to Support Eligibility Renewals Related to the Public Health Emergency (PHE) Unwind:

With the end of the public health emergency (PHE), members are once again required to have their Medicaid eligibility renewal on an annual basis. This is a new process for many members and requires the timely completion of a renewal packet. The following resources are available to support members through the renewal process:


  • A guide specifically for helping LTSS members through the renewal process.




  • The KeepCOCovered Toolkit includes information about other health insurance options. 



Additionally, HCPF is leveraging flexibility from the Centers for Medicare and Medicaid Services (CMS) to provide a 60-calendar-day extension to complete the renewal process for our vulnerable populations, including long-term care (LTC), members on waivered services, and buy-in recipients who have not returned their renewal packet on time during COVID unwind.


This extension also allows HCPF to do additional outreach to these members when they are up for renewal, while providing extra time for the members to return the information and the counties to process it.


The extension is in effect Sept. 5, 2023, through the remainder of the unwind period, June 2024. It does not affect members who have already submitted their renewal packet to the county or those who have completed the renewal process.


If a member has already turned in their renewal packet and still needs to submit additional information, the county may grant additional time through a Good Faith Extension for a member to turn in this information.


For more information about the extension and frequently asked questions please see the HCPF updates.

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Female provider, kneeling next to parents holding small child.


In February 2024,

1,259,749 Coloradans were enrolled in Health First Colorado and 75,268 were enrolled in Child Health Plan Plus (CHP+).