Providers and families tell HCPF caps risk care access and legal confusion
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Summary
In an open forum at the CFC Council meeting, case managers, providers and advocates warned that the proposed caregiver-hour limits and soft caps could worsen rural access, strain the workforce and create legal ambiguity for appeals; HCPF said it will publish memos, operational guidance and seek legal clarification.
Stakeholders at the Department of Health Care Policy & Financing Community First Choice Council meeting told HCPF staff that the announced soft caps and per-caregiver limits could hinder access to care and create confusion for families and providers.
Molly, a former case manager who spoke during open forum, said the limits could reduce caregivers’ ability to keep people in their homes and called the policy “cruel” in practice. "So that seems cruel really or just really poorly thought out," she said, describing how a single caregiver who currently covers many hours might be unable to continue serving the same member under the new per-caregiver weekly limit.
Megan Bowser of Family Voices Colorado raised legal concerns about children’s protections under EPSDT (Early and Periodic Screening, Diagnostic and Treatment). "EPSDT is...anything that is medically necessary has to be available to them," she said, and asked whether CFC services — which live on the state plan but resemble waiver long-term services — remain subject to EPSDT. HCPF staff said they do not believe CFC services fall under EPSDT protections, that appeal rights would follow notice-of-action and waiver-appeal processes, and that the question will be forwarded to HCPF’s legal division and the Attorney General’s office for clarification.
Provider and family speakers also asked operational questions. Tara from About Kids Home Care asked why HCPF would pay the total available hours but not allow a single family caregiver to receive all of those hours; Eggers said HCPF would take that question back and include it in forthcoming materials. Bryce Rafferty (CCDC) and other attendees asked where the age-appropriate task standards and time units came from; HCPF’s Danny said the task standards are tied to national standards and research from the University of Massachusetts and that updated operational guidance and a revised calculator would be posted shortly.
Several speakers warned of an unintended consequence: in rural areas with tight labor markets, the new per-caregiver cap could force families to seek additional caregivers who may not exist, potentially pushing some members toward institutional care at higher cost. "The end result and the unintended consequence is going to be forcing families and forcing members into institutional care at much higher cost to HCPF," said one participant.
HCPF response and next steps: staff acknowledged stakeholder concerns, said they will publish the DC services calculator update, operational memos and a mid-December rule draft, and promised to accept stakeholder feedback through roughly Jan. 12. HCPF staff said legal questions (for example, EPSDT applicability and appeals procedures) will be routed to their legal division and the Attorney General’s office for formal guidance.
Sources: Open-forum remarks and Q&A at the CFC Council meeting; direct quotes and clarifications from HCPF staff.
