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Office of Community Living warns legislators that long‑term services growth is unsustainable and outlines caps, caregiver limits and wait‑list changes
Summary
The Office of Community Living told the Joint Budget Committee LTSS costs have surged and proposed a package of actions—soft annual HCBS caps, a 56‑hour weekly limit per paid caregiver, rate alignments, and changes to DD waiver auto‑enrollment and PEDI—to slow growth and preserve services for those with the greatest needs.
Bonnie Silva, director of the Office of Community Living, told the Joint Budget Committee that long‑term services and supports (LTSS) spending has been rising rapidly and set out a suite of proposed sustainability actions intended to preserve community care while slowing unsustainable trends.
Silva said the office serves roughly 93,000 Coloradans across nine HCBS waivers, PACE and facility programs and that LTSS accounts for a disproportionate and growing share of Medicaid benefit spending. She said three drivers explain the trend: rising utilization per member, prior wage‑driven rate increases to stabilize the workforce, and enrollment growth (notably among children in certain waivers). The office reported a FY27 LTSS budget that would grow without action and presented R6 sustainability steps projected to save approximately $161.9 million total funds in FY27 and more in later years if implemented.
Key proposed actions include a soft annual cap on combined HCBS authorizations for personal care, homemaker and health maintenance activities with an exceptions review; a 56‑hour weekly cap per paid caregiver (aimed at reducing sole‑caregiver burnout and provider reliance on a single paid family caregiver while preserving total member hours); unit limits for community‑connector services; aligning individual residential services rates to host‑home settings; and applying post‑eligibility treatment of income (PEDI) to residential services to capture member contributions consistent with other residential programs. The department also proposed changing automatic DD waiver enrollments for youth aging out of children’s waivers to prioritize child‑welfare cases and increase transition planning, rather than automatic enrollment for all youth.
Silva and HCPCS staff said each proposal includes exceptions, appeals and monitoring and emphasized that the department will continue stakeholder engagement. Committee members requested concrete household‑level scenarios showing how combined changes would affect families; HCPCS committed to provide example case studies and more granular fiscal impacts.
