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Families and providers warn JBC that proposed HCPCS cuts — including a 56‑hour caregiver cap — would endanger medically complex Coloradans
Summary
Dozens of family caregivers, clinicians and providers told the Joint Budget Committee that proposed HCPCS changes — notably a 56‑hour cap on paid family caregiver hours and rate alignments — would force medically fragile people into hospitals or institutions and shift uncompensated care onto families.
Hundreds of Coloradans packed the Joint Budget Committee hearing to oppose a slate of Medicaid changes proposed by the Department of Health Care Policy and Financing (HCPCS). At the center of the opposition was a proposed hard 56‑hour weekly cap on paid family‑caregiver hours and multiple rate reductions and rule changes that advocates say would reduce access to home‑and‑community‑based services.
"Capping caregiver hours doesn't reduce the labor; it merely makes that labor unpaid," said Dr. Chloe Webber (SEG 096), a pediatrician and full‑time parent caregiver, describing the experience of families who already struggle to find paid respite staff. "If this cap passes, I will lose roughly half of my income while losing none of the responsibility, none of the work, and none of the care my child requires."
Why it mattered: Testimony across panels emphasized that many children and adults who rely on waiver services require continuous, skilled supervision (g‑tube feeding, suctioning, seizure monitoring, ventilator care) that cannot safely be provided by short‑term or casual substitutes. Family caregivers and clinical witnesses repeatedly said that workforce shortages mean third‑party replacements are not available; cutting hours would therefore either force families to give up work, place loved ones in institutional care, or raise the risk of emergency hospitalizations.
What witnesses said: Parents and providers gave specific examples. Casey Christiansen (SEG 6230–6279) said his son, a ventilator‑dependent young man, would be unsafe without his primary caregivers. Multiple parents described children whose medical teams have certified the current number of paid hours as medically necessary; caregivers said the proposed age‑based calculator and changes to CES/DD waivers would eliminate homemaker and community‑connect hours for many under‑6 children. Provider groups including AA Home Care and DME suppliers warned that proposed cuts to durable medical equipment reimbursement would reduce rural access and increase costly hospital stays.
Department response and committee questions: Committee members asked for clarification about program integrity, prepayment reviews and benchmarks for rates; several witnesses rejected claims that fraud or overutilization were driving the growth in these programs, arguing instead that expanded eligibility and unmet need explain spending increases. Providers requested targeted program integrity efforts with due process rather than system‑wide prepayment holds.
What comes next: Testimony repeatedly asked the JBC to adopt alternatives to across‑the‑board cuts (for example: improved oversight of agency overhead, targeted rate adjustments, phased exceptions for high‑acuity pediatric cases, or residency and waiting‑period proposals for new enrollees). Witnesses urged the committee to preserve medically necessary hours and to require HCPCS to demonstrate workforce capacity and an exceptions process before implementing any cap.
The hearing recessed with the committee still considering the department's recommendations and with many witnesses urging the JBC to reject or substantially alter the proposed HCPCS changes.
