Budget panel backs phased cap on caregiver hours, raises concerns about single-parent and rural impacts

The Joint Budget Committee, meeting jointly with the Joint Technology Committee, approved a comeback request from the Office of State Planning and Budgeting to implement a phased soft cap on caregiver hours for home-and-community-based services, designed to bring a new standard to caregiver-authorized hours and reduce a rapidly growing cost driver in Medicaid.

OSPB officials told the committee the proposal would phase in a 56-hour-per-week cap for a single caregiver across eligible services, and that the administration is proposing a stair-step implementation (beginning in July and reaching the target by November 1, 2026) to avoid abrupt dislocations. Director Bonnie Silva said the department pushed the implementation timeline to give stakeholders more time to prepare and to adopt a more measured approach.

The department presented scenario sheets showing potential household impacts: in one example, a caregiver receiving roughly $121,000 a year under current authorizations could see compensation fall to about $61,000 after the cap and related rate actions, assuming existing hours remain unchanged. OSPB said it had included a phased approach and an exceptions process to limit harm to individuals with complex needs.

Several members pressed for clarity about how exceptions would work and whether there would be staff available to process appeals quickly. Vice Chair Bridges said the committee should fund a term-limited FTE so families could obtain timely exemptions; staff and OSPB agreed an appeals surge was likely and recommended a limited FTE tied to an annualized review. Representative Taggart and others described calls and emails from single caregivers in rural areas who fear losing vital hours and income and urged robust exceptions and implementation safeguards.

Director Silva and OSPB staff emphasized that the policy is intended to align Colorado with national norms (many states cap similar services at around 40 hours) while preserving access through targeted exceptions and a phased rollout. They said a significant share of current authorizations exceeded the new cap and that the action is meant to slow unsustainable LTSS growth.

The committee voted to approve the department comeback on the soft-cap package, including a term-limited FTE to manage exemptions and a commitment to return with updated proration and staffing needs at figure setting.

The measure as approved is a policy direction and funding comeback; additional rulemaking and administrative steps (including potential federal approvals) were identified as required next steps.