ACC Program Improvement Advisory
Committee
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November 18th, 2020
Kim Bimestefer, Executive Director
• COVID-19 Updates
• Healthcare Disparities
• Impact of the Economic Downturn
• Governor's 2021-2022 Budget
• 2020 Colorado Election Updates
• ACA Discussion
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Today’s Agenda
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COVID-19 Updates: Colorado Data to 11/17/20
https://covid19.colorado.gov/
Positive Cases: 167,713
People tested: 1,472,457
Deaths among cases: 2,578
Deaths due to COVID-19: 2,276
• 1 of 110 in CO are contagious
• 1 in 64 in Denver
Colorado Hospital Stats
• 180 new hospital admissions
• 43% of adult ventilators in use
• 15% of beds occupied by COVID
• Hospitals increasing capacity,
augmenting staff, scale back
elective procedures
• Emergency Operations Center
returned to highest level
• CO-Polis unique leadership
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CO & US COVID Stats, as of Sat, Nov 14
United States
• 45 states w/ 10%+ increase
in cases wk over wk
• 69,455 people hospitalized
• 10.9M+ cases
• 245,600 deaths
• Emerging risks: winter
indoors, holiday gatherings, flu
season
Colorado Convention
Center
Denver
Tier 3 facility
Max capacity: 2,000 beds
St. Mary Corwin
Hospital
Pueblo
Tier 2.5 facility
Max capacity: 120 beds
St. Anthony North
Hospital
Westminster
Tier 2.5 facility
Max capacity: 78 beds
Alternate Care Sites In Case of System Breach
Significant staffing challenge
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Over 60% of COVID deaths are in nursing
homes, other residential care settings
Through 11/6, 239 residential
care facilities have had an outbreak.
"This past week brought startling
increases in almost every tracked
category." Strike Force Nov 13 report
Enforcement & Education
Testing for Disease
Presence
Cohorting & Facility Isolation
Staffing
Situational Awareness
Health &
Wellbeing /
Equity
Protecting Our Most Vulnerable
Recognized by
AARP as a national model
Actions You Can Do to help…
1. Socially distance
2. Wear your mask
3. Wash hands
4. Only interact with your
household during holidays
5. Help message: Share This
PSA with Your Contacts !
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We need YOUR leadership
Holiday stay safe Step-Up Campaign covid19.colorado.gov/social-media-graphics
Add Exposure Notifications to
Your Phone (contact
tracing) addyourphone.com
Stakeholder Resource Centers• New PHE Planning Stakeholder & Partner Resource Center available at
colorado.gov/hcpf/phe-planning➢ Latest federal updates
➢ HCPF Letter to Centers for Medicare & Medicaid Services
➢ Member messaging, member FAQs
• County & Eligibility partner FAQs, call center/front line worker talking
points and other materials in development.
• Member COVID Resources
• County & Eligibility Site COVID Resources
• Provider COVID Resources
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Healthcare Disparities
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“Hispanic residents are about 20% more likely
than white residents to die of treatable
conditions. There’s no one explanation for the
disparity in deaths, experts say.”
Denver Post, Oct 4, 2020
Health Equity Opportunity - People of Color
In Colorado:
• Hispanics are 22% of the pop and 38%
of COVID cases and hospitalizations.
• Black people are almost 5% of the pop
and nearly 10% of COVID hospitalizations and
7% of deaths,
• White people are 68% of the pop and 38% of
COVID cases.
Healthcare Disparities Opportunities
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Colorado has higher alcohol-related death and suicide rates
• #45 in the US for alcohol-related deaths
• #45 in the US for suicide rate
• More severe LGBTQ, veterans, American Indians/Alaskan Native, and
rural residents
• In May 2020 alone, 128 Coloradans died of drug overdoses (73 in
2019).
• COVID19 is driving increased need for behavioral health and
substance use disorder treatment
Addressing Disparities
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• Renewed focus: “Systemic, persistent racism is a public
health issue. When the color of your skin correlates with
your well-being and longevity, that is a public health
injustice that must be addressed.” – Jill Hunsaker Ryan (1)
• Stimulus $$ to provide increased insights
• Collaborate on a list of top priorities
•Advocates, carriers, providers, state agencies
• Gov EO, state example for employer EDI focus
• EDI lead hired at HCPF & in other agencies
•Targeting disparities in care as well
Impact of theEconomic Downturn
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672,000 Coloradans Received Unemployment Insurance March-Oct (22% of 2019 workforce)
2020 Month February March April May June July August September
Unemployment
%
2.5% 5.2% 12.2% 10.2% 10.6% 7.4% 6.7% 6.4%
Source: Unemployment Data from Colorado Department of Labor and Employment. Chart for the OSPB September 18, 2020 Revenue Forecast available at
https://www.colorado.gov/governor/office-state-planning-budgeting
Applications Received Daily broken out by Program
AF = Adult
Financial
CW = Colorado
Works
FA(SNAP) =
Expedited &
Non-Expedited
Food Assistance
MA = Medical
Assistance
This shows what assistance Coloradans are seeking. Over the last 30 days, 53% of
applications received were for a Food Assistance program. The second largest category
was for Medical Assistance, at 32%. Adult Financial and Colorado Works account for 15%
combined.
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Families are Struggling: Rent, Food, Health Care• 20% of Coloradans worry about feeding their family
• 22% of Coloradans are worried about losing their home
• 18% report being unable to pay for basic necessities (1)
• Applications for SNAP went up 55% between February and April (2)
2nd survey went out last week to verify WHY struggling to get covered
We must connect Coloradans to affordable coverage
- Sept 24th stakeholder meeting 200+ attendees, Dec 3 follow-up
Medicaid
Category
EnrollmentCount of Clients enrolled by aid code.
Chart shows total enrollments by time periods
and the changes in its composition over time.
The two populations
which have seen the
greatest increase in
enrollment are
Medicaid Children
and Expansion
Adults.
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Governor's FY 2021-22 Budget
HCPF Details
Overall Budget Picture• Thanks to an improved economic forecast, the Governor’s FY 2021-22
Budget is able to restore many of the major reductions taken in FY 2020-21. The overall operating increase is more than 7% above FY 2019-20.
• Governor's budget includes $1.3 billion in stimulus to pursue targeted economic stimulus - making immediate investments in Colorado businesses and families to help them make it through the winter and rebound our economy.
• However, the long-term budget outlook is still out-of-balance and uncertain. The State needs to minimize ongoing operating costs that could require more painful cuts in FY 2022-23.
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2021-2022 Budget Basics
• State Budget: $35.4B Total Funds, $13.6B General Funds
• State Totals Cuts:
➢ $422M Total Funds and $272M General Fund
• HCPF Total Cuts
➢ $165M Total Funds and $146M General Funds
• HCPF will account for 37.6% of TF and 29% GF (is 34%, 26%)
• HCPF budget will be $12.4B TF and 3.5B GF
• Increase of $1.7B TF (15.6% from 2019-2020)
• Increase of $557.3M GF (18.9% from 2019-2020)
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Revenue Insights• Improving 2020-2021 budget outlook
• Colorado is still the #1 economy in the nation, but 672k Coloradans have filed for Unemployment Insurance (22% of working population)
• Longer-term budget outlook is still out-of-balance and uncertain
➢ $1.6B revenue shortfall for FY 2021-2022 (released budget)
➢ $2.2B revenue shortfall projection for FY 2022-2023
• Governor's budget includes $1.28B in 2020-2021 stimulus
➢ to boost economic growth since the Fed is not acting
➢ makes immediate investments in Colorado businesses, families.
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Gov State Stimulus Opportunity, while Fed is in gridlock
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HCPF Stimulus - Decision Items
The one-time stimulus $$ directly impacting HCPF:• Behavioral Health Task Force Acceleration – Shared
Eligibility/Intake, Claims Processing and Reporting – 75 non-Medicaid programs to be administered by HCPF tools (PEAK, MMIS DXC payments, reporting)
• Addressing Health Care Disparities – investments in data collection by Medicaid and carriers in the eligibility intake and capture process, including info like race, age, gender, LGBTQ, zip code, income, disability status. This will help us identify disparities, which is critical to addressing them.
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HCPF Budget Year to Year & Drivers
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Total Funds General Fund
FY 2020-21 Appropriation $12,034 M $3,185 M
FY 2021-2022 Caseload Requests $297 M $248 MContinuous Coverage
Recession impact
Decision Items $20 M $10 M
Budget Reductions ($165 M) ($146 M)
FY 2021-22 Budget Request $12,336 M $3,511 M
Year-over-year Change $302 M $327 M
Percent Change 2.5% 10.3%
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Temporary Budget Reductions
Temporary budget reductions: $100M TF, $120.3M GF
“Temporary” means that the reductions create savings in the current year, but not in future years.
• $80M GF transfer from the Healthcare Affordability and Sustainability Fee (hospital provider fee)
• $10M GF transfer from the Primary Care Fund
• Reduction to Inpatient SUD Budget based on lower-than-expected projected costs (not a benefit or reimbursement change)
• Savings from federal funds associated with enhanced FMAP
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Permanent Budget Reductions
“Permanent” means that the reductions will not be restored until the General Assembly takes new action.
• Capping enrollment in PACE
• Reducing BH incentive payments (25%)
• Targeted rate and benefit reductions
No across-the-board provider rate reductions.
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Permanent budget reductions: $69.5M TF, $29.9M GF
Enhanced Federal Funding
The Families First Coronavirus Response Act increased the federal match rate for most Medicaid services for all states while the Public Health Emergency is in effect.
• Colorado’s federal medical assistance percentage (FMAP) went from 50% to 56.2%
• So far, the enhanced federal funds have created $565M of General Fund relief.
• Asking Fed to extend PHE, after 1/23/21, day after inauguration
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Decision ItemsTotal impact: $20M TF, $9.5M GF increase.
Key requests include:
• Convert contractor resources to FTE
• Restoring reductions to Family Medicine Residency Training Programs
• Nurse Advice Line
• HCBS Remote Supports benefit
• Supported Living Services Flexibility
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Next Steps
Joint Budget Committee Briefing and Hearing:
➢ Briefing: December 10, 2020
➢ Hearing: January 7, 2021
➢ Figure Setting: March 2021
• Next revenue forecast: December 18, 2020
• Start of the Legislative Session: January 13, 2021
• Budget https://www.colorado.gov/pacific/hcpf/budget-1
https://www.colorado.gov/governor/office-state-planning-budgeting
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Colorado Elections
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State of Colorado ElectionsSenate Minority Elections:
Minority Leader: Chris Holbert
Assistant Minority Leader: John Cooke
Minority Chair: Jim Smallwood
Minority Whip: Paul Lundeen
JBC Member: Bob Rankin
House Majority Elections:
Speaker: Alec Garnett
Majority Leader: Daneya Esgar
(House still meeting on other positions)
Senate Majority Elections
President of the Senate: Leroy Garcia
Majority Leader: Stephen Fenberg
President Pro Tempore: Kerry Donovan
Assistant Majority Leader: Rhonda Fields
Majority Whip: Jeff Bridges
Caucus Chair: Julie Gonzales
JBC Appointment 1: Dominick Moreno
JBC Appointment 2: Chris Hansen
• State House: 41 Ds – 24 Rs (no change, one Rep seat flipped (Ortiz) and
one Dem seat flipped (Luck))
• State Senate: 20 Ds – 15 Rs (Dems flipped Sen. Tate’s seat with Chris
Kolker)
• New Legislators• Senate: 3 completely new members (Kirkmeyer, Kolker, Simpson); 4
members moved from the House (Jacquez Lewis, Buckner, Coleman, Liston)
• House: 15 completely new members (7 Reps, 8 Dems)
• Process Reminders: New committee assignments expected in early
December.
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Colorado General Assembly
• 116 – PASSED: Reduce State Income Tax Rate (applies 2020 & beyond, – est.
to reduce state revenues by 1.2% ($154 million for 2021-22 budget year)
• 117 – PASSED: Voter approval for some State Enterprises (seeking
clarification on impact to CHASE)
• 118 – PASSED: Paid Family Leave – 12 weeks funded through payroll
(employers and employees 50/50), first premiums paid January 2023,
benefits begin January 2024
• EE – PASSED: Increase Nicotine Tax, Taxes Vaping (more $s to state)
• B – PASSED: Property Tax Rates – Repeals “Gallagher Amendment”
(removes residential and non-residential tax rates set in Constitution,
allows General Assembly, local governments to make changes)
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Pertinent Ballot Measures
ACA Discussion
Supreme Court ACA Hearing. May or June likely decision.
Just some of the potential ACA impact:
• Medicaid expansion up to 138% FPL, 90/10 Fed $$ (462k in CO)
• Exchanges, fed subsidies up to 400% FPL (123k of 167k in CO)
• Young adults can stay on their parent's insurance up to age 26
• Employer-sponsored coverage employers > 50 employees
• Consumer protections
• Reinsurance funding
• Medicaid Expansion Federal Funding: $2.1 billion
Cautiously optimistic based on Justice's questions on outcome
39 states & DC have passed Medicaid expansion – alignment to act
Biden Administration response will depend on GA Senate run-off
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ACA Supreme Court Hearing
Thank You!
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