In a historic session that saw the passage of the largest state budget on record, Colorado lawmakers adjourned the 73rd General Assembly on May 11th on a productive note.
Of the 650 pieces of legislation introduced at the capitol this year, 132 bills were passed by the legislature and acted on by the governor, including the largest state budget on record with $36.4 billion appropriated for FY 2022-23.
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Here are some of the main areas of health policy progress highlighted by legislators looking back on the session.
Home and Community-Based Services
The state is currently in phase 2 of a 4-stage process that has earmarked $529 million, $310.8 million from reinvested state funds and $218.2 million from matching federal funds, toward Home and Community-Based Services (HCBS) initiatives through 2024. As part of post-COVID recovery efforts, the measures focus on improving access to and quality of community-based services and supports under Medicaid, strengthening the provider network, and investing in the critical workforce providing HCBS services.
Several measures passed this session that would regulate the eligibility, benefits, and the price-transparency around these expanded services. Senate Bill 81 requires Colorado’s health benefit exchange to conduct consumer-targeted outreach and education about the coverage options available.
SB 68 funds the creation of a tool aimed at improving administrative transparency and cost-efficiency around all-payer health claims in the state’s database. Senator Jim Smallwood (R – Parker), a prime sponsor on both bills, shared his impressions on the 2022 session and the progress made.
“From a health care perspective, generally speaking, I think it was a good session,” said Smallwood.
“We sent [SB 81] to the governor with a $4 million annual budget for each of the next five years to go to explain what is a complicated topic for the layperson: eligibility and benefits under Medicaid, under subsidized health insurance and unsubsidized health insurance, and finally under Medicare, because I still run into people all the time who are Medicare age but who haven’t enrolled in Part A yet. I was probably most excited about that bill.
Senate Bill 40 was a bipartisan, bicameral bill that finally will allow lawmakers to have an actuarial base tool anytime they propose [health] benefit mandate changes. It’s not a requirement. Unfortunately, that was one of the things that my colleagues on the other side of the aisle had a real problem with in years past, having it be a requirement.
Now it’s just out there as an optional tool, but I’m hoping that lawmakers that are serious about health care policy would view it as sort of obvious that if the tool is there, and it’s funded, you should probably use it when proposing health [insurance] benefit mandate changes.”
Smallwood also sponsored SB 173, which removes location restrictions aimed at expanding telepharmacy outlets and services throughout the state to address what he calls ‘pharmacy deserts’ in both rural and metropolitan areas of the state.
Support for Older Coloradans and Care Workers
Improving access and services for older adults has been top policy priority during the pandemic and the session continued to make strides on this front.
Governor Jared Polis signed the Modernization of The Older Coloradans Act last month which restructured, codified, and re-imagined a holistic, statewide approach to servicing the needs of older adults.
Representative Mary Bradfield (R – Colorado Springs), one of the prime sponsors of the bill who sits on the Public & Behavioral Health & Human Services Committee, said the support system will take time to build. While the session had to table legislation addressing the needs of the deaf and hard of hearing community, Bradfield said those needs will be prioritized in the next session.
“In the end, the people that will benefit most will be those who need it the most: senior citizens,” said Bradfield. “When you get over the age of 65, and you don’t need any of those services, good for you. But we do have a significant number of older people who have no savings and their only income is Social Security and that certainly doesn’t give you a comfortable lifestyle.”
Statewide medical staffing shortages at hospitals and nursing homes created a health emergency at peak periods during the pandemic. An estimated 2,000 workers have left the nursing home industry since 2020, causing a staffing shortage that has forced providers to stop accepting new residents due to the inability to properly manage the elders already under their care.
Increased investments in higher education ($5.4 billion) and workforce ($311 million) have been allocated in the budget’s general fund to bolster staffing and emergency response for future public health threats.
Another major focus of the session was improving and expanding behavioral health services. Lawmakers approved $450 million in additional investments into the system, including the establishment of the Behavioral Health Administration (BHA).
Following the recent passage of HB 1278, the administration is tasked with establishing the following by 2024:
- A statewide behavioral health grievance system;
- A behavioral health performance monitoring system;
- A comprehensive behavioral health safety net system;
- Regionally-based behavioral health administrative service organizations;
- The BHA as the licensing authority for all behavioral health entities; and
- A BHA advisory council to provide feedback to the BHA on the behavioral health system in the state
Dr. Morgan Medlock, who heads the new administration, spoke about her commitment to improve behavioral health care for Tribal, urban, rural, and frontier populations in a recent op-ed for State of Reform. Lawmakers shared the optimism on improving health equity.
“I am extremely proud of how much Colorado has chosen to finally invest in mental and behavioral health services for the state of Colorado,” said Representative Leslie Herod (D – Denver).
“It is unprecedented how much we’ve been able to invest in meeting the needs of Colorado citizens, specifically as a member of the Joint Budget Committee. We started these conversations early on last year, when we heard about the federal stimulus dollars coming in and thought about how we can actually rise to the challenge of not only getting this money out quickly, but also getting it out in a way that would have lasting impacts on Coloradans. We knew that we had to invest in behavioral health and so we were able to successfully set aside funding for behavioral health.”
House Bill 1281 issues $90 million in BHA grants to community-based organizations to invest in youth and family mental health support services. Services would be tailored to each community’s unique needs and address a wide range of issues from substance abuse to providing culturally appropriate crisis counseling and technical assistance.
“Equity was a big piece. As far as ensuring another part of this whole mental health system is that we’re not able to find culturally competent health professionals,” said Representative Naquetta Ricks (D – Aurora), who sponsored the bill and sits on the Public & Behavioral Health & Human Services Committee. “Sometimes [individuals] can relate better to people who can speak their language or they feel that they can open up to [and] trust. We made it possible for community-based organizations to apply to do some of the counseling, especially with our youth.”
This session also saw the Reproductive Health Equity Act (RHEA) become law. With RHEA, Colorado now has one of the most unrestrictive abortion protections in the country, being just one of three states without gestation cut-offs, Targeted Regulation of Abortion Providers (TRAP) laws, and telemedicine bans.
The law declares that abortion is an individual’s “fundamental right” and that a “fertilized egg, embryo, or fetus does not have independent or derivative rights under the laws of the state.” It also contains a provision that would protect abortion regardless of the high court’s decisions from state and local interference.
The bill’s prime sponsor, Representative Meg Froelich (D – Greenwood Village), worked with a coalition of abortion rights groups that blocked anti-abortion legislation in Colorado and oversaw the strategy to drafting and passing the historic HB 1279 this session.
“What we saw for other major legislation is almost all the big bills came after the budget,” said Froelich of the circumstances contributing to the bill’s passage. “And that was because they cost money. And RHEA, it didn’t cost any money. It was a big policy bill but not a big ding on the budget, zero impact on the budget. But we also have a constitutional amendment banning any funds going to abortion, so there was no way that this bill would impact our budget and our fiscal situation.
This coalition has worked alongside providers and the faith community for decades. That’s who came to testify, which was pretty powerful, and people who had needed abortion care at times in their lives. Almost 90% of the debate was focused on abortion even though we feel that access to contraceptives is equally important. RHEA was purposely gender-neutral and does not contain any gestational language. Those are two ways we are moving beyond Roe. [I’m] very proud that we put women of color in the center of our work,” said Froelich on working with COLOR Latina and COBALT, two pro-choice coalition members.
Democrats hope to enshrine abortion rights in the state constitution with a ballot measure that will be put forth to voters in 2024.
Lawmakers will reconvene for the First Regular Session of the 74th General Assembly on January 9th, 2023.
Colorado’s $36.4 billion state budget neither includes nor accounts for the $1.5 billion in federal funds the state is receiving from the American Rescue Plan Act (ARPA), which would support a range of COVID recovery programs centered around behavioral health, affordable housing, broadband access, and economic relief in Colorado.
Much of the record $17.6 billion in total funds approved this session for health care related spending will be centered on workforce and health services expansion. The bipartisan consensus was that this session was a transformative one for Coloradans as officials look to address the lingering effects of the pandemic by bolstering public health and mental health care systems.
Funding for HCPF, as in previous years, makes up the largest portion of the total state operating budget at 41.5% (26.8% of the general fund budget), or $14.18 billion in total funds.
Total fund appropriations in the department budget include:
- Medical Services Premiums ($10.5 billion)
- Behavioral Health Community Programs ($1.13 billion)
- Office of Community Living ($976.16 million)
- Executive Director’s Office ($499.6 million)
- Other Medical Services ($494.7 million)
- Indigent Care Program ($468.7 million)
- Department of Human Services Medicaid ($127.6 million)