By Matt VanAuken, DP Chief Executive Officer & Executive Director
A lot is happening at the state and federal levels around disability policy. With this Policy Pulse series, our goal is to make sense of the noise, providing clarity, context, and resources for our community.
This post focuses on two things:
- A quick primer on Medicaid.
a. Medicaid is a joint federal-state program providing health coverage for specific populations, especially critical for people with disabilities in Colorado. - What we know (and don’t know) about HR 1 or OBBBA.
a. HR 1, also called the One Big Beautiful Bill Act (OBBBA), proposes $1 trillion in Medicaid cuts over 10 years. Still, much of the impact depends on future rules, state decisions, and elections. Colorado faces added budget pressures, making it essential for communities to stay informed and engaged.
Medicaid in Plain Language
What is Medicaid?
Medicaid is a public health insurance program created in 1965, alongside Medicare. Unlike Medicare, which serves primarily older adults, Medicaid was initially designed as a safety net for targeted, specific populations.
Key points to know:
- Jointly funded: Medicaid is paid for by both the federal and state governments.
- State flexibility: States design and run their own programs, leading to differences in who qualifies and what’s covered, but may need federal approval for some components.
- Who qualifies: Historically, Medicaid served children, pregnant women, older adults, and people with disabilities. After the Affordable Care Act (ACA) in 2014, many states (including Colorado) expanded eligibility so more low-income adults could enroll.
Colorado’s variety of programs and populations has changed significantly over the past decade. In addition to health/medical insurance coverage, Medicaid in Colorado includes programs like:
- Community First Choice (CFC)
- Long-Term Home Health (LTHH)
- Home and Community-Based Services (HCBS) Waiver programs
- Certain state general fund programs
Together, these programs help people with disabilities and aging adults live in their communities with the supports they need.
Learn more: History of Medicaid | MACPAC Overview of the ACA and Medicaid
HR 1 or OBBBA: What We Know So Far
HR 1 or OBBBA proposes about $1 trillion in Medicaid cuts over the next 10 years. While this sounds dramatic, there are still many unknowns, and it’s important to remember:
- Implementation will take time: Many details depend on how federal rules are written.
- No direct cuts to Long-Term Care (LTC) yet: However, ripple effects, like reduced state funding and new administrative requirements, could strain Medicaid programs in Colorado.
- Uncertainty is high: Advocacy groups and state agencies are still analyzing what this means in practice.
Stay updated: Colorado HCPF | KFF Medicaid Resources
Colorado’s Budget: Big Picture
Even before HR 1 or OBBBA, Colorado was facing tighter finances. Here’s the context:
- Medicaid is a big piece of the state budget: People with disabilities in long-term services and supports (LTSS) make up only 4-5% of Medicaid enrollees but account for about 42% of spending.
- Administrative strain: HR 1 or OBBBA introduces new requirements like work verification and more frequent eligibility checks, increasing workloads and resources required for the state, counties, and county partners.
- State-level pressure: Governor Polis recently called for a special session to address budget and tax code concerns, which began on Aug. 21. Departments are preparing for 5-10% budget reductions for next year’s proposals. While we don’t anticipate cuts to Medicaid or LTC Medicaid programs during this special session, we are closely monitoring conversations directly and in partnership with advocacy and state partners.
Resources: Colorado HCPF Stakeholder Updates
What This Means for Our Community
Over the past decade, the disability community has weathered enormous changes: ACA expansion, waiver consolidation, COVID-19, American Rescue Plan Act (ARPA) funding, Case Management Redesign (CMRD), CFC, and more. HR 1 or OBBBA adds another layer of uncertainty.
DP is not an advocacy organization, but we believe in staying informed and connected. We encourage you to explore local advocacy resources and remain engaged in conversations shaping disability services in Colorado.
Explore: Colorado Advocacy Organizations
Key takeaway: Medicaid is the backbone of disability services, and while HR 1 or OBBBA signals changes ahead, many details are still unfolding. Staying informed and connected is the best way to prepare. Stay tuned for future blog posts where we explore the landscape further.