Colorado LTSS Sustainability Tracker
Colorado's spending on Long-Term Services and Supports is growing faster than the state can fund. This page follows every change HCPF has made or proposed to slow that growth, with its status, its date, and what it means for the family caregiver doing the work.
The short answer: LTSS spending is outrunning Colorado's budget. Medicaid needs about $425 million more General Fund than forecast for FY 2026-27, and $244 million of that is community-based LTSS. HCPF's response so far: 11 changes in effect and 8 more proposed. A change becomes permanent when the Medical Services Board adopts its rule; 7 have, 4 more had final votes October 9, and none of the 8 proposals has reached the Board yet.
Why the current growth can't hold
Much of LTSS growth is what Colorado set out to do: more families paid to care at home, better wages for direct care workers. The problem is speed. Spending is growing faster than HCPF forecast and faster than the state budget can absorb, and HCPF's own numbers show where.
HCPF says Colorado's LTSS share is in line with other states. The growth rate is the problem.
- $244M community-based LTSS (57%)
- $181M rest of Medicaid (43%)
HCPF also spent about $158 million over its General Fund authority in FY 2025-26, across the whole agency.
- 45.9% more services used per member
- 42.7% provider rate increases
- 11.4% more people enrolled
HCPF says the growth doesn't mean members are getting care they don't need; they have assessed needs.
Proposal figures are HCPF's preliminary annual estimates from its October 2026 impact summaries: $78.0 million for Round 1 and $71.6 million for Round 2. Several overlap (the two 7-hour Homemaker limits reach many of the same hours, and removing children's Personal Care would change what a parent limit saves), so passing all of them would save less than the sum. Most adopted changes have no current published estimate, and some estimates don't state whether they're General Fund, so we leave those out rather than guess. Each card shows the estimate HCPF published, if any.
See these numbers as a table
| Measure | Value |
|---|---|
| Colorado Medicaid members using LTSS | About 8% |
| Medicaid General Fund spending on LTSS | 48% |
| FY 2026-27 General Fund need above forecast | About $425 million |
| Share of that tied to community-based LTSS | About $244 million |
| FY 2025-26 spending over General Fund authority | About $158 million |
| LTSS growth from utilization / provider rates / enrollment | 45.9% / 42.7% / 11.4% |
| Open proposals, HCPF preliminary annual General Fund estimates (Round 1 / Round 2 / total, before overlap) | $78.0 million / $71.6 million / $149.6 million |
| 1.6% provider rate rollback, FY 2026-27 General Fund (all Medicaid providers) | $57.0 million |
| Adopted LTSS changes with a stated FY 2026-27 General Fund estimate | $31.3 million (Align Community Connector rate with Supported Community Connections, Cut Community Connector annual units in half, End the nursing facility minimum wage supplemental payment, Community Connector rate reduction, Delay LTSS Presumptive Eligibility) |
Source: HCPF, Medicaid Sustainability and Colorado's LTSS System. The $181 million is the $425 million total minus the $244 million HCPF attributes to community-based LTSS. Savings estimates come from HCPF's October 2026 policy impact summaries, its November 2025 budget reduction fact sheet, and Medical Services Board rule documents; we confirmed the fact sheet's FY 2026-27 figures are General Fund against the January 2026 supplemental request.
Next dates to watch
- Nov12026 Phase 2 exception requests openOpen now through Nov 30 for caregivers above 70 hours a week without an approved exception, ahead of the Jan 1 drop to 70.
- Fri13Nov Medical Services Board meetingAgenda not posted yet. Minutes from Oct 9 (group rates, PDN, DD youth transitions) should post with it. Written testimony is due by 5 p.m. Nov 12.
- Fri11Dec Medical Services Board meetingLast scheduled 2026 meeting.
- Jan12027 DD Waiver youth transition change startsAutomatic CES and CHRP to DD Waiver transitions end.
- Jan12027 Weekly caregiver limit drops to 70 hoursFrom 84 hours a week per caregiver, per member. It drops to 56 on July 1, 2027.
Every action, by status
Cards that change a family caregiver's hours or pay come first. Tap a filter or search a program name.
Showing 32 of 32
Remove the live-in caregiver exemption from EVV
HCPF is considering removing the exemption that lets live-in caregivers skip Electronic Visit Verification (EVV). HCPF cites a federal Office of Inspector General audit and CMS guidance that recommends EVV for every caregiver. About 32,843 members and 590 providers had live-in caregiver claims from May 2025 through April 2026, totaling about $1.689 billion. ADA reasonable modifications would still allow some exemptions. Needs a rule and system changes only, with no federal approval.
Medical Services Board: No rule filed yet
HCPF savings estimate: $10.8 million a year, State General Fund (HCPF preliminary estimate) HCPF impact summary
What it means for you: If you live with the person you care for, you'd clock in and out for each visit at home, and claims without an EVV record would be denied until corrected. Your authorized hours wouldn't change. Because it needs only a rule, this could move faster than the others.
Remove Protective Oversight and Accompaniment from Personal Care, plus Life Skills and meals changes
Four changes: remove Protective Oversight from Personal Care (9,689 members, $20.9 million) and Accompaniment tasks (15,954 members, $8.9 million), with no exception process; move Home Delivered Meals from Community First Choice (CFC) to the waivers and limit it to 365 days after a transition (1,234 members, $902,100); and cut Life Skills Training from 6 to 4 hours a day and 40 to 20 hours a week (724 members, $120,400). Figures are HCPF's preliminary annual General Fund estimates.
Medical Services Board: No rule filed yet
HCPF savings estimate: $30.8 million a year combined, State General Fund (HCPF preliminary estimates) HCPF impact summary
What it means for you: Protective Oversight is line-of-sight supervision to prevent harm; Accompaniment is help at medical appointments and errands. If your Personal Care plan includes either, those hours would end with no exception. Other Personal Care tasks would stay.
Remove eight services from certain HCBS waivers
HCPF is considering removing eight services from certain waivers. The largest: Community Connector from CES and CHRP (11,282 members, $15.6 million) and Extraordinary Cleaning from CES and SLS (7,825 members, $12.8 million). The other six are Mentorship, Primary Caregiver Education, Substance Use Counseling, Mental Health Counseling, Adaptive Therapeutic Recreation Equipment and Fees, and Youth Day Services.
Medical Services Board: No rule filed yet
HCPF savings estimate: $30.0 million a year combined, State General Fund (HCPF preliminary estimates) HCPF impact summary
What it means for you: Families on CES are hit hardest: Community Connector and Extraordinary Cleaning together reach more than 19,000 member authorizations. HCPF says removing a service doesn't mean another one will replace it. Needs a waiver amendment and a rule.
Lower the Personal Care soft cap to about 40 hours a week
HCPF is considering a Personal Care soft cap of 8,320 units a year (about 40 hours a week), down from 10,000 units (about 47.75 hours). HCPF counts about 3,800 members (11% of Personal Care members) authorized above 40 hours. An exception process would exist for assessed need. Needs a State Plan Amendment and a rule.
Medical Services Board: No rule filed yet
HCPF savings estimate: $9 million a year, State General Fund (HCPF preliminary estimate) HCPF impact summary
What it means for you: About 8 fewer hours a week before an exception is needed. It would apply at your next Continued Stay Review, and a reduction comes with written notice and appeal rights; benefits can continue during an appeal.
Lower the Homemaker soft cap to about 7 hours a week
HCPF is considering a Homemaker soft cap of 1,456 units a year (about 7 hours a week) for every member, down from 4,500 units (about 21.5 hours). It would apply to agency care, IHSS, and CDASS. HCPF counts about 34,000 members (79% of Homemaker members) authorized above 7 hours. A narrow exception process would exist. Needs a State Plan Amendment and a rule.
Medical Services Board: No rule filed yet
HCPF savings estimate: $12 million a year, State General Fund (HCPF preliminary estimate) HCPF impact summary
What it means for you: This would cut the Homemaker ceiling by about two thirds, whoever provides the care. It would apply at your next Continued Stay Review, with written notice and appeal rights if your hours drop.
Limit paid Homemaker by family caregivers to 7 hours a week
HCPF is considering extending the 7-hour weekly Homemaker limit for parents of minors and spouses to every family caregiver related by blood, marriage, adoption, or common law. All family caregivers for one member would share the 7 hours. There would be no exception process. HCPF estimates about 60% of members with more than 7 Homemaker hours get them from a family member. Needs a State Plan Amendment and a rule; federal approval is under review.
Medical Services Board: No rule filed yet
HCPF savings estimate: $29 million a year, State General Fund (HCPF preliminary estimate) HCPF impact summary
What it means for you: Adult children, siblings, and grandparents would be capped at 7 paid Homemaker hours a week per member, with no exceptions. Any hours above that would have to come from a caregiver outside the family.
Limit paid Personal Care by parents and guardians of children to 7 hours a week
HCPF is considering a hard 7-hour weekly limit on paid Personal Care from a parent or legal guardian of a minor child. Two parents would share the 7 hours, and other relatives wouldn't be limited. There would be no exception process. About 4,150 members under 20 (76%) are authorized for more than 7 hours a week; HCPF doesn't know how many of those hours a parent provides. Needs a State Plan Amendment and a rule; federal approval is under review.
Medical Services Board: No rule filed yet
HCPF savings estimate: $11 million a year, State General Fund (HCPF preliminary estimate) HCPF impact summary
What it means for you: For a parent paid for Personal Care today, this is the biggest proposal on the page. Hours above 7 would need another caregiver, and HCPF's summary says some care could go unpaid.
Remove Personal Care for children from Community First Choice (CFC)
HCPF is considering removing Personal Care for children from Community First Choice (CFC). About 5,500 children are authorized for it today, nearly all newly. Qualifying children could move to Pediatric Personal Care through the State Plan, which uses a separate assessment and doesn't allow family members to be the paid caregiver. There would be no exception process. Needs a State Plan Amendment and a rule; federal approval is under review.
Medical Services Board: No rule filed yet
HCPF savings estimate: $17 million a year, State General Fund (HCPF preliminary estimate) HCPF impact summary
What it means for you: Parents paid for their child's Personal Care today would likely lose that income; HCPF's own summary says so. Child Personal Care participation rose 1,563% between March 2025 and March 2026, which is why it's on the table.
Weekly caregiver limit (phasing down to 56 hours)
Limits paid caregiving for one member from a single caregiver, phasing down: 84 hours a week from July 1 through December 31, 2026; 70 hours from January 1 through June 30, 2027; 56 hours from July 1, 2027. The 16-hour daily cap stays. Covers Home Health Aide, Personal Care, Homemaker, HMA, and Nursing. An exception process exists. See OM 26-043.
Medical Services Board: Permanent rule adopted
- Jun 12, 2026 Emergency adoption: Adopted 8-1 MSB 26-05-05-B
Caregiver Limits, Secs. 8.520, 8.7400, 8.7500 - Aug 14, 2026 Final adoption + emergency renewal: Adopted 10-0 MSB 26-06-14-B / 26-08-01-B
Added exceptions for extraordinary clinical acuity, workforce access barriers, transition or stabilization needs, and end of life; 21-day exception review
HCPF savings estimate: No estimate published for the phased version. HCPF's November 2025 estimate ($1.1 million General Fund, FY 2026-27) covered an earlier design. HCPF budget fact sheet
What it means for you: Today's limit is 84 hours. Plan now for 70 in January and 56 next July: hours above the limit will need an exception or a second caregiver.
Annual soft caps on Personal Care, Homemaker, and HMA
Annual caps of about 19,000 units for HMA (about 13 hours a day), 10,000 for Personal Care (about 6.8 hours a day), and 4,500 for Homemaker (about 3 hours a day). Exceptions exist for demonstrated need. See OM 26-003.
Medical Services Board: Permanent rule adopted
- Apr 10, 2026 Final adoption: Adopted 7-0, as amended MSB 26-02-25-A
Made February 2026 emergency rules permanent. HCPF estimated about 6% of Personal Care, 10% of Homemaker, and 7% of HMA users affected; requests above a cap go to HCPF, which answers within 14 days
HCPF savings estimate: $2.6 million General Fund (HCPF rule document, April 2026; time period not stated). HCPF's November 2025 estimate was $6.9 million for FY 2026-27. MSB 26-02-25-A
What it means for you: These are the caps Round 1 proposes to lower. HMA is untouched by the new proposals so far.
Weekly Homemaker cap for legally responsible persons: 7 hours
Homemaker paid to legally responsible persons (parents of minors, spouses) is capped at 7 hours a week per member. HCPF's first version allowed 5 hours a week per LRP. See OM 26-042.
Medical Services Board: Permanent rule adopted
- Apr 10, 2026 Final adoption: Adopted 7-0, as amended MSB 26-02-25-A
Set up to two LRPs at 260 Homemaker hours a year each (about 5 a week) - Jun 12, 2026 Approval: Approved 9-0 MSB 26-05-05-A
Replaced that with 7 hours a week per member, however many LRPs live in the home - Aug 14, 2026 Final adoption + emergency renewal: Adopted 10-0 MSB 26-06-14-C / 26-08-01-C
HCPF savings estimate: No estimate published for the 7-hour version. HCPF's November 2025 estimate ($223,000 General Fund, FY 2026-27) covered the 5-hour design. HCPF budget fact sheet
What it means for you: Stakeholder pushback moved the structure from 5 hours per parent to 7 per member. Comments do change outcomes.
Across-the-board provider rate reductions (1.6% and 2%)
A 1.6% reduction took effect October 1, 2025. On March 31, 2026, the Joint Budget Committee approved a 2% reduction in place of HCPF's proposed 0.75%, effective July 1, 2026.
HCPF savings estimate: 1.6% rollback: $38.3 million General Fund in FY 2025-26 and $57.0 million in FY 2026-27, across all Medicaid providers. No published estimate found for the 2% reduction. HCPF budget fact sheet
What it means for you: Agencies got paid less per hour twice in nine months. Ask yours whether either reduction reached your paycheck.
Agency marketing, conflict of interest, and IHSS back-up rules
Sets marketing, outreach, and conflict-of-interest rules for HCBS and Community First Choice (CFC) provider agencies, and back-up support requirements for In-Home Support Services. Not listed on HCPF's sustainability page.
Medical Services Board: Permanent rule adopted
- Jul 10, 2026 Initial approval: Approved 8-0 MSB 26-03-02-A
- Aug 14, 2026 Final adoption: Adopted 10-0 MSB 26-03-02-A
HCPF savings estimate: No savings estimate found in HCPF's published documents.
What it means for you: Agencies face new limits on how they recruit families, and IHSS agencies must have back-up coverage ready. HCPF says enforcement starts with education and escalates for repeat problems.
Group rates for IHSS, Personal Care, Homemaker, and CNA
Lets one caregiver serve more than one member at the same time at a group rate, for LTHH CNA and for Personal Care, Homemaker, and HMA under Community First Choice (CFC), including IHSS. CDASS is excluded. HCPF's rule says group rates are expected to be no less than 50% of the individual rate.
Medical Services Board: Final vote held, result not posted
- Sep 11, 2026 Initial approval: Approved MSB 26-04-15-A
Secs. 8.520, 8.7000 - Oct 9, 2026 Final adoption: Vote not yet posted MSB 26-04-15-A
Proposed effective Nov 30, 2026; HCPF plans a State Plan Amendment for Jan 1, 2027
HCPF savings estimate: HCPF expects "significant savings" but published no figure. MSB 26-04-15-A
What it means for you: If you care for two family members at the same time under one roof, each hour could bill at a lower rate per member. The final vote happened October 9; the result posts with the Board's minutes.
Colorado Single Assessment (CSA) rollout
A single assessment tool and Person-Centered Support Plan for everyone seeking or receiving LTSS, rolling out gradually over the first year.
HCPF savings estimate: No savings estimate found in HCPF's published documents.
What it means for you: Your next assessment may use a new tool. Bring your documentation; the assessment drives every hour on your plan.
Medical documentation requirements for LTSS eligibility
A Medical Services Board rule revising medical documentation requirements for LTSS (Sec. 8.7100.A). Not listed on HCPF's sustainability page; tracked here because it controls who qualifies.
Medical Services Board: Final vote held, result not posted
- Sep 11, 2026 Initial approval: Approved MSB 26-02-04-B
- Oct 9, 2026 Final adoption (consent): Vote not yet posted MSB 26-02-04-B
HCPF savings estimate: No savings estimate found in HCPF's published documents.
What it means for you: If your family member's next eligibility review asks for new paperwork from a doctor, this rule is likely why. Keep a current letter from a treating provider on file.
Align Community Connector rate with Supported Community Connections
Reduces Community Connector pay to the Tier 3 Supported Community Connections rate, about $7.71 per 15-minute unit. See OM 26-034 (May 14, 2026), which replaced OM 26-034 and OM 26-011.
HCPF savings estimate: $1.5 million General Fund in FY 2025-26; $9.2 million in FY 2026-27 HCPF budget fact sheet
What it means for you: Lower rate for a service many CES families use.
Cut Community Connector annual units in half
Maximum units drop from 2,080 to 1,040 per support plan year. See OM 26-034 (May 14, 2026), which replaced OM 26-034 and OM 26-011.
Medical Services Board: Permanent rule adopted
- Apr 10, 2026 Final adoption: Adopted 7-0, as amended MSB 26-02-25-A
Same rule as the annual soft caps
HCPF savings estimate: $1.2 million General Fund in FY 2025-26; $10.2 million in FY 2026-27. Covers the unit cut and the extraordinary-need rules together. MSB 26-02-25-A
What it means for you: Half the hours a year.
Community Connector requires extraordinary support need
Services must rest on an age-appropriate assessed need that substantially exceeds typical parental responsibilities. Age alone can't be the reason for a denial.
HCPF savings estimate: Counted with the unit cut: $10.2 million General Fund in FY 2026-27 for both. MSB 26-02-25-A
What it means for you: Documentation now carries the authorization.
Reduce DD Waiver churn enrollments by 50%
Pauses churn enrollments in the DD Waiver, cutting them by half. Members stay on the waitlist and keep their current waiver until the pause lifts.
Medical Services Board: Board history
- Apr 10, 2026 Initial approval: Pulled from agenda MSB 25-10-22-A
The youth-transition piece came back as MSB 26-07-05-A
HCPF savings estimate: $6.5 million in FY 2026-27 and $18.7 million in FY 2027-28. Fund type not stated. MSB 25-10-22-A
What it means for you: Longer waits for the DD Waiver.
Remove equine services from HCBS waivers
Removed because of system issues delaying implementation. HCPF reports no members currently use the service.
Medical Services Board: Permanent rule adopted
- May 8, 2026 Initial approval: Approved 6-0 MSB 25-10-22-C
Repeals Sec. 8.7524 - Jun 12, 2026 Final adoption (consent): Adopted 10-0 MSB 25-10-22-C
HCPF savings estimate: No savings figure; HCPF reports no members were using the service. HCPF hub
What it means for you: No one loses a service they have today.
DD Waiver cost of care contribution (PETI)
Applies Post-Eligibility Treatment of Income to DD Waiver members, so they contribute part of their income toward service costs like other residential waivers.
Medical Services Board: Permanent rule adopted
- Apr 10, 2026 Initial approval: Approved 7-0 MSB 25-10-22-B
Commenters said more than 10,000 waiver members would be affected - May 8, 2026 Final adoption: Adopted 6-2 MSB 25-10-22-B
HCPF savings estimate: $6.3 million in FY 2026-27 (3,828 members) and $13.1 million in FY 2027-28 (3,977 members). Fund type not stated. MSB 25-10-22-B
What it means for you: Some DD Waiver members now pay part of the cost of care.
End automatic youth transitions onto the DD Waiver
Ends automatic DD Waiver enrollment for youth aging out of CES or CHRP. They can move to Community First Choice (CFC) or another waiver and join the DD waitlist. Youth in foster care or crisis keep prioritized enrollment.
Medical Services Board: Final vote held, result not posted
- Apr 10, 2026 Initial approval: Pulled from agenda MSB 25-10-22-A
- Sep 11, 2026 Initial approval: Approved MSB 26-07-05-A
- Oct 9, 2026 Final adoption: Vote not yet posted MSB 26-07-05-A
Proposed effective Nov 30, 2026. Case management agency payment liability language was removed before the final reading
HCPF savings estimate: $15.3 million in FY 2026-27 and $43.7 million in FY 2027-28. Fund type not stated. MSB 25-10-22-A
What it means for you: Families with a teen on CES or CHRP should plan the adult transition early.
Private Duty Nursing 60-day acute benefit
After a hospital discharge or new admission, PDN may be provided for up to 60 days without a prior authorization in place.
Medical Services Board: Final vote held, result not posted
- Sep 11, 2026 Initial approval: Approved MSB 26-04-01-A
Private Duty Nursing, Sec. 8.540 - Oct 9, 2026 Final adoption: Vote not yet posted MSB 26-04-01-A
HCPF savings estimate: No savings estimate found in HCPF's published documents.
What it means for you: One of the few items that adds flexibility.
New billing units for Long-Term Home Health
Converts LTHH CNA to 15-minute units and PT, OT, and speech therapy to 30-minute units.
HCPF savings estimate: No savings estimate found in HCPF's published documents.
What it means for you: Mostly an agency billing change.
Standard rate tool for Residential Habilitation negotiated rates
A new rate-setting method for negotiated residential rates in the DD and CHRP waivers.
HCPF savings estimate: No savings estimate found in HCPF's published documents.
What it means for you: Affects residential providers only.
End the nursing facility minimum wage supplemental payment
The payment was set to sunset in 2027; HCPF ended it a year early. Spring 2026 payments didn't go out.
HCPF savings estimate: $4.4 million General Fund in FY 2025-26 and again in FY 2026-27 HCPF budget fact sheet
What it means for you: Nursing facilities only.
Community Connector rate reduction
Aligned Community Connector rates to service scope and training requirements. See OM 26-005.
HCPF savings estimate: $3.0 million General Fund in FY 2025-26; $6.0 million in FY 2026-27 HCPF budget fact sheet
What it means for you: The first of three Community Connector changes this year.
Delay LTSS Presumptive Eligibility
Postpones a program that would let people who appear eligible start limited services while Medicaid eligibility is pending. HCPF now expects to launch it in Summer 2027.
HCPF savings estimate: $690,000 General Fund in FY 2025-26; $1.47 million in FY 2026-27 HCPF budget fact sheet
What it means for you: New families still wait for full eligibility before services start.
IRSS rate alignment for Host Homes and Family Caregiver Homes
Paused pending Colorado legislative and federal approval. See OM 26-009.
HCPF savings estimate: Paused. HCPF's November 2025 estimate was $2.3 million General Fund for FY 2026-27. HCPF budget fact sheet
What it means for you: On hold. Could come back.
Movement Therapy rate reduction
HCPF requested withdrawal, saying a cut isn't justified given the professional standards for these therapies.
HCPF savings estimate: Withdrawn. HCPF had estimated $358,000 General Fund for FY 2026-27. HCPF budget fact sheet
What it means for you: Off the table.
Private Duty Nursing per diem rate
Dropped after HCPF found the savings didn't outweigh the operational complexity. Hourly PDN billing stays.
HCPF savings estimate: No savings estimate found in HCPF's published documents.
What it means for you: Off the table.
Medical Services Board record
The Board writes HCPF's changes into rule. Every vote tied to an action on this page, newest first. Next meeting: November 13, 2026. The October 9 votes on group rates, Private Duty Nursing, DD Waiver youth transitions, and LTSS medical documentation will show in the Board's minutes, which usually post with the next meeting's materials.
| Date | Action and rule | Reading | Outcome |
|---|---|---|---|
| Oct 9, 2026 | Group rates for IHSS, Personal Care, Homemaker, and CNA MSB 26-04-15-A | Final adoption | Vote not yet posted |
| Oct 9, 2026 | Medical documentation requirements for LTSS eligibility MSB 26-02-04-B | Final adoption (consent) | Vote not yet posted |
| Oct 9, 2026 | End automatic youth transitions onto the DD Waiver MSB 26-07-05-A | Final adoption | Vote not yet posted |
| Oct 9, 2026 | Private Duty Nursing 60-day acute benefit MSB 26-04-01-A | Final adoption | Vote not yet posted |
| Sep 11, 2026 | Group rates for IHSS, Personal Care, Homemaker, and CNA MSB 26-04-15-A | Initial approval | Approved |
| Sep 11, 2026 | Medical documentation requirements for LTSS eligibility MSB 26-02-04-B | Initial approval | Approved |
| Sep 11, 2026 | End automatic youth transitions onto the DD Waiver MSB 26-07-05-A | Initial approval | Approved |
| Sep 11, 2026 | Private Duty Nursing 60-day acute benefit MSB 26-04-01-A | Initial approval | Approved |
| Aug 14, 2026 | Weekly caregiver limit (phasing down to 56 hours) MSB 26-06-14-B / 26-08-01-B | Final adoption + emergency renewal | Adopted 10-0 |
| Aug 14, 2026 | Weekly Homemaker cap for legally responsible persons: 7 hours MSB 26-06-14-C / 26-08-01-C | Final adoption + emergency renewal | Adopted 10-0 |
| Aug 14, 2026 | Agency marketing, conflict of interest, and IHSS back-up rules MSB 26-03-02-A | Final adoption | Adopted 10-0 |
| Jul 10, 2026 | Agency marketing, conflict of interest, and IHSS back-up rules MSB 26-03-02-A | Initial approval | Approved 8-0 |
| Jun 12, 2026 | Weekly caregiver limit (phasing down to 56 hours) MSB 26-05-05-B | Emergency adoption | Adopted 8-1 |
| Jun 12, 2026 | Weekly Homemaker cap for legally responsible persons: 7 hours MSB 26-05-05-A | Approval | Approved 9-0 |
| Jun 12, 2026 | Remove equine services from HCBS waivers MSB 25-10-22-C | Final adoption (consent) | Adopted 10-0 |
| May 8, 2026 | Remove equine services from HCBS waivers MSB 25-10-22-C | Initial approval | Approved 6-0 |
| May 8, 2026 | DD Waiver cost of care contribution (PETI) MSB 25-10-22-B | Final adoption | Adopted 6-2 |
| Apr 10, 2026 | Annual soft caps on Personal Care, Homemaker, and HMA MSB 26-02-25-A | Final adoption | Adopted 7-0, as amended |
| Apr 10, 2026 | Weekly Homemaker cap for legally responsible persons: 7 hours MSB 26-02-25-A | Final adoption | Adopted 7-0, as amended |
| Apr 10, 2026 | Cut Community Connector annual units in half MSB 26-02-25-A | Final adoption | Adopted 7-0, as amended |
| Apr 10, 2026 | Reduce DD Waiver churn enrollments by 50% MSB 25-10-22-A | Initial approval | Pulled from agenda |
| Apr 10, 2026 | DD Waiver cost of care contribution (PETI) MSB 25-10-22-B | Initial approval | Approved 7-0 |
| Apr 10, 2026 | End automatic youth transitions onto the DD Waiver MSB 25-10-22-A | Initial approval | Pulled from agenda |
How a change becomes a rule
HCPF's feedback sessions and impact summaries come first, and they're optional; HCPF calls them early input gathered before it files a formal notice. The formal path for a permanent rule has seven steps, per HCPF's stakeholder engagement protocols:
- NoticePeople signed up under Executive Order 5 get an email that a rule revision has started.
- Rule developmentThe rule author asks stakeholders and partners for input on the draft.
- DORAThe draft goes to the Department of Regulatory Agencies; anyone can request a cost-benefit analysis.
- Colorado RegisterThe Secretary of State publishes the notice of proposed rulemaking.
- Public rule reviewHCPF holds a meeting to talk through the draft with the rule author.
- MSB initial readingFirst Board vote. The rule can still change, and you can testify.
- MSB final readingSecond Board vote. Some changes are still possible, and you can testify again.
Four other ways changes arrive
- Emergency rules. The Board adopts a rule at one meeting and it takes effect right away, for up to 120 days after adoption (C.R.S. 24-4-103(6)). To last longer, it has to be renewed or made permanent. The weekly caregiver limit started this way on June 12, 2026, and became permanent August 14.
- The budget. The legislature's Joint Budget Committee sets provider rates. It chose the 2% across-the-board reduction on March 31, 2026; HCPF then posts new rate schedules.
- Federal approval. Waiver amendments and State Plan Amendments go to CMS. A Board-adopted rule can still wait on that approval, which is why several actions on this page say "pending federal approval."
- Memos. HCPF's memo series tells case managers and agencies how to carry out a law, rule, or policy, and often sets the working start date.
The Board meets the second Friday of each month. Email written testimony to hcpf_medical_services_board@state.co.us by 5 p.m. the Thursday before; later testimony reaches Board members only after the meeting.
Questions families ask us
What is LTSS sustainability in Colorado?
It's HCPF's name for its work to bring Long-Term Services and Supports spending growth back to a pace Colorado can fund. LTSS serves about 8% of Colorado Medicaid members but accounts for 48% of Medicaid General Fund spending. HCPF says Colorado isn't unusual in that share; the problem is how fast spending has grown. It attributes recent growth to utilization (45.9%), provider rate increases (42.7%), and enrollment (11.4%).
Are the new Personal Care and Homemaker changes final?
No. As of November 1, 2026, HCPF says no final decisions have been made on the Round 1 or Round 2 proposals. Round 1 feedback closed in October 2026 and HCPF is analyzing it. Round 2 feedback sessions ran October 27 and 28, and HCPF's written feedback form is still posted. Any change still needs a rule through the Medical Services Board, and many need federal approval.
Which LTSS changes are permanent rules?
As of November 1, 2026, the Medical Services Board has adopted permanent rules for the phased weekly caregiver limit, the 7-hour LRP Homemaker cap, and agency marketing and IHSS back-up rules (all August 14, 2026, 10-0), the annual Personal Care, Homemaker, and HMA soft caps (April 10, 2026), DD Waiver PETI (May 8, 2026), and the equine repeal (June 12, 2026). Final votes on group rates, Private Duty Nursing, and DD Waiver youth transitions happened October 9, 2026; results post with the Board's minutes.
How much would these changes save?
HCPF's preliminary estimates for the 8 pending proposals add up to about $149.6 million a year in State General Fund ($78.0 million for Round 1 and $71.6 million for Round 2), but several overlap, so passing all of them would save less. Adopted LTSS changes with a stated FY 2026-27 General Fund estimate total about $31.3 million, and the 1.6% provider rate rollback adds $57.0 million across all Medicaid providers. Colorado Medicaid's FY 2026-27 General Fund need above forecast is about $425 million.
Will I have to use EVV if I live with the person I care for?
Not today. Live-in caregivers are currently exempt from Electronic Visit Verification. In October 2026 HCPF proposed removing that exemption, with no effective date yet. You can comment through HCPF's written feedback form.
What is Colorado's weekly caregiver limit?
It limits how many paid hours one caregiver can work for one member each week, across Home Health Aide, Personal Care, Homemaker, HMA, and nursing services. It phases down: 84 hours a week from July 1 through December 31, 2026; 70 hours from January 1 through June 30, 2027; and 56 hours from July 1, 2027. The 16-hour daily cap still applies, and an exception process exists for members who meet the criteria. Our exception process guide walks through each phase.
How do I comment on a proposal?
Submit HCPF's written feedback form, which doesn't require attending anything. Join a feedback session; HCPF says Round 3 sessions come in fall 2026, with dates not announced yet. Or testify at the Medical Services Board once a rule reaches its agenda; written testimony is due by 5 p.m. the Thursday before the meeting.
How often is this tracker updated?
Every Sunday. We check HCPF's Medicaid Sustainability page, the Medical Services Board's agendas and minutes, and HCPF's operational memos, then update statuses, dates, and agendas. The last-checked date at the top shows the most recent review.
Caregivers First Choice tracks these actions from HCPF's Medicaid Sustainability and LTSS page, the Medical Services Board page, and the 2026 memo series. The "what it means" notes are our reading; HCPF's documents and adopted rules control. Last checked November 1, 2026.
