The Center of the Wheel: Why the 56-Hour Cap Fails Families (and How We’re Fighting Back)

Key Takeaways: The May 1st Crisis Update

• Existing Hours Protected: As of today, the state confirmed that existing hours will be allowed to continue while an exception process is pending.
  
• Broadened Exception Criteria: The criteria for exceptions have been expanded to recognize the reality of multifaceted complex care.
• The Frizell Amendment: Despite tireless advocacy, the budget passed without this amendment, making the 56-hour cap a reality we must now bypass through exceptions.
• CFC Handles the Red Tape: As your provider agency, we are responsible for initiating the request, gathering evidence, and proving the "staffing vacuum."

How do I get an exception to the Colorado Medicaid 56-hour cap?

To secure an exception, your provider agency (like Caregivers First Choice) must submit a request to your Case Management Agency (CMA) documenting your multifaceted complex care expertise. Requests can be submitted 30 days prior to the cap’s start date. Crucially, your current authorized hours remain in place while the state reviews your case.

A Personal Message

The defeat of the Frizell amendment in the Senate was a blow, it was a fight to keep the state's $1.2 billion deficit off the backs of families managing complex care. But while that legislative door closed, the Exception Process has been thrown wide open. The official language for this process is forthcoming, but we are already preparing. We aren't going to accept a policy that says your years of dedication count for "entry-level" on a pay scale, or that your choice is to allow a stranger in your home or manage the complexities of care as an off-the-clock parent, spouse, or sibling.

My personal frustration is remembering how this management of care was handled by institutionalization or emergency room visits not too long ago. This isn't about saving money, this is about shifting the burden of responsibility. As a long time advocate for family caregiving, even supporting the expansion of this program in other states, or fighting for Community First Choice being brought to Colorado alongside lifetime advocacy giants, I understand this pain and this challenge. 

I want to offer our commitment that we will fight for you, and prove you are the expert in care. We are already building the infrastructure to handle this new challenge but I must stress, this isn't an us for them approach that is needed. This is a real budgetary challenge with real collaboration needed across all facets of your care team.  

The Specialist at the Center of the Wheel

The state’s 2026 budget refers to your life’s work as "unskilled labor". This isn't just an insult; it’s a dangerous medical fallacy. For 20 years, you haven't just been "helping out," you have been the Center of the Wheel, managing multifaceted complex care that no medical professional could comprehend in a single shift. When the state looks at your home, they see a budget item. When I look at your home, I see a specialist managing:

• Advanced Medical Coordination: You are the only person who understands the subtle precursors to a crisis that a stranger would miss.
• Life Experience as Professional Tenure: Your 10, 15, or 20 years of family caregiving count as professional tenure deserving of professional wages.
• The Staffing Paradox: Forcing a stranger into a home where you are the only one who knows the "language" of care is a safety risk, not a "sustainability" measure.

The true "horror story" is the removal of this expertise. When the wheel breaks, the safety of your loved one is at risk. We are here to prove you are irreplaceable.

The 2026 Timeline: The Phased "Ramp-Down"

The state is phasing this in to address budget deficits, but we are using this time to secure your exceptions.

The Shield: Our May 1st Breakthrough

Today’s stakeholder meeting provided a vital shield. The state has confirmed that your current hours will stay in place while your exception is being reviewed. You don't have to fear a sudden loss of income while we fight the bureaucracy.

How CFC Provides "Radical Ease" in This Crisis:

• Agency-Led Advocacy: We are responsible for initiating the request to CMAs and gathering all supporting documentation.
• Documenting the "Why": we translate your years of multifaceted complex care into the clinical evidence the state requires.
• Proving Efforts: We take on the burden of providing proof of efforts to find backup caregivers, proving that your expertise is the only safe option.
• One-Week Pivot: Once a decision is rendered, we have one week to comply—meaning we must get your documentation right the first time to ensure a win.