Colorado Personal Care & Homemaker Cuts: What HCPF Is Proposing

The Colorado Department of Health Care Policy and Financing (HCPF) is weighing five Personal Care and Homemaker cuts, each estimated to save between $9 million and $29 million a year in state General Fund dollars. They’re options on the table, not a package, and none of them is final.

Each still needs state rule making and a State Plan Amendment approved by the federal government, and for current members, the two proposed hour limits would apply at each person's next annual reassessment, not on a single statewide date.

If you're a family caregiver, nothing about your hours or your pay changes today. Here's what's on the table, why HCPF is looking at it, and what Caregivers First Choice, an Arvada home care agency that enrolls family caregivers, thinks the State should do with it.

Why HCPF is weighing Personal Care and Homemaker cuts now

The growth came faster than anyone planned for.

HCPF projects Community-Based Long-Term Care will need about $245 million more General Fund in fiscal year 2026-27 than it previously forecast. Two services sit at the center of that number: Homemaker, which covers household help like cleaning, laundry, and meal prep, and Personal Care, which covers hands-on help with bathing, dressing, eating, and getting around.

• Paid Homemaker claims went from $172 million in FY 2024-25 to $346 million in FY 2025-26 (HCPF's preliminary figures), a 101% increase in one year.
• Average monthly participants rose from 13,030 to 22,571.
• Personal Care went from $558 million to $727 million over the same stretch.
• Children's Personal Care participation rose 1,563% between March 2025 and March 2026; about 5,500 children were authorized as of May 2026, nearly all of them new.

Community First Choice, the Medicaid benefit Colorado launched on July 1, 2025, is part of that story. It expanded when family members can be paid for Personal Care and Homemaker, and for the first time it let parents be paid for a minor child's Personal Care. HCPF expected participation to rise but the rise was much larger than projected. Homemaker spending was already climbing before it started, and HCPF points to two broader drivers: more people using more services, and provider rate increases between 2021 and 2025, some of which the State has since rolled back with reductions in October 2025 and July 2026. Community First Choice also brings in an enhanced federal match that saves the State money.

HCPF has also been clear about what the growth doesn't mean. It says it hasn't concluded that members are receiving services they don't need, and that people receiving these services have assessed needs. The problem it's trying to solve is paying for those needs within the money available.

A service whose spending doubles in a year can't keep growing at that rate. We agree. Where we part ways with some of these proposals is in how they respond.

HCPF also deserves credit for how it's handling this. It published a separate impact summary for each proposal, openly said where the data falls short, and ran a public survey to gather feedback before anything is decided, open to Medicaid members, paid and unpaid family caregivers, advocates, providers, and case managers. We submitted our input, and we'd encourage HCPF to keep that door open as proposals move into rule making.

Where the money comes from, and why a General Fund gap forces choices

Colorado's budget draws on three main sources. The General Fund is the most flexible money; it comes mostly from income and sales taxes and pays for education, health care, human services, and prisons. Cash funds come mostly from fees, and state law dictates how they're spent (gas taxes and vehicle registration fees go to transportation, for example). Federal funds come from Washington for programs like Medicaid.

Medicaid runs on two of those: state dollars, largely General Fund, plus a federal match. Every savings figure in HCPF's proposals counts General Fund only. Community First Choice also earns an extra 6% federal match, so each General Fund dollar cut from it removes a bit more than $2 of care once the federal share is counted (our estimate).

The State can't borrow to cover the gap. Colorado's constitution requires a balanced budget every year, and the Taxpayer's Bill of Rights (TABOR) limits how much revenue the State can keep. When Medicaid's General Fund need jumps by $245 million, that money has to come out of other programs or out of Medicaid itself. That's the choice in front of HCPF.

The five proposals, simplified

Two limit how much care a member can get. Two limit who can be paid to provide it. One ends a benefit for children.

1. Lower the Homemaker soft cap to about 7 hours a week
The annual Homemaker limit would drop from 4,500 units (about 21.5 hours a week) to 1,456 units (about 7 hours a week). It applies however a member receives care: through an agency, Consumer-Directed Attendant Support Services (CDASS), or In-Home Support Services (IHSS). About 34,000 members, roughly 79% of everyone receiving Homemaker, are currently authorized above 7 hours. A narrow exception process based on assessed need would be available. Estimated savings: $12 million a year.

2. Limit paid family caregivers to 7 Homemaker hours a week, combined
This one carries the largest savings, $29 million a year. Family caregivers, meaning anyone related to the member by blood, marriage, adoption, or common law, could be paid for no more than 7 Homemaker hours a week per member, combined across every relative providing care. There's no exception process.
The member's authorization doesn't change; any hours above 7 would need to come from a caregiver who isn't family. The proposal expands a 7-hour Homemaker limit that already applies to Legally Responsible Persons (LRPs), meaning parents of minor children and spouses, so that it covers every family caregiver. HCPF doesn't have data on how many members get Homemaker from family. It estimates about 60% of members authorized above 7 hours.

3. Remove Personal Care for children from Community First Choice
Children would no longer receive Personal Care through Community First Choice. They could apply for the older State Plan Pediatric Personal Care benefit instead, which uses a different assessment (the Personal Care Assessment Tool, or PCAT) and doesn't allow family members to be paid. About 5,500 children could be affected. There's no exception process, and HCPF hasn't set a transition timeline. Estimated savings: $17 million a year.

4. Lower the Personal Care soft cap to about 40 hours a week
The annual limit would drop from 10,000 units (about 47.75 hours a week) to 8,320 units (about 40). About 3,800 members, roughly 11% of Personal Care recipients, are authorized above that line. An exception process based on assessed need would be available. Estimated savings: $9 million a year.

5. Limit parents' paid Personal Care to 7 hours a week
Parents and legal guardians of minor children could be paid for up to 7 Personal Care hours a week per child, combined. It's a hard cap with no exceptions, and it wouldn't apply to other relatives such as grandparents, aunts, or adult siblings. HCPF doesn't know how many parents are paid above 7 hours today; about 4,150 members under age 20, roughly 76%, are authorized above that amount. Estimated savings: $11 million a year.

All five need a State Plan Amendment and state rulemaking. None needs a waiver amendment. HCPF says the two soft caps are federally allowable; the two caregiver limits and the children's removal are still under federal review.

What these proposals don't solve

Several of these Personal Care and Homemaker cuts are alternatives to each other, so expect HCPF to move forward with some and set others aside. The parent limit and removing children's Personal Care target the same children; if the benefit is removed, the parent limit has nothing left to apply to. The Homemaker soft cap and the family Homemaker limit overlap the same way. If most authorizations drop to 7 hours, a 7-hour family limit has little left to do.

That's why HCPF's five estimates can't simply be added up. On paper they total $78 million. By our estimate, built from HCPF's figures, the largest realistic combination saves $55 million to $65 million (our calculation, not HCPF's). Against a $245 million forecast increase, even that leaves most of the gap open.

Timing matters too. Because the hour limits apply at each member's annual reassessment, savings build over the year after the rules take effect. By our read, most of them arrive after July 2027.

They also aren't the first round. Several sustainability actions are already in effect:

• Since April 1, 2026: annual soft caps on Personal Care (10,000 units), Homemaker (4,500 units), and Health Maintenance Activities (19,000 units), each with an exception process.
• Also April 1, 2026: the Homemaker limit for Legally Responsible Persons dropped from 10 hours a week to 7.
• Since July 1, 2026: a phase down to 56-hour weekly limit on paid care from any single caregiver, with an exception process.
• October 1, 2025 and July 1, 2026: across-the-board provider rate reductions of 1.6% and 2%.

And they won't be the last. These five proposals came out of the first of three roundtables HCPF has planned. The second will review the full package of HCBS and Community First Choice benefits; the third will look at enrollment trends and program design. Both are set for fall 2026, with dates still to be announced. HCPF also expects more pressure as federal Medicaid changes under H.R. 1 take effect over the next few years, and its sustainability page says that the agency "cannot rely on a single policy or program change."

Families should plan for more proposals rather than panic about each one. The benefit package review deserves the closest watch, because it could redefine what Personal Care and Homemaker include.

Where Caregivers First Choice stands

Full transperancy: we enroll family caregivers, so two of these proposals hit our model directly. Weigh our position with that in mind. We've tried to build it on HCPF's own numbers.

Personal Care soft cap at 40 hours: support, with conditions. It affects about 1 in 9 members and keeps a path to more hours. Our conditions: publish exception criteria before the cap takes effect, decide requests within 14 days, report approval rates publicly, and continue care during an appeal when a family disputes how the member's needs were measured.

Homemaker soft cap at 7 hours: change it. Before setting a lower cap, bring authorizations in line with HCPF's Direct Care Services Calculator (DCSC). Then set the cap from that baseline. Treat any cap as temporary until the Colorado Single Assessment, HCPF's new needs assessment, is fully in use. HCPF lists its rollout as phasing in gradually starting in fiscal year 2026-27, and a cap built on today's tools shouldn't outlast the tools themselves.

Family Homemaker limit: oppose as written. Reimbursement rates are set by service, so the State pays the same hourly rate whether a relative or an unrelated caregiver provides the care. That means this proposal saves money mainly when the displaced hours go unpaid. It also has no exception for members with no other caregiver available, which is common in rural counties and for overnight or behavioral care. Members who direct their own care can choose who provides it, and HCPF's own survey lists preserving self-direction as a priority; a family limit with no exceptions narrows that choice. HCPF also has no reliable way today to identify which caregivers are family. Our ask: apply the limit only to new authorizations, allow an exception when no non-family caregiver is available, and collect caregiver relationship data before enforcing anything.

Removing children's Personal Care: oppose. The parent limit saves $11 million and keeps the benefit. Removal saves $6 million more and ends Personal Care under Community First Choice for every child, including kids cared for by grandparents or agency staff. Federal law still requires Medicaid to cover care children medically need, under EPSDT (Early and Periodic Screening, Diagnostic and Treatment), so the need doesn't disappear. HCPF's own summary notes some children may shift to Long-Term Home Health, which can cost more.

Parent Personal Care limit: better than removal, wrong as written. Keeping the benefit beats ending it, but a flat 7 hours a week doesn't match how many of these children live. A child with high behavioral needs may need hands-on help through every part of the day: dressing, bathing, eating, and staying safe. For support that doesn't rise to Health Maintenance Activities, Personal Care is usually the right service, and for many of these families no outside caregiver will take the hours. Our ask: set the parent limit by assessed need, with higher hours for children with significant behavioral or medical needs, a hospital level of care, or no available non-parent caregiver, plus a transition period of at least one reassessment cycle for families already receiving care.

One idea runs across all five. Apply new limits to people who enroll after the rules take effect, and let families already providing care keep their hours. That matches HCPF's stated goal of slowing growth, and since these changes phase in slowly anyway, it costs the State very little this year.

What families should do right now

Case managers will carry most of the work if any of this passes: new assessments, notices, exception requests. They're learning about these proposals on the same timeline you are. If your case manager doesn't have answers yet, it's because nobody does.

In the meantime:

• Don't change your work schedule or care arrangement because of a proposal. None has been adopted.
• Make sure your support plan matches the care you actually give, and keep documentation. If limits arrive at reassessment, that documentation is what an exception request rests on.
• If you later receive a notice reducing your hours, move fast. To keep services in place during an appeal, the Office of Administrative Courts has to receive your request within 10 days of the date the change takes effect. Filing before that date is safest.
• Watch for the next comment windows. The written feedback deadline for this first round was October 11, 2026. Two more roundtables are planned for fall 2026, and any proposal that moves forward still goes through formal rulemaking, with public comment before Colorado's Medical Services Board. HCPF's OCL Digest newsletter announces meetings. When you comment, specifics carry the most weight: how many hours you provide, who else could cover them, and what happens if no one can.

What we're doing next. We'll attend HCPF's remaining roundtables and follow any proposal that moves into rulemaking. We'll also keep bringing what families tell us to HCPF through its stakeholder process, so those experiences reach the people making these decisions. When something changes, we'll post it, with what it means and what you can do about it.

If you're not sure which proposals touch your situation, call Caregivers First Choice at (303) 800-7081. We'll walk through it with you.