ACC Program Improvement Advisory

Committee

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November 18th, 2020

Kim Bimestefer, Executive Director

• COVID-19 Updates

• Healthcare Disparities

• Impact of the Economic Downturn

• Governor's 2021-2022 Budget

• 2020 Colorado Election Updates

• ACA Discussion

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Today’s Agenda

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COVID-19 Updates: Colorado Data to 11/17/20

https://covid19.colorado.gov/

Positive Cases: 167,713

People tested: 1,472,457

Deaths among cases: 2,578

Deaths due to COVID-19: 2,276

• 1 of 110 in CO are contagious

• 1 in 64 in Denver

Colorado Hospital Stats

• 180 new hospital admissions

• 43% of adult ventilators in use

• 15% of beds occupied by COVID

• Hospitals increasing capacity,

augmenting staff, scale back

elective procedures

• Emergency Operations Center

returned to highest level

• CO-Polis unique leadership

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CO & US COVID Stats, as of Sat, Nov 14

United States

• 45 states w/ 10%+ increase

in cases wk over wk

• 69,455 people hospitalized

• 10.9M+ cases

• 245,600 deaths

• Emerging risks: winter

indoors, holiday gatherings, flu

season

Colorado Convention

Center

Denver

Tier 3 facility

Max capacity: 2,000 beds

St. Mary Corwin

Hospital

Pueblo

Tier 2.5 facility

Max capacity: 120 beds

St. Anthony North

Hospital

Westminster

Tier 2.5 facility

Max capacity: 78 beds

Alternate Care Sites In Case of System Breach

Significant staffing challenge

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Over 60% of COVID deaths are in nursing

homes, other residential care settings

Through 11/6, 239 residential

care facilities have had an outbreak.

"This past week brought startling

increases in almost every tracked

category." Strike Force Nov 13 report

Enforcement & Education

Testing for Disease

Presence

Cohorting & Facility Isolation

Staffing

Situational Awareness

Health &

Wellbeing /

Equity

Protecting Our Most Vulnerable

Recognized by

AARP as a national model

Actions You Can Do to help…

1. Socially distance

2. Wear your mask

3. Wash hands

4. Only interact with your

household during holidays

5. Help message: Share This

PSA with Your Contacts !

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We need YOUR leadership

Holiday stay safe Step-Up Campaign covid19.colorado.gov/social-media-graphics

Add Exposure Notifications to

Your Phone (contact

tracing) addyourphone.com

Stakeholder Resource Centers• New PHE Planning Stakeholder & Partner Resource Center available at

colorado.gov/hcpf/phe-planning➢ Latest federal updates

➢ HCPF Letter to Centers for Medicare & Medicaid Services

➢ Member messaging, member FAQs

• County & Eligibility partner FAQs, call center/front line worker talking

points and other materials in development.

• Member COVID Resources

• County & Eligibility Site COVID Resources

• Provider COVID Resources

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Healthcare Disparities

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“Hispanic residents are about 20% more likely

than white residents to die of treatable

conditions. There’s no one explanation for the

disparity in deaths, experts say.”

Denver Post, Oct 4, 2020

Health Equity Opportunity - People of Color

In Colorado:

• Hispanics are 22% of the pop and 38%

of COVID cases and hospitalizations.

• Black people are almost 5% of the pop

and nearly 10% of COVID hospitalizations and

7% of deaths,

• White people are 68% of the pop and 38% of

COVID cases.

Healthcare Disparities Opportunities

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Colorado has higher alcohol-related death and suicide rates

• #45 in the US for alcohol-related deaths

• #45 in the US for suicide rate

• More severe LGBTQ, veterans, American Indians/Alaskan Native, and

rural residents

• In May 2020 alone, 128 Coloradans died of drug overdoses (73 in

2019).

• COVID19 is driving increased need for behavioral health and

substance use disorder treatment

Addressing Disparities

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• Renewed focus: “Systemic, persistent racism is a public

health issue. When the color of your skin correlates with

your well-being and longevity, that is a public health

injustice that must be addressed.” – Jill Hunsaker Ryan (1)

• Stimulus $$ to provide increased insights

• Collaborate on a list of top priorities

•Advocates, carriers, providers, state agencies

• Gov EO, state example for employer EDI focus

• EDI lead hired at HCPF & in other agencies

•Targeting disparities in care as well

Impact of theEconomic Downturn

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672,000 Coloradans Received Unemployment Insurance March-Oct (22% of 2019 workforce)

2020 Month February March April May June July August September

Unemployment

%

2.5% 5.2% 12.2% 10.2% 10.6% 7.4% 6.7% 6.4%

Source: Unemployment Data from Colorado Department of Labor and Employment. Chart for the OSPB September 18, 2020 Revenue Forecast available at

https://www.colorado.gov/governor/office-state-planning-budgeting

Applications Received Daily broken out by Program

AF = Adult

Financial

CW = Colorado

Works

FA(SNAP) =

Expedited &

Non-Expedited

Food Assistance

MA = Medical

Assistance

This shows what assistance Coloradans are seeking. Over the last 30 days, 53% of

applications received were for a Food Assistance program. The second largest category

was for Medical Assistance, at 32%. Adult Financial and Colorado Works account for 15%

combined.

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Families are Struggling: Rent, Food, Health Care• 20% of Coloradans worry about feeding their family

• 22% of Coloradans are worried about losing their home

• 18% report being unable to pay for basic necessities (1)

• Applications for SNAP went up 55% between February and April (2)

2nd survey went out last week to verify WHY struggling to get covered

We must connect Coloradans to affordable coverage

- Sept 24th stakeholder meeting 200+ attendees, Dec 3 follow-up

Medicaid

Category

EnrollmentCount of Clients enrolled by aid code.

Chart shows total enrollments by time periods

and the changes in its composition over time.

The two populations

which have seen the

greatest increase in

enrollment are

Medicaid Children

and Expansion

Adults.

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Governor's FY 2021-22 Budget

HCPF Details

Overall Budget Picture• Thanks to an improved economic forecast, the Governor’s FY 2021-22

Budget is able to restore many of the major reductions taken in FY 2020-21. The overall operating increase is more than 7% above FY 2019-20.

• Governor's budget includes $1.3 billion in stimulus to pursue targeted economic stimulus - making immediate investments in Colorado businesses and families to help them make it through the winter and rebound our economy.

• However, the long-term budget outlook is still out-of-balance and uncertain. The State needs to minimize ongoing operating costs that could require more painful cuts in FY 2022-23.

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2021-2022 Budget Basics

• State Budget: $35.4B Total Funds, $13.6B General Funds

• State Totals Cuts:

➢ $422M Total Funds and $272M General Fund

• HCPF Total Cuts

➢ $165M Total Funds and $146M General Funds

• HCPF will account for 37.6% of TF and 29% GF (is 34%, 26%)

• HCPF budget will be $12.4B TF and 3.5B GF

• Increase of $1.7B TF (15.6% from 2019-2020)

• Increase of $557.3M GF (18.9% from 2019-2020)

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Revenue Insights• Improving 2020-2021 budget outlook

• Colorado is still the #1 economy in the nation, but 672k Coloradans have filed for Unemployment Insurance (22% of working population)

• Longer-term budget outlook is still out-of-balance and uncertain

➢ $1.6B revenue shortfall for FY 2021-2022 (released budget)

➢ $2.2B revenue shortfall projection for FY 2022-2023

• Governor's budget includes $1.28B in 2020-2021 stimulus

➢ to boost economic growth since the Fed is not acting

➢ makes immediate investments in Colorado businesses, families.

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Gov State Stimulus Opportunity, while Fed is in gridlock

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HCPF Stimulus - Decision Items

The one-time stimulus $$ directly impacting HCPF:• Behavioral Health Task Force Acceleration – Shared

Eligibility/Intake, Claims Processing and Reporting – 75 non-Medicaid programs to be administered by HCPF tools (PEAK, MMIS DXC payments, reporting)

• Addressing Health Care Disparities – investments in data collection by Medicaid and carriers in the eligibility intake and capture process, including info like race, age, gender, LGBTQ, zip code, income, disability status. This will help us identify disparities, which is critical to addressing them.

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HCPF Budget Year to Year & Drivers

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Total Funds General Fund

FY 2020-21 Appropriation $12,034 M $3,185 M

FY 2021-2022 Caseload Requests $297 M $248 MContinuous Coverage

Recession impact

Decision Items $20 M $10 M

Budget Reductions ($165 M) ($146 M)

FY 2021-22 Budget Request $12,336 M $3,511 M

Year-over-year Change $302 M $327 M

Percent Change 2.5% 10.3%

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Temporary Budget Reductions

Temporary budget reductions: $100M TF, $120.3M GF

“Temporary” means that the reductions create savings in the current year, but not in future years.

• $80M GF transfer from the Healthcare Affordability and Sustainability Fee (hospital provider fee)

• $10M GF transfer from the Primary Care Fund

• Reduction to Inpatient SUD Budget based on lower-than-expected projected costs (not a benefit or reimbursement change)

• Savings from federal funds associated with enhanced FMAP

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Permanent Budget Reductions

“Permanent” means that the reductions will not be restored until the General Assembly takes new action.

• Capping enrollment in PACE

• Reducing BH incentive payments (25%)

• Targeted rate and benefit reductions

No across-the-board provider rate reductions.

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Permanent budget reductions: $69.5M TF, $29.9M GF

Enhanced Federal Funding

The Families First Coronavirus Response Act increased the federal match rate for most Medicaid services for all states while the Public Health Emergency is in effect.

• Colorado’s federal medical assistance percentage (FMAP) went from 50% to 56.2%

• So far, the enhanced federal funds have created $565M of General Fund relief.

• Asking Fed to extend PHE, after 1/23/21, day after inauguration

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Decision ItemsTotal impact: $20M TF, $9.5M GF increase.

Key requests include:

• Convert contractor resources to FTE

• Restoring reductions to Family Medicine Residency Training Programs

• Nurse Advice Line

• HCBS Remote Supports benefit

• Supported Living Services Flexibility

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Next Steps

Joint Budget Committee Briefing and Hearing:

➢ Briefing: December 10, 2020

➢ Hearing: January 7, 2021

➢ Figure Setting: March 2021

• Next revenue forecast: December 18, 2020

• Start of the Legislative Session: January 13, 2021

• Budget https://www.colorado.gov/pacific/hcpf/budget-1

https://www.colorado.gov/governor/office-state-planning-budgeting

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Colorado Elections

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State of Colorado ElectionsSenate Minority Elections:

Minority Leader: Chris Holbert

Assistant Minority Leader: John Cooke

Minority Chair: Jim Smallwood

Minority Whip: Paul Lundeen

JBC Member: Bob Rankin

House Majority Elections:

Speaker: Alec Garnett

Majority Leader: Daneya Esgar

(House still meeting on other positions)

Senate Majority Elections

President of the Senate: Leroy Garcia

Majority Leader: Stephen Fenberg

President Pro Tempore: Kerry Donovan

Assistant Majority Leader: Rhonda Fields

Majority Whip: Jeff Bridges

Caucus Chair: Julie Gonzales

JBC Appointment 1: Dominick Moreno

JBC Appointment 2: Chris Hansen

• State House: 41 Ds – 24 Rs (no change, one Rep seat flipped (Ortiz) and

one Dem seat flipped (Luck))

• State Senate: 20 Ds – 15 Rs (Dems flipped Sen. Tate’s seat with Chris

Kolker)

• New Legislators• Senate: 3 completely new members (Kirkmeyer, Kolker, Simpson); 4

members moved from the House (Jacquez Lewis, Buckner, Coleman, Liston)

• House: 15 completely new members (7 Reps, 8 Dems)

• Process Reminders: New committee assignments expected in early

December.

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Colorado General Assembly

• 116 – PASSED: Reduce State Income Tax Rate (applies 2020 & beyond, – est.

to reduce state revenues by 1.2% ($154 million for 2021-22 budget year)

• 117 – PASSED: Voter approval for some State Enterprises (seeking

clarification on impact to CHASE)

• 118 – PASSED: Paid Family Leave – 12 weeks funded through payroll

(employers and employees 50/50), first premiums paid January 2023,

benefits begin January 2024

• EE – PASSED: Increase Nicotine Tax, Taxes Vaping (more $s to state)

• B – PASSED: Property Tax Rates – Repeals “Gallagher Amendment”

(removes residential and non-residential tax rates set in Constitution,

allows General Assembly, local governments to make changes)

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Pertinent Ballot Measures

ACA Discussion

Supreme Court ACA Hearing. May or June likely decision.

Just some of the potential ACA impact:

• Medicaid expansion up to 138% FPL, 90/10 Fed $$ (462k in CO)

• Exchanges, fed subsidies up to 400% FPL (123k of 167k in CO)

• Young adults can stay on their parent's insurance up to age 26

• Employer-sponsored coverage employers > 50 employees

• Consumer protections

• Reinsurance funding

• Medicaid Expansion Federal Funding: $2.1 billion

Cautiously optimistic based on Justice's questions on outcome

39 states & DC have passed Medicaid expansion – alignment to act

Biden Administration response will depend on GA Senate run-off

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ACA Supreme Court Hearing

Thank You!

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