Long-Term Services and Supports Sustainability Action Update (April 2026)

A Message From Bonnie Silva, Office of Community Living Director

April 8, 2026

Dear Community,

I know the last several months have been incredibly hard. Members and families have been carrying stress, uncertainty, and fear about what the changes to Medicaid mean for their daily lives. At the same time, advocates, providers, and case managers have been working tirelessly to understand the impact and do all they can to support people through it. I want to begin by acknowledging that openly. I know this is a long letter. There is a lot to say. I appreciate the time you invest in reading this.

Long-Term Services and Supports are not optional. They are life changing, and in many circumstances, life saving services. I understand why there is so much anger, grief, and frustration. These changes affect real people, real families, and real routines in ways that matter deeply.

I wish we were not in a position where changes like these were necessary. Colorado is facing a serious fiscal challenge, and Medicaid, including Long-Term Services and Supports, is a significant and growing part of the state budget. Over the last several years, costs have increased for many reasons, including higher enrollment, increased use of services, benefit expansions, and rate increases needed to support the workforce and keep pace with minimum wage.

Those investments mattered. They helped expand access and strengthen services. At the same time, the current rate of growth, in specific areas, is not something the state can sustain. If we do nothing, future cuts will be even deeper, more abrupt, and more harmful. That is what we are trying to prevent.

I know that does not make these decisions feel any less painful. But I want to be clear about this: The goal is to preserve this system for the long term so Colorado can continue supporting people with disabilities of all ages for many years to come.

We may not always agree on the path forward, and I know there is real anger about these decisions. I understand that. Even so, I know we are fighting for the same thing: a strong, stable, reliable system. I remain committed to listening, sharing information as clearly as possible, and moving through this with honesty, care, and respect.

Why the process has felt unusual

I also want to acknowledge that the communication and rollout of these changes has been confusing, with shifting guidance and timelines. I know that has created additional stress  for everyone involved and I am sorry for that.

This has not been a typical budget year. A significant budget shortfall following the passage of H.R.1., further exacerbated by Colorado’s structural budget deficit, required action more quickly than the normal legislative process usually allows. On July 1, the first day of our state fiscal year, we had a balanced budget. On July 5, 2025 after the passage of H.R.1. we had a $1 Billion deficit. The sudden lack of income caused by H.R.1. required the Governor to call a Special Session of the legislature to help balance the budget. Following the Special Session, the Governor issued Executive Orders directing state agencies to reduce spending on an accelerated timeline. The Governor is constitutionally required to act in this way when it appears we will not have enough money to meet our obligations.

Those orders required us to act quickly, while we also continued the traditional processes of legislative action, state rulemaking, and federal approval needed for lasting authority for all of these actions. Because all of these processes were happening at once, with negotiation at each stage, some changes have been revised, delayed, or paused as decisions evolved.

I recognize how difficult that uncertainty has been. We now have more clarity following recent decisions by the Colorado Joint Budget Committee. The information below will provide you with more information on where we are now after these decisions.

I also want to take a minute to address confusion we have heard around the implementation of the new Community Connector unit limit. Similar to the other reductions that were effective April 1, 2026, case managers were instructed to apply the Community Connector change at either the Continued Stay Review or during a quarterly monitoring visit. This change is not retroactive for any member. But, we understand that this service in particular is unique and that members vary their use significantly throughout the year. Because of this, making the reduction to the service midway through the service plan year at quarterly monitoring, feels unfair. We’ve heard you on this and are making a change to address it. The Community Connector unit limit will now be changed for all members at their CSR only. There is more information provided below within this newsletter about what this change means.

Recent Changes (Effective April 1, 2026)

HCPF has begun implementing several policy changes as approved by the JBC and/or the Medical Services Board. These changes, except for Community Connector Service Limits, are being phase in over nine months.

Your case manager will discuss these updates with you during your next Continued Stay Review or quarterly monitoring meeting if they apply to you.

Service Limits (Soft Caps)

New annual limits have been set for certain services:

• Health Maintenance Activities (HMA): about 19,000 units/year (~13 hours/day)
• Personal Care: about 10,000 units/year (~6.8 hours/day)
• Homemaker: about 4,500 units/year (~3 hours/day)
• Exceptions are available for individuals with demonstrated needs above these limits.

Homemaker Services for Legally Responsible Persons (LRPs)

• Weekly limit reduced from 10 hours to 5 hours per LRP
• Members may have up to two LRPs providing services

Community Connector Services (CES and CHRP waivers)

• Annual limit reduced from 2,080 to 1,040 units
• All members will receive this change at the CSR through March 2027
• Exceptions are available when additional need is demonstrated

Jump to this article for more information

Community Connector services are ONLY for Extraordinary Needs

• Services must be based on needs that go beyond typical parental responsibilities

All of these changes have been approved by the Colorado legislature and the federal Centers for Medicare and Medicaid Services (CMS). Emergency rules were adopted in February and permanent rules are currently in progress.

Upcoming Changes (Expected July 1, 2026)

The following actions are moving forward, pending final approval from CMS, Medical Services Board, and the state legislature:

End Automatic Youth Transitions to DD Waiver

• Youth aging out of CES or CHRP will no longer automatically transition to the DD waiver.  They will all be offered the opportunity to enroll in the SLS waiver (assuming they qualify) and some may also be eligible for other waivers.
• Does not affect child welfare transitions
• Exceptions remain for emergency and specific circumstances

Reduce DD Waiver Churn Enrollment

• Fewer transitions onto the DD waiver from the waiting list (a 50% reduction to enrollment)
• Individuals on the waiting list will continue to receive services through other HCBS waivers and/or the state plan
• Members will still be able to access the waiver in an emergency or to get out of an institution such as a nursing facility or regional center.

Require Cost of Care Contributions in DD Waiver

• Members will contribute a portion of their income toward care through the Post-Eligibility Treatment of Income (PETI) calculation which is done for people in residential programs in other waivers).
• For people in the DD waiver who live in their own home, the cost of the contribution will be considered after expenses needed to maintain their life in the home and community are deducted.
• All people who are employed will be exempted.
• Phased in through Continued Stay Reviews through June 2027

Cap on Weekly Caregiving Hours (Per Caregiver, Per Member)

• Gradual reduction to a maximum of 56 hours/week per caregiver (see “Implementation Timeline” below)
• Applies to the following services: Personal Care, Homemaker, Health Maintenance Activities, and Nursing
• Exceptions will be available
• Implementation timeline:July 2026: 84 hours/week per caregiver
  January 2027: 70 hours/week per caregiver
  July 2027: 56 hours/week per caregiver
  

Jump to this article for more information

Remove Equine Services

• This service will no longer be offered through HCBS waivers (it was never fully implemented).
• A second budget reduction proposed would have removed the equine (hippotherapy) service under occupational therapy from the state plan. Currently, it does not appear that this second proposal will move forward.

2% Across the Board (ATB) Provider Rate Decrease

• All LTSS, HCBS, and case management services will receive a 2% rate decrease on July 1, 2026.
• These rate reductions impact: All provider rates and Case Management Agency (CMA) contract rates, including State General Fund programs and Targeted Case Management.

What’s Next

Some of these changes are still going through final approval at the state and federal levels. We are sharing this information now so members, families, advocates, providers, and case managers have as much notice as possible.

If you are hearing information that is different from what is outlined  here or through other current HCPF communication, please first reach out to your Case Management Agency (CMA). Find your CMA contact information here. If you are not satisfied with the information provided by your CMA, please reach out to HCPF through the Escalation and Complaint Form.

I will be hosting an informational webinar next week to walk through these changes, provide updates, and answer questions. A recording will be available afterward for those who cannot attend live. We will also continue to provide regular updates through this newsletter and on our Medicaid Sustainability and Colorado’s LTSS System Webpage.

I am committed to ongoing communication and continued collaboration as this work moves forward. Updates will continue to be shared through this newsletter and on the Medicaid Sustainability and Colorado’s LTSS System webpage. My team and I will continue listening to members, families, advocates, providers, and case managers, and will keep working to provide clear information, respond to concerns, and make space for questions and feedback along the way.

I want to close by again recognizing the very real impact these decisions have on members and families. We have heard your concern, your fear, and your frustration. These are not abstract policy choices. They affect daily life, stability, and independence.

These decisions were not made lightly. They were made because we believe that taking targeted action now gives us the best chance of protecting this system over time and avoiding even more severe disruptions later.

While we may not agree on every decision I hope it is clear that the goal is not to walk away from this system. The goal is to preserve it and strengthen its future. That is what we are working toward.

With care,

Bonnie Silva