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Comprehensive Person-Centered State Work Incentive Initiatives:

A Resource Center for Developing & Implementing Medicaid Buy In Programs
and
Related Employment Initiatives for Persons with Disabilities


Colorado


I. Overview of a State's Comprehensive Person-Centered Employment Initiatives

“The Colorado Department of Health Care Policy and Financing, the State Medicaid Agency, is developing several new initiatives related to long-term care, consumer direction and systems change.

Colorado has received three new federal grants under the Systems Change for Community Living initiative, sponsored by Centers for Medicare and Medicaid Services. These grants are part of the federal New Freedom Initiative, and are designed to help states address issues raised by the Olmstead decision. All of the grants will be administered within Health Care Policy and Financing, Long-Term Benefits Division, Systems Change Section, but will involve collaboration with a variety of stakeholders.”

The above statement of initiatives in Colorado is taken from the Colorado Department of Health Care Policy and Financing’s web site at
http://www.chcpf.state.co.us/SysChange/SystemChangeIndex.html

 

II. What's New and Persons to Contact

In April, 2003 a report was submitted to the Colorado Department of Health Care Policy and Financing by a consultant that stated that a cost neutral Medicaid Buy-In program is not feasible. The study had been mandated by state legislation enacted in 2001.

Download a Word version of the report
“Actuarial Study:The Feasibility of A Budget Neutral Colorado Medicaid Buy-In Program Under TWWIIA and HB 01-1271”

For a direct link to a pdf version of the report
http://www.chcpf.state.co.us/SysChange/Actuarial_Study.pdfSee

Section III for the history of the development of the legislation
For a direct link to the Web site of the Medicaid Infrastructure Grant Project and other Systems Change activities go to:
http://www.chcpf.state.co.us/SysChange/BuyInIntro.html

Persons to Contact:
Julie Friedman-Peremel
Colorado Department of Health Care Policy and Financing
Denver, CO
303-866-5600
julia.friedman-peremel@state.co.us

Julie Reiskin
Executive Director
Colorado Cross-Disability Coalition
655 Broadway Suite 775
Denver, CO 80203
303-839-1775
Jries29622@aol.com

Link to Web Page of Coalition: http://www.colorado2.com/ccdc/

III. Program Development - Past and Present

  • Executive Branch Leadership, Cross Disability Coalition Leadership and Interagency Working Groups

    The Department convened a Task Force in 2000 and it met a number of times including active participation of members of the Colorado Cross-Disability Coalition.

  • Initial Planning, Information Gathering and Program and Fiscal Estimates

In April, 2003 a report was submitted to the Colorado Department of Health Care Policy and Financing by a consultant that stated that a cost neutral Medicaid Buy-In program is not feasible. The study had been mandated by state legislation enacted in 2001.

Down load a Word version of the report
“Actuarial Study:The Feasibility of A Budget Neutral Colorado Medicaid Buy-In Program Under TWWIIA and HB 01-1271”

For a direct link to a pdf version of the report
http://www.chcpf.state.co.us/SysChange/Actuarial_Study.pdf

On April 17, the Colorado House approved H 1271, a bill which authorizes the State Medicaid agency to submit a State Plan amendment to establish a Medicaid Buy In program. The bill does not contain details on the eligibility provisions of a Medicaid Buy In program. As amended in the House, the bill requires that the program be budget neutral and that the State must apply for and receive an Infrastructure grand from HCFA for the program to be placed in operation.

Link to a page on the Colorado Legislatures web page to see the history of the bill and a link to language of the bill and the fiscal note.
http://www.leg.state.co.us/2001/inetcbill.nsf/fsbillcont/
B9877533D6D480C5872569CE004FEC39?Open&target=/
2001/inetcbill.nsf/billsummary/E0A3ADD7E1B38897
872569CB000A33D9

On November 1, 2000, the Colorado Department of Health Care Policy and Financing submitted a report to the Colorado Senate and House Health, Environment, Welfare, and Institutions Committees on "Employment Incentives for People with Disabilities through Medicaid Buy-In Options"
Download a file containing the text of the report.

The following are the Taskforce recommendations from the report:
"The Taskforce recommends the following:

  1. Pursuing the Ticket to Work Work Incentives Improvement Act (TWWIIA) Medicaid option and not the Disability Work Incentive Program (DWIN), as TWWIIA is a more flexible and generous program and does not explicitly limit eligibility. Also, the future of DWIN is uncertain, at best, at this time.
  2. Implementing both Option I and Option II of TWWIIA. Option II would not cost the state any additional dollars, as the only people who could be included under Option II would be the ones that th estate would already have been covering under Option I.
  3. No income cap. Such a cap would still limit an individual's full ability to work and budget neutrality would not be compromised by not limiting income.
  4. Including Home and Community Based Services (HCBS) waiver eligibility under the TWWIIA program, as this will encourage employment by Home and Community Based Services (HCBS) clients without increasing the cost to the state.
  5. Conducting an actuarial analysis of a potential Medicaid buy-in option under TWWIIA prior to making a final decision regarding the viability of this program. Such an analysis would determine the appropriate client cost sharing requirements and the cost savings that can be incurred from state-only program and overall economic benefits of employment."

IV. State Legislation - Adopted and Pending


On April 17, 2001 the Colorado House approved H 1271, a bill which authorizes the State Medicaid agency to submit a State Plan amendment to establish a Medicaid Buy In program. The bill does not contain details on the eligibility provisions of a Medicaid Buy In program. As amended in the House, the bill requires that the program be budget neutral and that the State must apply for and receive an Infrastructure grand from HCFA for the program to be placed in operation.

Link to a page on the Colorado Legislatures web page to see the history of the bill and a link to language of the bill and the fiscal note.
http://www.leg.state.co.us/2001/inetcbill.nsf/fsbillcont/
B9877533D6D480C5872569CE004FEC39?Open&target=/
2001/inetcbill.nsf/billsummary/E0A3ADD7E1B38897
872569CB000A33D9


History
The Colorado Legislature during the 2000 session, included in an Appropriation Act (HB 0-1451 Footnote 50b) a requirement for the Department of Health Care Policy and Financing to meet with consumers with disabilities and Medicaid providers and to submit a report to the Legislature delineating options and recommendations related to te new Federal Work Incentives/Ticket to Work Act.


State Legislation Enacted in 2000
Footnote 50b of HB 0-1451
"Department of Health Care Policy and Financing, Medical Services Premiums - It is the intent of the General Assembly that the Department meet with Medicaid consumers with disabilities and Medicaid providers to examine state options with regard to the new Federal Work Incentives/Ticket to Work Act. The Department is requested to submit a report delineating options and recommendations for providing incentives for persons with disabilities to return to work. This report is requested to be submitted to the Senate and House Health, Environment, Welfare, and Institutions Committee by October 15, 2000. This report is requested to include a discussion of the pilot programs created in S.B. 97-147 and analysis and recommendations on whether this existing initiative can be accomplished under the new Act without the requested waiver."

State Legislation Enacted in 1997 to Establish a Medicaid Buy-In Program under a Medicaid Waiver
S.B. 97-147

Download file of S.B. 97-147

V. Current State Policies and Program Descriptions

  • State Policies: State Plans, Regulations and Waiver Requests to Federal Agencies - Pending and Adopted Programs
  • Ensuring Informed Choice and Person - Centered Programs: Benefits Counseling, Work Force Investment Act Implementation and Related Educational Services
  • Descriptions for Consumers and Staff Training Activities

 

VI. Program Data and Impact

  • Medicaid Buy-In Data
  • Consumer Surveys and Evaluations Studies

 

VII. Comprehensive Employment Initiatives

Personal Assistance Services
Colorado Community Personal Assistance Services and Supports (COmPASS) Grant
A primary intent of the grant is as follows:
“Design and implement a PASS option in which consumers exercise control over key aspects of the service: selection of attendants, scheduling, location and service delivery decisions, care planning and training.”

Link to description of the grant
http://www.chcpf.state.co.us/SysChange/SysChg_Hndout_03.html


Center for the Study and Advancement of Disability Policy and Center for Health Services Research and Policy at George Washington University

Supported by a grant from the Robert Wood Johnson Foundation with additional support provided by NIDRR of the US Department of Education through the RRTC on Workforce Investment and Employment Policy at the Law, Health Policy and Disability Center at the University of Iowa. (#H133B980042) 

Website created and maintained by the Law, Health Policy and Disability Center at the University of Iowa College of Law. The opinions and analyses set out in the articles on this website are those of the authors and do not necessarily reflect the positions of the Robert Wood Johnson Foundation, the US Department of Education, George Washington University or the University of Iowa.