Colorado Medicaid commission approves pharmacy review, rejects hard cap
Members also directed reviews of benefit changes and transitions off Medicaid, while leaving a proposal concerning home- and community-based services for further study.
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The Colorado General Assembly Commission on Medicaid rejected a hard cap on program growth and approved an independent review of a state-directed pharmacy benefit administrator, while setting directions for tracking savings and evaluating benefit changes. The commission’s Nov. 10 votes establish policy directions, not final decisions to change benefits or pharmacy administration.
The commission approved a recommendation to evaluate moving Medicaid pharmacy administration to a single state-directed benefit administrator, including comparisons with approaches in other states. It also directed revisions to savings and spending reports: compare projected savings with actual results, focus on major programs and outliers, and report more frequently. Those measures call for evaluation and tracking; they do not establish that a particular change will save money.
Members rejected the proposed hard cap by an 8-1 vote and rejected a proposal to merge the state health and human services departments without objection. Staff said data would arrive in waves over the coming months, and that many requested figures would not be ready for the next meeting or the report.
The commission directed a review of benefit, coverage and utilization-management changes made since 2019, assessing them one by one for costs and savings. It also directed a study of ways to ease transitions when people leave Medicaid, with costs and funding sources to be identified. These directions do not repeal benefits or create a funded transition program.
A proposal concerning Community First Choice, which provides home- and community-based services, remains under consideration. The commission tabled it until members receive more information, including data on growth by population and service and measurable outcomes. The department told members it was not planning to end the program, though services could change as policy and budget details are developed.
Staff told commission members another $344 million in reductions remained to be identified, with the gap expected to be addressed in a January supplemental budget proposal. The commission’s votes did not assign savings amounts to specific proposals. Members are scheduled to meet again Nov. 18, review a draft report Dec. 9 and aim to finalize recommendations by Dec. 11.