This number is about one-third of the number recommended by the Medicaid Provider Rate Review Advisory Committee (MPPRAC), which is appointed by the state Legislature and tasked with advising HCPF on how to manage Medicaid rates. MPPRAC’s analysis of pediatric behavioral treatment rates found the state met approximately 78 percent of the standards set by 10 peer states and recommended that approximately $35 million would be needed to meet those standards. did.
HCPF argued that MPPRAC’s analysis included Nebraska, an extreme outlier state with a higher rate than the nine other states included in the benchmark study. If you exclude Nebraska for comparison, Colorado Medicaid pays about 91 percent of the benchmark.
Eric Martin, a therapist at the SOAR Autism Center, said he was perplexed by the disconnect between the agency and the commission.
“I think that if you take out the high states and the high interest rates and don’t adjust for the low states at all, you’re not looking at the big picture. That’s not really the right way to budget.” said Martin.
JJ Tomas, founder of Aurora Autism Care Clinic BehaviorSpan, said he was disappointed in HCPF’s budget request.
“It’s not going to prevent companies from leaving Colorado,” he said. “I know a few people who are thinking about it, but as the days go by, they don’t get any more courageous.”
Other audience members said they were concerned about HCPF Executive Director Kim Bimestefer’s comments. He said higher fees would not necessarily solve workforce issues at private equity-funded clinics.
“The requirements for private equity returns are to earn 15, 20, 30 percent every year and double your money every four to seven years,” Bimestefer told the Joint Budget Committee. “That economic model cannot be supported by increased Medicaid reimbursement.”
Bimestefer then said their focus is on protecting and retaining the non-private equity workforce.
“There was significant turnover in nursing homes, and we were focused on maintaining an engaged workforce,” she said. “So we may end up changing ownership and we are passionate about caring for children with autism, supporting families and building collective interests to be able to do that.” We need to preserve and promote the workforce as individuals.”
Tomasz said the problems facing his clinic and others cannot be solved with passion. He said BehaviorSpan is losing employees to retail and food jobs and is unable to scale up staffing to alleviate burnout.
“Companies that go out of business have passion. Passion is not something that is on the table,” he said. “What’s on the table is whether we’ll be here within a year.”
Members of the bipartisan Joint Budget Committee appear to share Tomasz’s concerns. Republican state Sen. Barbara Kirkmeyer questioned the relationship between HCPF and MPPRAC.
“I wonder why we have MPPRAC if we don’t follow their recommendations,” she said.
Lawmakers praised a proposal to expand eligibility for Child Health Plan Plus, the state’s public low-cost health insurance for certain children and pregnant women. The change would provide an avenue of support for children with autism who lost Medicaid eligibility after COVID-19 relief measures ended this spring.
But lawmakers questioned whether autism caregivers would really be able to adequately serve these children if they were no longer able to find sustainable income support.
“It’s like serving syrup, which is great, but if you don’t have pancakes to put syrup on, that’s a problem, right?” asked Rep. Shannon Byrd.
If HCPF’s $13 million request is approved by the Joint Budget Committee, providers will receive a small rate adjustment in July 2024.
