November 2024

CBHC Newsroom: November 2024

Election Update: What the Results Might Mean for Colorado’s Behavioral Health System

State legislative election results signify largely status quo for the General Assembly, though a dire state budget picture will complicate policymaking. On the federal level, the Republican trifecta—with single-party control of the White House, US Senate and US Congress—signals uncertainty for vitally important health care priorities such as Medicaid funding and the Affordable Care Act. Here’s a top-level look at key developments from the election and their implications for Colorado’s behavioral health system.

Colorado General Assembly Election Results and Leadership
  • State Senate: Democrats maintained their 23-12 majority, with both parties flipping one seat. Representative Marc Snyder (D) flipped Senate District 12 in El Paso County, while Republican Scott Bright secured Senate District 13 in Weld and Adams counties previously held by term-limited Senator Kevin Priola (who changed his affiliation from Republican to Democrat two years ago). James Coleman (D-Denver), a moderate Democrat, is the new Senate President, while Paul Lundeen (R-Monument) continues as the Republican minority leader.  
  • State House: Democrats retained control, winning 43 seats compared to Republicans’ 20, but lost their supermajority pending recounts in two races. Republican Rebecca Keltie defeated Democratic Rep. Stephanie Vigil by seven votes in House District 16 (El Paso County). In House District 19 (Weld County), Republican former state Rep. Dan Woog defeated Democrat Jillaire McMillan by 123 votes, or 0.22 percentage points. This has been a swing seat: Woog lost the seat to Democrat Jennifer Parenti two years ago; Parenti dropped her re-election bid this summer. The House leadership remains with Speaker Julie McCluskie (D-Dillon), while Rose Pugliese (R-Colorado Springs) retains her role as minority leader.  
  • In addition to the recounts mentioned above, another development will affect membership in each chamber (though not overall numbers). After the election, Sen. Chris Hansen (D-Denver) announced that he will step down from the seat to which he had just been re-elected. A vacancy committee will elect his successor. Two House Democrats from Denver—Rep. Steve Woodrow and Rep-elect Sean Camacho—have both expressed interest in throwing their hats in that ring. If either of them wins, another vacancy committee will elect their replacement. This highlights a notable fact about Colorado’s legislature: nearly 25% of state lawmakers have initially secured their positions through a vacancy committee process. 

Ballot Measures 

Colorado voters demonstrated their unique stance on several statewide issues. Two have direct or potential implications for the behavioral health system 

  • Proposition KK imposes a new excise tax on firearms and ammunition. Of the estimated $39 million the tax would raise annually, an estimated $5 million would go to certain veterans mental health programs and $3 million to youth mental health grants. 

  • Proposition 130 requires the General Assembly to direct $350 million to law enforcement but does not identify a revenue source. Accordingly, this will have to be accomplished by reallocating existing funds. While lawmakers are still determining exactly how and over what period of time this will be done, it will inevitably impact other state budget priorities, potentially including behavioral health programs. 

Implications 

The continued Democratic control of the Colorado legislature ensures stability in advancing their policy agenda. However, the fiscal challenges of a budget deficit totaling more than $600 million (see the budget item below) and reallocations resulting from the passage of Proposition 130 will require careful navigation.  Additionally, uncertainty around potential changes to federal Medicaid policy and commercial insurance requirements in the coming years makes it even more important to ensure that Colorado lawmakers craft policies that deploy scarce state resources thoughtfully. 

CBHC remains committed to advocating for policies that support equitable access to behavioral health care. We’ll continue to provide updates and resources to help our members navigate these changes and understand their implications for your communities. 

Budget Updates

The Governor’s proposed budget, released on November 1st, was not quite as austere as anticipated, after the September forecast projected a nearly $1 billion deficit. Nonetheless, the state still faces a $635 million shortfall, necessitating 1.2% cuts across all departments. In addition to these budget cuts, the major components of the governor’s proposal to close that deficit are sweeping interest from cash funds, a cap on future interest, restructuring severance distributions, a new strategy to fund higher education controlled maintenance and converting the state-chartered workers’ compensation carrier to a private entity in exchange for money to shore up the state pension system.

Medicaid: Medicaid costs have surged beyond projections due to significant increases in acute care costs, straining the budget. According to recent public comments from HCPF staff, historically, acute care costs have risen around 8% annually. The department budgeted for an 18% increase in the previous fiscal year. However, they witnessed an actual 26% increase, meaning they started the current year in deficit, raising questions about whether this will become the new baseline. Uncertainties surrounding future Medicaid enrollment and beneficiary acuity further complicate budget planning. Overall, Medicaid spending is projected to grow by 11% this fiscal year and 6% next year; enrollment is projected to grow by 72,000 members. The proposed Medicaid budget keeps behavioral health provider rates flat, while cutting those for other providers—notably, rolling back a small increase to rates for autism providers that was enacted last year. On the positive side, though, it includes $44.5 million for administrative improvements to the Colorado Benefits Management System – critically important for streamlining enrollment and eligibility redetermination processes.

Behavioral Health: While the Department of Human Services (of which BHA is part), like all others, was required to cut its overall budget by 1.2%, the budget proposes a modest $3.2 million increase for the BHA. $1.2 million of this would go to providers for services for un- and under-insured individuals with serious mental illness and children with severe emotional disturbance; $1 million to enable service navigation through the behavioral health administrative service organizations that will launch next July; and $1 million to support capacity building for safety-net providers (e.g., consultants to assist with electronic health record system changes). To offset costs, it includes savings from consolidating the crisis line, right-sizing the iMatter program, and consolidating vendors for school mental health screenings. However, we are concerned about a proposed $1.6 million reduction in funding for the Circle program, which covers comprehensive community-based residential treatment services for individuals with co-occurring substance use and mental health issues.

 

CBHC’s Policy Platform

Over the next 2-3 years, CBHC’s policy work and legislative positions will be guided by two fundamental priorities: 

  • Mend the safety net 
  • Fund the safety net 

These priorities reflect, on one level, the reality that reforms to both the behavioral health and criminal justice systems in recent years have inadvertently loosened the connection between the emergency and involuntary commitment systems with outpatient care. They also reflect the fact that access to care and important community-focused programs are in danger of being compromised as a result of structural and financing reforms to the behavioral health safety net. In a tight budget environment, these principles will require creativity and commitment. 

Accordingly, we will prioritize our work in the following areas: 

  • Working with our partners at the state to help their current budget dollars go further by thoughtfully evolving requirements that inadvertently are limiting access to care and increasing costs. 
  • Continuing to actively shape and support initiatives to secure new sources of funding that support access to high-quality behavioral health care, particularly through the federal Certified Community Behavioral Healthcare Clinic grant program. We will also explore other initiatives to expand funding for the safety net. 
  • Guarding against further cuts to behavioral health funding. 
  • Seeking ways to better knit together the emergency and involuntary commitment systems with outpatient care and fill the gaps between inpatient and community treatment. 

In the latest CBHC Leadership Blog, Kara Johnson-Hufford delivers a powerful call to action: advocating for Colorado’s mental and physical health safety net before it’s too late. Highlighting the financial and operational challenges faced by providers, Kara emphasizes the need for sustainable funding and policy support to ensure all Coloradans have access to vital care.

This thought-provoking piece underscores CBHC’s commitment to protecting our communities’ well-being through resilience, advocacy, and collaboration.

Read the Full Blog Here

Save Our Safety Net

CBHC has joined forces with the Colorado Community Health Network (representing federally qualified health centers, or FQHCs), Colorado Safety Net Collaborative (representing non-FQHC primary care clinics), and the Colorado Hospital Association to form the Save Our Safety Net Coalition. The goal is to continue drawing attention to the serious challenges faced by safety net providers as a result of the end of the COVID public health emergency. While all providers knew that the continuation of Medicaid enrollment without eligibility redetermination would end, and planned accordingly, the rate of disenrollment was steeper and deeper in some regions than the state had projected. The resulting increase in uncompensated care has posed significant financial challenges for some of CBHC’s members as well as for other safety net providers. For some community mental health centers, it has been exacerbated by the new Medicaid payment model as well as reductions in municipal and county supports as local governments face their own funding challenges. Our hardest-hit members have had to resort to hiring freezes, program consolidations and, in the worst cases, layoffs.  

The Save Our Safety Net Coalition held a listening session with the Colorado General Assembly’s Joint Budget Committee in October, sharing sobering illustrations of the impact across the state. While the seriously constrained state budget means the committee can’t ride to the rescue with stopgap funding, members and other legislators have made clear they will not support budget actions that place further strains on the safety net. Members have also expressed support for improvements to the Medicaid enrollment and redetermination processes as called for in the policy recommendations in the Coalition’s platform.

Download the Document Now

The Diversified Minds Mental Health Institute (DMMHI) is an innovative program in Colorado Springs addressing the critical shortage of diverse mental health professionals. A collaborative effort between local school districts, Diversus Health, and various partners, DMMHI offers high school students leadership training, credentialing, and career pathways in mental health, emphasizing equity and inclusion by removing barriers like cost and transportation.

Funded by a $300,000 grant from the Colorado Behavioral Health Administration, the program fosters collaboration, leadership, and real-world experience, empowering students to become future mental health advocates. Through targeted outreach, partnerships, and student engagement, DMMHI aims to inspire similar initiatives nationwide while addressing workforce shortages in mental health.

Check out the full Articles:

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