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Colorado Medicaid covers up to 80 of 88 services in insurance comparison
Health First Colorado covered more medical-service categories than the average individual-market or employer plan in a new comparison. The findings come as Medicaid consumes about a third of the state budget and lawmakers weigh how to manage rising costs without shifting more burden onto patients and other public services.
Colorado’s Medicaid program covers a wider range of medical services than the average private insurance plan, according to a report released Oct. 26 by the Common Sense Institute, a Colorado-based research organization.
The report compared coverage across 88 categories in Health First Colorado, the state’s Medicaid program, individual marketplace plans and large-group employer-sponsored plans. Health First Colorado covered as many as 80 categories, compared with an average of 65 for marketplace plans and 62 for employer plans.
Among services covered by Medicaid but not typically included in the private plans examined were non-emergency medical transportation, long-term or custodial nursing facility care, and equine therapy. The comparison measures the breadth of covered services; it does not, by itself, show how easy it is for patients to obtain care or what their out-of-pocket costs are.
The report argues that some Medicaid benefits could be reduced, alongside other system changes, to help address a projected loss of federal funding. Its proposal comes as Medicaid spending accounts for about one-third of Colorado’s budget. Enrollment has grown more than fivefold over the past two decades, and program spending exceeded its budget by $158 million last year.
Colorado lawmakers created a bipartisan Commission on Medicaid during the last legislative session to evaluate options for making the program sustainable. Sen. Judy Amabile, a Boulder Democrat who chairs the commission, has identified long-term services and supports, pharmacy benefits, behavioral health and administrative costs as the program’s fastest-growing spending areas.
Those costs include care for people with extensive needs. Amabile pointed to children with complex disabilities who may need round-the-clock support, as well as older adults requiring nursing-home-level care.
Rep. Emily Sirota, a Denver Democrat who chairs the Joint Budget Committee, has warned that continued Medicaid growth could force cuts to other public services, including K-12 and higher education. Those sectors have already faced reductions, including an $82 million cut for the Department of Education; the Department of Agriculture also received a $2 million reduction.
The debate leaves lawmakers balancing pressure on the state budget against the care Medicaid provides to children, people with disabilities and older adults. Any benefit changes would affect people who may have few alternatives for obtaining those services.