Payments from Colorado’s Medicaid program to FreedomCare, a New York-based for-profit home-care company, climbed to $22 million this year from $1 million last year, prompting lawmakers to question state oversight and communication. The state has terminated its agreement with the company, and the dispute is now in court. The Department of Health Care Policy and Financing, which administers Health First Colorado, says FreedomCare failed to maintain systems needed to protect clients and ensure uninterrupted care. In a termination letter, the department cited shortcomings in complaint handling, backup staffing, caregiver background checks and required staff skills assessments, as well as gaps in care plans and documentation. FreedomCare arranges caregivers for more than 700 Medicaid members in 17 Colorado counties. Caregivers help with daily needs such as preparing meals, laundry and getting in and out of bed. The company’s attorney disputed the state’s findings, saying FreedomCare responded to them and sent a team of 36 people, including 13 registered nurses, to Colorado. Sen. Judy Amabile, a Boulder Democrat who chairs the state Medicaid Commission, said providers can exploit program rules to increase billings. She called the situation “grift,” while distinguishing it from outright fraud, and said state officials and lawmakers need to address what she described as a recurring problem with unexpectedly high provider markups. The $21 million increase is a small share of Colorado’s more than $18 billion Medicaid budget. But Republican commissioner Rick Taggart, who represents Grand Junction, said he was surprised to learn the dispute had reached litigation without the commission being informed. He urged the agency to collaborate with lawmakers and be more transparent. Sen. Kyle Mullica, a Thornton Democrat and emergency department nurse, also pressed agency leaders about transparency at a commission meeting this week. He said the state needs to identify potential abuses earlier and establish safeguards to prevent them from continuing. The dispute comes amid other scrutiny of Medicaid spending, including concerns involving transportation and oversized wheelchairs. Colorado is also confronting a projected $1.6 billion budget shortfall for the 2027-28 fiscal year. The health department declined to comment on the FreedomCare case, citing active litigation.