Colorado’s Medicaid Deep Dive: What to Know About the New State Commission

Colorado lawmakers are promising a discerning look at the state’s Medicaid program amid onerous federal cuts and mounting criticism about the program’s rapid-but-unsustainable growth.

Sponsored by members of the Joint Budget Committee, SB 26-187 creates a temporary Commission on Medicaid to review Colorado’s Medicaid program and recommend changes in the coming months. Lawmakers set aside about $500,000 to stand up the working group. At the time of publication, the bill is still pending Gov. Jared Polis’s signature but, if signed, the first meeting of this newly formed commission is scheduled for June 4.

The legislation follows months of challenging conversations among lawmakers over rising Medicaid costs and a series of payment and forecasting issues. Those include multimillion-dollar overpayments in areas such as non-emergency medical transportation and autism services as well as higher-than-expected costs for programs serving children and pregnant women without legal status. These concerns came to a head during budget deliberations, when JBC members raised questions about whether the Department of Health Care Policy and Financing (HCPF) had provided a clear and reliable picture of the program’s cost drivers, past overpayments and long-term funding needs.

Through SB 26-187, the JBC is seeking to formalize that deeper interim review and identify opportunities to improve accountability, strengthen cost-containment strategies, prevent future errors and provide recommendations for the next administration.

Here is what you can expect from this 10-member committee convening in just over a week.

Commission Membership, Meetings and Vacancy Process

The commission will be made up of 10 legislators and will choose its own chair and vice chair. Commission members will include:

• All 6 JBC members, which currently includes Rep. Emily Sirota (D) as chair and Sen. Jeff Bridges (D) as vice chair with Reps. Kyle Brown (D) and Rick Taggart (R) and Sens. Judy Amabile (D) and Barbara Kirkmeyer (R) filling the remaining seats.

• Chair of the Senate Health and Human Services Committee, currently Sen. Kyle Mullica (D).
• Chair of the House Health and Human Services Committee, currently Rep. Lindsay Gilchrist (D).
• One additional member of the House Health and Human Services Committee appointed by the House minority leader, who plans to appoint Rep. Carlos Barron (R).
• One additional member of the Senate Health and Human Services Committee appointed by the Senate minority leader, who is planning to appoint Sen. Lisa Frizell (R).

The commission must meet at least six times, but no more than 12, before Dec. 11, 2026. The chair will ultimately decide how often the commission meets and how long they run. The bill appropriates funding for commission members to receive a per diem and travel expenses for their attendance at commission meetings during the 2026 interim.

SB 26-187 also includes a process for replacing commission members if a seat becomes vacant. In most cases, the same person or office that made the original appointment must name a replacement within 10 business days.

The bill allows some flexibility for replacements, so it does not always need to hold the exact same title as the person leaving, but the seat must still be filled by someone who fits the same general role. For example, if a JBC-related seat becomes vacant, the replacement would be appointed by the speaker of the House, Senate president, House minority leader or Senate minority leader, depending on which seat is open. If a Health and Human Services Committee seat becomes vacant, the replacement must still come from that committee.

This structure is intended to keep the commission’s membership balanced while making sure vacancies do not slow down its work.

The bill’s fiscal note outlines the commission’s budget by line item.

Technical Advisor, Subject Matter Expertise and Stakeholder Input

The commission will be able to seek relevant outside opinions as well.

The bill permits and appropriates funding for a technical advisor. Identified through an RFP process (led by the director of research for the Legislative Council), the technical advisor must understand health care policy and HCPF, be free from conflicts of interest, know how to support and facilitate working group discussions and be able to help write the commission’s final report and recommendations.

The commission can also bring in state agencies and outside experts to help inform its work. This includes asking HCPF, the Behavioral Health Administration, the Department of Human Services, the Governor’s Office and other relevant agencies to present information or work directly with the commission. The commission can also invite Medicaid stakeholders, managed care organizations and national Medicaid experts to provide feedback on its recommendations.

If the commission needs data from HCPF or another state agency, it can request that information, and the agency must provide it using existing resources.

The Commission’s Goals and Focus Areas

As far as scope, the commission is expected to rely on existing state and national research, reports, audits and analyses rather than starting from scratch. Its work will include building a common understanding of upcoming federal Medicaid changes under H.R. 1, what those changes will require from HCPF, and how the state can prepare for impacts through 2028. The commission will also review how Colorado’s health care administrative systems have changed over the last decade, where those systems are working well or creating friction, and where there may be opportunities to improve overall efficiency.

But the main point is to review the state’s Medicaid woes. The commission will also look at major parts of the Medicaid program, including eligibility and enrollment, benefits, delivery systems, provider contracts, payment rates, statewide administrative challenges, program quality and overall value. On top of that, commissioners will examine Medicaid financing and how Colorado can maximize federal funding to support health care delivery.

Any recommendations must also be evaluated for their potential impact on access to care, quality of care and health equity, particularly for people with disabilities, rural communities and other vulnerable populations.

Commission Sunset and Report to the General Assembly

By Dec. 11, 2026, the commission must finish its work by submitting a report to the General Assembly and the governor. It must describe the commission’s process, identify stakeholders who provided input and include any recommendations for short-term and long-term legislative, executive or other policy changes.

The commission is temporary and will sunset on June 30, 2027, unless legislation is passed during the 2027 legislative session to extend its work.

Given the scale of the state’s Medicaid issues, this is unlikely the last we’ll hear from lawmakers on how to rein in health care spending and manage cuts. The Brownstein Colorado State Government Relations team will be in the room monitoring all commission meetings and looking beyond when those answers come.

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This document is intended to provide you with general information regarding Colorado’s temporary Commission on Medicaid. The contents of this document are not intended to provide specific legal advice. If you have any questions about the contents of this document or if you need legal advice as to an issue, please contact the attorneys listed or your regular Brownstein Hyatt Farber Schreck, LLP attorney. This communication may be considered advertising in some jurisdictions.