Better One or Better Two? The Prescription Colorado's Caregivers Are Still Waiting For

A completed fiscal and legal audit, a $1.5B state budget shortfall, and a zero-cost bill that changes both.

Better One or Better Two? In the latest part of our series, we focus on the prescription Colorado’s caregivers are still waiting for. We have the clear data-showing substantial savings and no cost to the general fund-so why is the caregiver still waiting in the dark? It’s time to move beyond binary choices and look at the real person behind the complex machine.

By Mark Fukae - Director of Advocacy | Professionals Who Care

Yesterday morning, an ophthalmologist asked Rose - who has end-stage progressive dementia - to compare two lenses after her post-surgical checkup.

She couldn't tell the difference between options two and three.

"Doesn't look any different," she said. "Both fuzzy."

The doctor wrote a new prescription.

That is what this week looked like from inside our multigenerational caregiving household. And it is, with almost uncomfortable precision, what this week looked like from inside Colorado's budget debate, from inside the Iran ceasefire, and from inside a Senate chamber trying to balance a $1.5 billion Medicaid-driven shortfall by capping the hours of the paid caregivers holding the system's most vulnerable people together.

The audit is complete.

The Colorado CARE Act has been through a full fiscal and legal review. The findings:

Fiscally: Revenue-neutral. Zero general fund appropriation. Projected net annual state savings of $23–38 million at full implementation - through Medicaid cost avoidance ($10–20M from preventing unnecessary institutionalizations), retained income tax revenue ($14.5M from workforce retention), and reduced public assistance enrollment ($2–5M). The mechanism is the $33,614 annual cost differential between SNF and HCBS care - documented in HCPF's own FY2023-24 data. Every caregiver the CARE Act keeps in the workforce reduces the probability that their care recipient enters institutional care. Every prevented placement saves the state that differential. As federal cuts under H.R. 1 increase Colorado's share of Medicaid costs, the savings argument strengthens.

Legally: The bill is sound. It uses the correct statutory target - CADA Section 24-34-402(1)(a) - the same provision used to add sexual orientation (2007) and gender identity (2008). The interactive accommodation process mirrors 30 years of ADA precedent. The Employment Detachment Event definition closes the creative dismissal enforcement gap. TABOR-compliant. No new program. No voter approval required.

Why this moment matters.

The Colorado Senate is debating the Long Bill right now - HB 26-1410, $46.8 billion, a $1.5 billion shortfall driven by Medicaid costs growing at 8.8% per year. The JBC response includes capping weekly paid caregiver hours at 56.

The Medicaid director resigned March 30 under threat of a 27-senator no-confidence vote. Sen. Mullica - who led that effort and chairs Senate Health and Human Services - said publicly this is "a critical opportunity to stabilize the department and put Colorado's Medicaid program on a sustainable long-term path."

The CARE Act is a zero-cost tool for exactly that stabilization. It reduces institutional placement risk by keeping employed caregivers in the workforce. It generates Medicaid savings the state needs without cutting a single benefit. It passes through existing enforcement infrastructure with no new program.

The session ends May 13. We are seeking a prime Senate sponsor.

Read and Listen to the full piece: therevenueneutralcaregiver.substack.com

Sign the petition: https://chng.it/DLWncS9wtT 757 signatures. 677 supporters. 243 from 1,000.

Contact: mark_fukae@casiadvocacy.org | (303) 817-6995 | casiadvocacy.org | professionalswhocare.org

Mark Fukae is Director of Advocacy for Professionals Who Care and Founder of CASI. He is a registered Colorado volunteer lobbyist developing the Colorado CARE Act for the 2027 session.