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The Storm Finds It Waiting

  • Writer: Mark Fukae
    Mark Fukae
  • Jun 6
  • 2 min read

The Colorado Commission on Medicaid met for the first time June 4. The brief was already in the room. This is what happened.


By Mark Fukae - Director of Advocacy - Professionals Who Care


A vibrant teal digital graphic with purple zigzag accents and geometric shapes. On the right, a large yellow circle displays the green text: "The Long Game #3 - The Storm Finds it Waiting." In the upper left, a tilted square inset photograph shows the interior of a grand, historic courtroom with rows of chairs facing a judicial bench under a large chandelier. A white quote in the bottom left reads: "H.R. 1 adds $57 million in administrative costs - 52 times the $1.1 million saved by the caregiver cap. The Commission is managing the wrong pressure point." The "Professionals Who Care" logo anchors the bottom right corner.
Managing the Wrong Pressure Point: For Dispatch Three of The Long Game, we bring the cold, hard math straight to the floor of the capitol.

The floors of the Colorado State Capitol are white marble. But if you look closer - at the wainscoting, the walls, the grand columns - the stone changes. Rose onyx. Quarried in 1893 from a small deposit near Beulah, in Pueblo County. The entire world supply was exhausted constructing and decorating this one building.


My mother's name is Rose. She is in the walls.


I sat in Room 220 on June 4 - the Old Supreme Court Chamber, first meeting of the Colorado Commission on Medicaid - and I thought about that.


What the Commission is holding.

The Legislative Council presented the state of Medicaid on June 4. The primary structural driver is elder care - chronic illness compounding across years, generating costs that TABOR's growth constraints cannot match. No work requirement aimed at working-age adults addresses this pressure.


H.R. 1 compounds the problem. Colorado will spend $57 million per year on administrative costs to enforce work requirement compliance - 52 times the $1.1 million projected savings from the caregiver hour cap. The federal government will not fully cover those costs. Colorado is being asked to build a compliance infrastructure to address a fraud problem that represents a fraction of a percent of spending, while the actual fiscal pressure - elder care - remains untouched.


The Colorado CARE Act addresses the correct pressure point. Zero administrative cost. $23-38 million in projected net savings using HCPF's own cost differential data. A documented conversation before a caregiver's employment arrangement changes. The Commission is wrestling with the cards H.R. 1 dealt. The CARE Act is the tool that addresses the problem that actually is.


The brief is in the room.

My 33-person calculation was submitted to Commission staff in late May - before the first meeting, before the CMS rule dropped. Nobody has responded. I am not concerned. Work gets through even when it hasn't been read yet.


The Caring Costs Survey is in active development - three to four equity-informed modules measuring legal awareness, creative dismissal, and accommodation outcomes. Late summer field date targeted. December 11 is the Commission's recommendation deadline.


772 signatures. 228 from 1,000. 18 organic. The argument travels when it reaches the right people.


Read the full dispatch: therevenueneutralcaregiver.substack.com Sign or share: https://chng.it/DLWncS9wtT Contact: mark_fukae@casiadvocacy.org | (303) 817-6995


 
 
 

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