What the Commission Doesn't Know

Five analytical gaps in Colorado's Medicaid Commission documents - and the tools being built to fill them.

The Missing Variable: For May 30, 2026, Dispatch Two of The Long Game explores the difficult math state committees face. Tasked with balancing budgets under heavy federal mandates, commissions are forced to focus on cost-containment. However, the formulas often assume a baseline that isn't guaranteed: that family caregiving capacity is permanently stable. Today, we look at why the data models need to account for what happens when family caregivers can no longer sustain the unpaid labor holding the system together.

By Mark Fukae - Director of Advocacy - Professionals Who Care

The Colorado Commission on Medicaid meets Thursday, June 4 - Room 220, Old Supreme Court Chamber, Colorado State Capitol. My written brief is on record. I will be there as a registered volunteer lobbyist.

Before that meeting, five things the Commission's documents probably don't know.

1. The 33-person calculation hasn't been modeled.

$1.1 million in projected FY 2026-27 savings from capping caregiver hours, divided by $33,614 - HCPF's own SNF/HCBS cost differential - equals 32.7. Thirty-three employed family caregivers exiting the workforce erases the savings entirely, before institutionalization costs compound annually. Two numbers from HCPF's own data. The model has not been run.

2. The work requirement trap.

H.R. 1 requires 80 hours per month of work for Medicaid expansion adults - explicitly including caregivers with dependents over 14. Colorado will spend $57 million per year on H.R. 1 eligibility review administration - 52 times the $1.1 million saved by the caregiver cap. Two pressures, same population, opposite directions.

3. The data gap.

No Colorado dataset measures the legal awareness gap, the creative dismissal pattern, or accommodation outcomes for employed family caregivers. CASI is building the Caring Costs survey - the first Colorado-specific primary data instrument designed to make this workforce visible to the people who make decisions about it. It will measure not how hard caregiving is, but what the law is not doing and what it costs when it fails.

4. The special session window.

Governor Polis flagged a potential special session contingent on H.R. 1's passage. It passed. Its Medicaid provisions land December 31 - the same month the Commission's recommendations are due. The CARE Act - zero general fund, with CASI's fiscal analysis projecting $23-38M in net annual savings using HCPF's own cost differential data - belongs in that conversation if a special session materializes.

5. The expertise cannot be purchased after it is lost.

Every cost-containment measure in HCPF's documents assumes caregiving capacity is stable. None models what happens when the people providing it lose their jobs. The knowledge - developed through months of sustained attention to one specific person - leaves with the caregiver. It cannot be rebuilt from scratch.

The Colorado CARE Act addresses all five gaps at zero general fund cost.

Read the full dispatch: therevenueneutralcaregiver.substack.com Sign or share: https://chng.it/DLWncS9wtT - 692 supporters, 771 signatures, 229 from 1,000 Contact: mark_fukae@casiadvocacy.org | (303) 817-6995