Urgent Family and Economic Impacts of Medicaid Provider Rate Reductions

[Kimberly Aguilar-Pauli]

Dear Larimer County Commissioner John Kefalas,

Thank you for your continued service to Colorado families and for the care and responsibility required to steward difficult budget decisions. I am writing to share urgent family and community impacts related to the recently approved Medicaid provider rate reductions, as these decisions move forward toward final approval by the Governor.

I am writing in two closely connected roles: as the Executive Director of The Arc of Larimer County and as a parent of children on the autism spectrum, one of whom receives provider support through Medicaid waivers. My purpose in reaching out is to ensure that the serious and time‑sensitive impacts these decisions are already creating for families and communities are clearly understood.

I recognize that the Joint Budget Committee has completed its work under extraordinary constraints. However, what is becoming clear in real time is that these provider rate reductions are already destabilizing families, providers, and the local workforce. The consequences extend well beyond individual households and will ripple through our economy if left unaddressed.

For families caring for children with disabilities, Medicaid Home and Community Based Services make it possible for parents to remain employed and for children to remain safely at home. When provider rates are reduced, providers lose staff, services become unavailable, and care hours are eliminated. In practice, that loss of care does not disappear. It is absorbed by families, often immediately and without warning.

In April, parents in our community reached out because they were facing sudden and significant care losses. One parent shared:

“I’m losing the majority of my care hours for my son, Harry, other than three hours per week. I may get some HMA hours, but that is up in the air, and those hours would also be taxed income.

I am already my child’s primary caregiver. Losing these hours means I will be doing nearly everything myself, without the support Medicaid is intended to provide.”

Another parent described the long‑term consequences of provider instability:

“My daughter lives with a severe brain injury. We were told she would not live past eight years old. This summer, she turns eleven. She is alive today because she has been able to remain at home with the support of Medicaid Home and Community-Based Services.

We have never been able to maintain consistent outside nursing care. Nurses come and go, sometimes staying only days. Because of this, I have had to serve as my daughter’s full-time caregiver.

If HCBS hours or funding are reduced, I will be forced to work outside the home to support my family. That means leaving my daughter without the constant, skilled care she requires.”

These stories reflect what many families across Colorado are already experiencing. When provider rates are reduced, families do not simply lose services. Parents are forced to reduce work hours or leave the workforce entirely. This affects household income, employer stability, and local economies. Over time, it increases reliance on emergency systems, hospitals, and institutional care, all of which carry significantly higher costs.

While families will continue to do everything possible for their children, there are real limits to what families can absorb without broader economic and social consequences. Provider workforce instability directly undermines family stability, workforce participation, and long‑term economic health.

My intent in sharing this information is to underscore the urgency of these impacts as implementation approaches. Ensuring that family experiences are fully understood at this stage may help prevent outcomes that are costly, disruptive, and difficult to reverse.

Thank you for taking the time to consider these perspectives during a critical moment in the process. I would welcome the opportunity to share additional information or connect you with families who are navigating these changes right now. I appreciate your continued commitment to understanding how policy decisions affect real families and our broader community.

With appreciation and concern,

Kimberly Aguilar-Pauli

Executive Director

The Arc of Larimer County 

www.arclc.org 

1721 W. Harmony Road, Unit 101 

Fort Collins, CO 80526 

970-204-6991 ext. 17 

Cell: 970-631-7295

 

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