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Support HB 18-1407: "Access to Disability Services and Stable Workforce"

The Problem


To ensure support for people with IDD in our community, Colorado must address these inextricably linked issues:

Aging caregivers and individuals with IDD should not have to wait until they reach a crisis point to get help.

Colorado has long sought ways to eliminate the waiting list for comprehensive IDD services (the Developmental Disabilities, or HCBS-DD, waiver). Approximately 2,900 people are on the waiting list, most of whom have been waiting for years or decades. As of March 2018, approximately 300 people on the waiting list are aged 45 or older and are likely to have an aging caregiver. Aging caregivers are more likely to have chronic illnesses or otherwise have diminished capacity to care for their loved ones with IDD. Currently, these caregivers must continue to provide support until their loved one’s name comes to the top of the list, or until an emergency occurs when the caregiver dies or can no longer physically provide supports. Colorado does not consider the age or health of caregivers in its waiting list criteria.


The workforce crisis among IDD Direct Support Professionals is a barrier to ending the waiting list.

Insufficient Medicaid provider rates have resulted in an IDD Direct Support Professional (DSP) workforce crisis, which in turn is jeopardizing the sustainability and continuity of supports for people with IDD. A dedicated workforce of DSPs provides supports so that people with IDD can live full lives in the community instead of institutions. Unfortunately, due primarily to low reimbursement rates, these workers often make poverty-level wages that are not commensurate with the responsibilities of their work. This leads to high turnover and vacancy rates, which translates to service disruption for people with IDD. Colorado currently has an average 39% DSP turnover rate, with some agencies experiencing up to 81% turnover. Each turnover costs agencies between $4,200 and $5,200 in direct and indirect costs. This crisis prevents Colorado from meeting the demand for services.

The Solution


The proposed bill would:

  • Fund 300 new HCBS-DD waiver resources for those who have been waiting the longest and are most likely to have aging caregivers. This infusion of new resources to be initiated in FY 2018-19 and distributed on a first-come-first-served basis will help ameliorate growing caregiver concerns across Colorado and begin to draw down the waitlist.

  • Direct the Department of Health Care Policy & Financing to promulgate rules to add emergency enrollment criteria related to caregiver status. This will create a mechanism to assist people on the waiting list who are reaching a crisis point due to caregiver concerns such as advanced age, terminal illness, or incapacitation. Rulemaking is inherently a stakeholder process, but the bill would also ensure that HCPF solicit feedback on the rules from people with IDD and their families, who are most impacted by the waiting list.

  • Ensure stakeholder awareness of the HCBS-DD waiver waiting list by releasing data on how many people are coming off the waiting list on a monthly basis.

  • Provide a 6.5% rate increase for specific services on the Supported Living Services, Children’s Extensive Supports, and Developmental Disabilities waivers, 100% of which must be used to increase DSP compensation as defined in the bill. This will begin to address the IDD direct support workforce crisis that Colorado is experiencing.

  • Establish robust accountability for the 6.5% increase through provider reporting which includes:

    • An attestation from the Executive level that the funds are spent as directed and that reporting is accurate;

    • A statement not only on who the funds can be spent on (compensation for program workers, meaning direct support professionals, case managers, program supervisors, etc.), but also on who and what the funds can’t be spent on (compensation for administrative workers and tasks, including, IT, HR, CEOs, COOs, CFOs, etc.); and

    • A directive for HCPF to track the expenditure of these funds using an agreed-upon tool. We propose a tool that tracks increases by position and differentiates between wages and other forms of compensation; and

    • A “claw-back” or recoupment measure so that if the increase is not spent on compensation, those funds can be recouped by the Department.

  • Require the Department to participate in the National Core Indicators Staff Stability Survey to collect independent data on Colorado’s direct support workforce.

  • Require the Department to use existing National Core Indicator data to examine the impact of the rate increase on individuals with IDD.




The Joint Budget Committee has set aside $12.2M for FY 18-19 to cover the costs of this bill for year one.


IN SUPPORT (Updated 3/20/18 @ 3pm)


Advocacy Groups:

  • AdvocacyDenver

  • Association of Community Living

  • Colorado Cross Disability Coalition

  • Colorado Developmental Disabilities Council 

  • Consulting on Quality

  • Disability Law Colorado

  • Families at the Forefront of Technology

  • Family Voices Colorado

  • JFK Partners

  • Lehman Disability Planning

  • The Arc of Arapahoe and Douglas

  • The Arc of Colorado

  • The Arc of Jefferson, Clear Creek & Gilpin Counties

  • The Arc of Larimer County

  • The Arc of Mesa County

  • The Arc of Pikes Peak Region

  • The Arc of Southwest Colorado

  • The Arc of the Central Mountains

  • The Arc of Weld County

  • The Arc of West Central Colorado


Community Centered Boards:

  • Blue Peaks Developmental Services, Inc.

  • Colorado Bluesky Enterprises, Inc.

  • Community Connections, Inc.

  • Community Options, Inc.

  • Developmental Disabilities Resource Center

  • Developmental Pathways

  • Eastern Colorado Services for the Developmentally Disabled

  • Envision

  • Foothills Gateway, Inc.

  • Horizons Specialized Services

  • Imagine!

  • Inspiration Field

  • Mountain Valley Developmental Services, Inc.

  • North Metro Community Services

  • Rocky Mountain Human Services

  • Southeastern Developmental Services, Inc.

  • Southern Colorado Developmental Disabilities

  • Starpoint

  • Strive


Other Supporters

  • Boulder County

  • Pueblo County Department of Social Services

  • Gem Pharmacy

Provider Agencies:

  • A Better Life Experience, Inc. (ABLE)

  • A Real Difference

  • Ability Access , LLC

  • Ability Specialists

  • Activity Options

  • All Friends, Inc.

  • Alliance of Therapy Specialists

  • Altra Services

  • Ariel Clinical Services

  • Ascendigo Autism Services

  • B-4 Day Program and Residential Services

  • Behavior Services of the Rockies

  • Belk Model, LLC

  • Bethesda Lutheran Communities

  • Boone Guest Home

  • Bridging Family

  • C.A.R.E. Inc


  • CommonWorks

  • Community Advantage

  • Community Link

  • Community Living Alternatives

  • Community Support Services

  • Continuum of Colorado

  • Cottonwood Community Alternatives


  • Devereux

  • Dirt Coffee

  • DRM Home Care

  • Dungarvin Colorado, Inc.

  • Dynamic Dimensions, Inc.

  • Easter Seals Colorado

  • Evergreen Service Providers

  • FRIENDS of Broomfield

  • Garden, Inc.

  • Gray Speak Therapy

  • Janet Pasterkamp

  • Jewish Family Service

  • Jordan Residential and Vocational Services

  • Karuna Care Services

  • Kerryn Lakers (Family Caregiver)

  • Laradon

  • Metro Support Services

  • Mesa Developmental Services

  • Mosaic

  • Oliver Behavioral Consultants

  • Overture

  • Parker Personal Care Homes, Inc.

  • Quality Life Services

  • Sample Supports

  • Schaefer Enterprises

  • Shared Touch, Inc.

  • Six Points Evaluation and Training, Inc.

  • Support, Inc.

  • Thrive Community Options

  • Triuspa LLC


Learn more about Aging Caregivers

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Learn more about Direct Support Professionals (DSPs)


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