Given the choice, many Coloradans would prefer to be home for the holidays, especially if the alternative is a hospital or a nursing home. This holiday season, we can be grateful for the invaluable services home care workers provide to make that possible for so many people.

But home care services in Colorado face a huge threat – a threat that keeps growing. What’s coming in January is proof of that. Home care service providers face an unfunded mandate that could place an untenable financial strain on agencies, affecting their ability to maintain current service levels for Colorado’s most vulnerable residents.

It’s critical the Colorado legislature take action to protect essential home care services in Colorado communities, before it’s too late.

Home care services are vital for Coloradans who have physical or mental conditions that limit their ability to care for themselves independently. Many of them receive in-home personal care and homemaking help through Colorado’s Medicaid program, Health First Colorado. These services include assistance with daily necessities such as bathing, eating and general household activities needed to maintain a healthy and safe living environment.

But the way the Colorado legislature sets Medicaid reimbursement rates each year puts these vital services at risk. For example, there are no guarantees minimum wage requirements for home care providers and Medicaid reimbursements will consistently match up year to year. The state has yet to adopt a proactive approach to rate setting.

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The result is home care service providers are often left with mandated cost increases – such as Denver’s minimum wage increase coming in January – without offsetting rate increases to cover those costs. This situation jeopardizes home care services for Colorado’s most vulnerable populations.

Ironically, it also ends up costing the state more money when people are forced out of their homes and into more costly care settings such as hospitals and nursing homes.

In Denver, beginning in January, the wage for direct care workers, who provide in-home care services, rises to $18.29 per hour. Denver’s the highest minimum wage in the state. Denver is also the city in Colorado with the largest population, so its minimum wage requirement impacts a significant number of home care agencies.

The soonest these agencies can hope to receive some relief for increased wage costs through the state’s Medicaid program is July 2024 – that’s a six-month delay.

In most cases, home care agencies are small businesses run on shoestring budgets. There are agencies that may not be able to survive that kind of unfunded mandate, at least not without significantly reducing staff and services.

Denver isn’t the only city that has adopted for a minimum wage higher than the state’s. In November, Boulder implemented a minimum wage of $15.69 per hour for 2024. This illustrates the burdensome nature of a patchwork approach to minimum wages in Colorado. With only a few months to prepare, businesses that operate in Boulder are being required to meet an unexpected increase that is $1.27 per hour higher than the state’s minimum wage for 2024.

There is no mechanism for the state’s Medicaid rate to accommodate such eleventh-hour minimum wage requirements. And according to Colorado state law, any local government can adopt a minimum wage higher than the state’s. Though Boulder is the latest local government to do so, it certainly won’t be the last.

The Colorado legislature needs to adopt a proactive rate setting process that accounts for wage mandates for the home care industry. If it fails to do so, it risks a great deal for Colorado’s Medicaid population and Colorado taxpayers. It risks losing vital home care services in Colorado.

Workers deserve to be well compensated for their invaluable work, and agencies who serve the state need support and resources from the state to make that possible.

Home care allows people to receive life-giving and dignity-preserving care in their homes. This includes assistance with bathing, dressing, grooming and going to the bathroom. It includes mobility assistance – helping people to sit, stand and walk. It includes help with medication, meal preparation and eating meals. It includes homemaking services like basic cleaning, laundry, bed making and dishwashing. It includes grocery shopping and essential errands.

For Medicaid recipients who are unable to meet these needs independently, personal care services and homemaking services must either be provided in the home or in an institution. Home care is the preferred option for most care recipients, and is the most cost effective care option for the state’s Medicaid program. Yet, funding decisions for these services are almost always reactive and often significantly delayed.

I urge state policymakers to take decisive action on Medicaid rates for home care services in the coming legislative session. May all of our reflections this holiday season on the things that really matter – good health, family and hope for the future – help guide those decisions in the New Year.

Don Knox is the executive director of the Home Care and Hospice Association of Colorado.