The Taxpayers Protection Alliance describes itself as a nonpartisan group “dedicated to educating the public through the research, analysis and dissemination of information on the government’s effects on the economy.”

Colorado Politics spoke with TPA’s senior fellow and attorney, Ross Marchand, about the organization’s work investigating Colorado’s Medicaid spending increase.

CP: Can you tell me a little bit about your organization?

Ross Marchand: Taxpayers Protection Alliance is a nonpartisan, nonprofit taxpayer and customer watchdog group dedicated to keeping the government honest and holding them accountable for wasteful policies. We spend a lot of time focusing on Medicaid because of the sheer size and complexity of the program, and we noticed that in Colorado, as is the case with many other states, spending on the program is large and growing even, (even) as enrollment is declining. And that is something we very much want to get to the bottom of.

CP: How are you working to get to the bottom of it?

Marchand: TPA’s 501(c)(3)-affiliated organization, the Taxpayers Protection Alliance Foundation, is sending information requests tomorrow to the Colorado state government to get greater insight as to why spending is ballooning, even as enrollment is going down. It seems that there are some big cost drivers that have to do with the remaining populations covered by Medicaid, and there is also some fraud in the mix. It was reported recently that there was a Medicaid fraud scheme targeting a free transportation program that is supposed to shuttle patients to medical appointments, and this fraud scheme costs taxpayers an estimated $25 million. You can’t make this up — people would pack their cars with patients and drive them hundreds of miles just to maximize taxpayer payouts.

CP: Do you know of any other examples or specific areas where fraud has taken place within the Department of Health Care Policy and Financing or other state agencies?

Marchand: One big focus of TPAF’s information request efforts is to gain greater insight as to why these spending figures are so high and why they’re increasing and why they’re such a big part of the state’s budget problem.

CP: HCPF’s budget has grown significantly in the past several years, correct?

Marchand: Their budget has increased by 83% since 2018, and the full-time staff has increased by 81%, even as Medicaid enrollment has declined. There are a variety of factors, some more apparent than others, but it is very important to understand all of these factors, ranging from increases in long-term care support services to general medical cost inflation to waste, fraud and abuse, and everything in between.

CP: Colorado’s 65-plus population is also growing at a rapid pace. Do you think that has anything to do with the increase in Medicaid spending?

Marchand: Yes, the 65-plus population is projected to grow by 48% by 2050, so that is definitely a big factor, but there are also implications from how the state determines eligibility for long-term care. When the state is trying to determine if you’re eligible for long-term care, they’ll examine your income and assets, and that’s the same in every state. But Colorado tends to be very lax in the process, and they exempt home values up to around $1.1 million, while the vast majority of states set that limit around $750,000. I believe 11 states have this $1.1 million limit that Colorado has, and California has no limit, but all of the other states set it around $750,000. So, Colorado is very much an outlier, even if it’s not quite as radical as California.

CP: What policy changes do you think the state should implement to resolve this issue?

Marchand: We have two suggested reforms right off the bat. One is regular monitoring and auditing for fraud and improper payments, and No. 2 is tightening long-term care service eligibility to ensure that millionaires are not on Medicaid.

CP: Is there a required schedule for audits, or are they currently only conducted as needed?

Marchand: It appears to be as needed, but they should be on a regular basis. If there is an annual reporting for Medicare and Medicaid at the federal level, it should absolutely be the case at the state level, as well. It makes the most sense for it to be passed legislatively so all of the parameters can be defined and all of the expectations for the agency could be clear.

CP: Has TPA been in talks with any state lawmakers in Colorado about legislation related to this issue?

Marchand: This is something where we are developing relationships with lawmakers to call attention to these issues, and we are very much watching out for the release of reform proposals and also ensuring that Colorado continues to look out for its taxpayers and is honest about the full extent of program costs.