Policy Updates from the Colorado Joint Budget Committee

An operator's summary of the four 2026–2027 rule changes for Home and Community-Based Service providers

The Colorado Joint Budget Committee — the legislative body that oversees the state's healthcare spending — has approved four policy changes that will reshape how home and community-based service providers operate over the next 12 months. Each change is being implemented through the Colorado Department of Health Care Policy and Financing.

Below is what each change does, when it takes effect, and what it means in practical terms.

1.New Limits on Paid Family Caregiver Hours

A Legally Responsible Person — typically a parent, spouse, or legal guardian — can be paid to provide Homemaker services to their family member when no other caregiver is available. Under the current rule, each Legally Responsible Person can provide up to 5 hours per week, with a maximum of 2 Legally Responsible Persons in the household. In total, a family can deliver up to 10 hours of paid Homemaker service per member when both arrangements are in place.

What is changing: The new rule replaces that structure with a single 7-hour weekly cap per member, regardless of how many family caregivers live in the household.

When it takes effect: Pending an emergency rule vote by the Medical Services Board on June 12, 2026. Effective shortly after.

What this means in practice: Agencies that depend heavily on family caregivers will need to rebalance how those hours are scheduled. Members who need additional Homemaker support may need to draw the remaining hours from non-family caregivers.

2.Phased Weekly Cap on Caregiver Hours

Currently, a single caregiver can provide many hours of weekly service to one member. The new rule introduces a weekly cap on how many hours one caregiver can deliver to a single member, applied across Personal Care, Homemaker, Health Maintenance Activities, Long-Term Home Health Aide, and Long-Term Home Health Nursing services.

What is changing: The cap will phase in over 12 months — 84 hours per week starting July 1, 2026, stepping down to 70 hours on January 1, 2027, and reaching the final cap of 56 hours on July 1, 2027. The existing 16-hour-per-day limit continues throughout.

When it takes effect: Phased rollout begins July 1, 2026.

What this means in practice: Members do not lose their authorized hours. The same hours simply have to be spread across more caregivers. For members who require continuous coverage by a single caregiver, an exception process will allow agencies to file for higher allowances when specific criteria are met. Those exception filings will require strong supporting documentation reaching back through the member's service history.

3.New Short-Term Skilled Nursing Benefit

Private Duty Nursing is skilled nursing care delivered in a member's home, typically for individuals with complex medical needs that require ongoing support from a registered nurse, licensed practical nurse, or certified nurse aide. Until now, accessing additional private duty nursing for sudden medical changes required prior authorization, which often delayed care during exactly the moments members most needed it.

What is changing: A new acute benefit allows agencies to deliver up to 60 days of intensive private duty nursing without prior authorization when a member experiences a sudden change in medical condition or is transitioning home from a hospital or institution.

When it takes effect: January 1, 2027, pending federal approval.

What this means in practice: Agencies offering skilled nursing services gain a fast-response tool to keep members at home through acute episodes — preventing avoidable hospitalizations or institutional placements. The state has also introduced a per-diem reimbursement option for situations where private duty nursing and certified nurse aide services are both delivered on the same day.

4.New Group Rates for Shared-Setting Services

Currently, when one direct care worker supports multiple members in the same setting — such as a day program or a shared residence — each member is billed individually, as if the service were one-on-one. The new rule introduces group rates that better reflect how services are actually delivered when multiple members are served at the same time.

What is changing: Group rates will apply to Personal Care, Homemaker, and Health Maintenance Activities under the Community First Choice benefit, and to certified nurse aide services under the Long-Term Home Health benefit, when delivered to multiple members in the same setting at the same time. Individual rates remain in place when services are delivered to a single member.

When it takes effect: January 1, 2027. Members transition to the new rates at their next Continued Stay Review or new authorization period throughout the calendar year.

What this means in practice: Reimbursement will align more closely with how services are actually delivered in shared settings. Agencies serving members in day programs and group residences will need to update their billing practices, but the change is intended to reduce duplicative billing and support more sustainable shared-setting operations.

The Common Thread

These four changes hit different parts of an agency's operation — workforce, family caregivers, billing, and acute response. But they share one operational dependency:

documentation strength.

The exception process for the caregiver hour cap will succeed or fail on the quality of the notes defending it. The acute private duty nursing benefit requires clear records of the medical change triggering it. Group billing requires clean records of which members were served when, and by whom. The family caregiver cap will require accurate tracking of who provided what within each household.

Agencies whose documentation systems already surface gaps in real time — during the shift, not at month-end — will absorb these changes smoothly. Agencies whose systems surface gaps only after the fact will find themselves rebuilding under deadline pressure, with revenue at risk.

This document summarizes publicly released information from the Colorado Department of Health Care Policy and Financing as of May 2026. Rule language remains subject to final approval by the Medical Services Board and, where indicated, the federal Centers for Medicare and Medicaid Services. Agencies are encouraged to review the original rule drafts and submit stakeholder feedback through the channels announced in the official Health Care Policy and Financing newsletters.