EDITORIAL: Colorado's latest Medicaid pratfall

It might have been easier to discount audit findings of state Medicaid mismanagement reported last week — if they weren't the latest among many such findings.

In reality, it's another episode in Colorado's ongoing Medicaid meltdown. And while the state bureaucrats charged with overseeing the health insurance program for the poor are insisting the audit's allegations miss their mark — it's their protests that ring hollow by this point.

As reported in The Gazette on Friday, a report from the U.S. Department of Health and Human Services inspector general found Colorado failed to follow federal and state requirements for some Medicaid personal care service payments. The federal agency is now seeking an $8 million repayment from the state.

The bigger picture is more troubling.

It's all part of a Medicaid mess that has been compounding for years under Gov. Jared Polis and his fellow Democrats who run the legislature. They have been shoveling money into the joint-federal-and-state program, incentivizing its long and wide-ranging pattern of mismanagement — while running up budget deficits.

The program has ballooned in size owing to a yearslong ideology whose mission has been to make publicly funded health care an end, in and of itself, not just a stopgap. The nonpartisan Common Sense Institute found spending by the Colorado Department of Health Care Policy and Financing, which runs Medicaid in the state, doubled in the past decade — skyrocketing from $8 billion in 2015 to $16 billion in 2025.

Some of that mushrooming spending stems from legislative policies that expanded coverage in one way or another for those already eligible. And some of the growth is from changing the game on eligibility. A particularly egregious example is "Cover All Coloradans," offering coverage for illegal immigrants. It began in 2024, with initial estimates pegging the program cost at $27 million for 3,600 enrollees. It now covers 30,000 women and children and is estimated to cost $112 million in the next budget.

Where so much money pours in, of course, hustlers are sure to follow.

As reported this year, for example, the state uncovered a spate of $25 million in abnormal billing about two years ago — leading authorities to what they described as an organized fraud ring. Perhaps one of many?

The state's Medicaid department has been beset by allegations of misspending that included $25 million to nonemergency transportation providers and $78 million in improper autism therapy payments. Last year, an audit by the inspector general for Health and Human Services found that thousands of deceased Coloradans had stayed on the state's Medicaid rolls while the state continued paying managed care organizations to cover them, thanks to outdated reporting and system delays.

Incredibly, the Polis administration's Medicaid managers nearly walked away from a badly needed, $455 million infusion of federal funding to ease pressure on Colorado's hard-pressed hospitals. The state relented after an outcry from the hospitals. The funding will allow Colorado to increase reimbursements to hospitals for treating Medicaid patients.

There's blame to go around, to be sure; Medicaid department chief Kim Bimestefer stepped down under fire last spring. A thoroughgoing reorganization of the department might be in order if our next governor has the appetite.

But Medicaid fraud and mismanagement are just symptoms of a fiscal disease. The brunt of the blame for Medicaid's extraordinary costs belongs to lawmakers and the governor, who have driven Medicaid's expansion.

The state will not bring Medicaid under control until ruling Democrats quit looking at it as a vehicle for expanding health coverage. That means refocusing on Medicaid's original mission — covering our most disadvantaged — and stop using it to reinvent the health care marketplace.