Colorado Legislative Council Staff



(replaces fiscal impact dated April 15, 1999)

Drafting Number:

Prime Sponsor(s):

LLS 99-0898

Rep. Tool

Sen. Lacy


Bill Status:

Fiscal Analyst:

April 28, 1999

Senate HEWI

Janis Baron (303-866-3523)



Fiscal Impact Summary

FY 1999/2000

FY 2000/2001

FY 2001/2002

State Revenues

Cash Funds Exempt

Possible Gifts, Grants, and Donations

State Expenditures*

General Fund

Cash Fund Exempt

Federal Fund



$ 3,230,293



FTE Position Change

0.0 FTE

0.0 FTE

0.0 FTE

Other State Impact: None

Effective Date: 90 days upon adjournment unless a petition is filed and approved by the voters

Appropriation Summary for FY 1999-2000: None required.

Local Government Impact: Should the county departments of social services be responsible for eligibility determinations, the counties' 20 percent share of cost is estimated at $1.6 million in FY 2001-02.


      *      No costs will be incurred until FY 2001-02; the pilot program must first receive federal approval. The costs identified for FY 2001-02 include both the service package for eligible clients and the administrative cost of performing eligibility determinations through the county departments of social services. The service package is not anticipated to require any additional General Fund; the cost for eligibility determinations will require added resources. The amounts identified in the table reflect maximum costs for eligibility determinations.

Summary of Legislation

            The reengrossed bill establishes a Family Planning Pilot Program to provide family planning services to individuals who are categorically eligible for Medicaid and are at or below 150 percent of the federal poverty level. The bill includes the following provisions:


               requires the Department of Health Care Policy and Financing (DHCPF), in consultation with the Department of Public Health and Environment (DPHE), to seek a federal waiver to implement the pilot program;

               states the funding splits for family planning services — 10 percent General Fund and 90 percent federal matching funds;


               as amended, requires DHCPF and DPHE to seek the necessary appropriation of General Fund through the normal budgetary process upon issuance of the federal waiver;


               authorizes DHCPF to accept and expend funds, grants, gifts, and donations for implementation of the pilot program;


               requires DHCPF to report on the findings of the Family Planning Pilot Program no later than 3 years after commencement of the program;


               requires that implementation of the program is contingent upon the issuance of federal waivers and available appropriations; and


               repeals the pilot program July1 five years after issuance of the federal waiver or July 1 in the year in which the waiver is terminated, whichever occurs first.

State Revenues

            The bill authorizes DHCPF to accept and expend funds, grants, gifts, and donations from any private or public source to implement the Family Planning Pilot Program. To the extent that the department receives such funds, they would be considered cash funds exempt for the purposes of TABOR.

State Expenditures

            FY 1999-00 — The bill does not have a fiscal impact for FY 1999-00. Although the bill requires DHCPF, in consultation with DPHE, to seek a federal waiver to implement the pilot program, DPHE indicates it has sufficient resources within existing appropriations to prepare the waiver.

            FY 2001-02 — The fiscal note assumes that, if federally approved, the pilot program will be implemented in FY 2001-02. Both DHCPF and DPHE indicate the maximum time for development and approval of a federal waiver for such program will require three years. Once approved, the respective departments, through budget decision items, will request the necessary funding to implement the pilot program. The table below provides an estimate of costs in FY 2001-02.


Unit Costs

FY 2001-02

Health Care Policy and Financing


                        Cost per Person

                    Total Benefits Need


                        Computer Systems Changes

                        MAC ID Cards

                    Total Program Need







Human Services

                    County Staff — Personal Services/Operating



TOTAL - Family Planning Pilot Program



            Financing for Family Planning Pilot Program — It is anticipated that current General Fund appropriations to the Department of Public Health and Environment, Women's Health - Family Planning, will be transferred to the Department of Health Care Policy and Financing to draw down a favorable federal funds match rate of 90 percent for family planning services. There will be no net increase in General Fund to provide benefits/services to clients. DHCPF will refinance existing General Fund. Using the estimated total program need of $10,726,492, as identified in the table above, DPHE will be required to transfer $1,223,707 General Fund to DHCPF to draw down $9,502,985 in new federal funding for the pilot program. Once federal funds have been secured, $9,250,063 cash funds exempt will be transferred from DHCPF to DPHE to provide family planning services through its network of providers.

            Eligibility Determinations — Federal approval and implementation of the Family Planning Pilot Program represents a significant expansion of Medicaid — 61,544 new Medicaid clients eligible for family planning services only, are anticipated. Currently, county departments of social services conduct eligibility determinations for Medicaid eligible clients. For certain Medicaid programs, namely, Baby Care Kids Care, clinics and hospitals have designation as presumptive eligibility sites. Staff at these sites are authorized to conduct presumptive eligibility on clients with the requirement that the paperwork be forwarded to the county departments within 75 days for certification, follow-up, and any case management services.

            Should the county departments of social services be responsible for conducting Medicaid eligibility determinations and providing case management services for the Family Planning Pilot Program, costs are estimated at $8.0 million. This cost is predicated on four hours of county staff time per client per year. Of the total estimated cost, $3.2 million would be General Fund, $3.2 million would be federal funds, and $1.6 million would be county funds. Should the clinics providing family planning services be authorized as presumptive eligibility sites, eligibility costs may be reduced. However, assuming only one hour per client per year for Medicaid eligibility determinations, would still represent a significant increase in workload. Although these costs are high relative to the cost of services provided, eligibility determinations and case management are estimated to be the same whether one is determining Medicaid eligibility for a comprehensive package of medical services or a single service, such as family planning.

            Because federal approval of Medicaid waivers requires that program costs demonstrate cost savings or at a minimum be budget neutral, the fiscal note assumes that the cost of eligibility determinations will be factored into the waiver submitted to the federal Health Care Financing Administration.


Local Government Impact

            There will be no fiscal impact in FY 1999-00. Should the counties be responsible for Medicaid eligibility determinations for the pilot program, county costs could be $1.6 million in FY 2001-02.

State Appropriations

            None required.

Departments Contacted


            Health Care Policy and Financing 

            Human Services

            Public Health and Environment