Source: Colorado Politics
Kim Bimestefer resigned Monday as Colorado’s top Medicaid official, stepping down just as a bipartisan bloc of state senators prepared to formally urge Gov. Jared Polis to remove her over what they called years of mismanagement, waste and costly errors inside the state’s largest agency.
In her resignation statement released by the governor’s office, Bimestefer said, “It has been a true blessing to serve the State of Colorado as the Executive Director of HCPF, as a member of Governor Polis’ Cabinet and Lt. Governor Primavera’s Health Cabinet. Across my career, this public service chapter has proven to be the most important and meaningful, and I am honored to have had this opportunity. I have had the privilege of advancing systems that help Coloradans – often in the most difficult times in their lives – get the care and support they need to rise and thrive. Working alongside HCPF leaders, staff and stakeholders, we have navigated one unprecedented challenge after another for over 8 years to protect the state’s most vulnerable, with this current chapter proving to be incredibly difficult. Under the Governor’s and the Lt. Governor’s leadership, I am confident that my successor, in collaboration with HCPF’s outstanding leaders and staff, will continue to successfully navigate the challenging terrain ahead.”
In accepting her resignation on Monday, Polis said in a statement, “Kim has been leading on health care in Colorado for decades and has committed her career to serving her fellow Coloradans. I am incredibly grateful for her passion and commitment to making our state a better place for everyone, and for her unrelenting quest to really move the needle on health care costs and efficiency.”
In total, 27 of the chamber’s 35 senators were prepared to introduce a resolution on Monday, calling for Bimestefer’s removal. The resolution was authored by Sen. Kyle Mullica, D-Thornton.
Mullica said Monday, “I, along with a number of my colleagues in the legislature, have raised serious concerns about the management of HCPF. This leadership change is a necessary step toward accountability and gives us a critical opportunity to stabilize the department and put Colorado’s Medicaid program on a sustainable long-term path.”
The resolution came on the heels of the state’s Medicaid program nabbing headlines in recent weeks with allegations of a fraudulent billing ring, improper payments for autism therapy, and exploding costs in a relatively new program meant to provide health care to pregnant women and children illegally staying in the U.S.
The Department of Health Care Policy and Financing has blamed “outrageous behaviors” among providers, while at the same time acknowledging that assumptions — such as the health of the immigrant population covered by the new program — have been wrong.
Every Republican in the Senate supported the resolution, along with a majority of the chamber’s Democrats, a mix of both progressive and moderate members.
Overspending by HCPF on the Medicaid portion of its budget has been blowing holes in the state budget for at least two years, with an additional $600 million in general funds in 2024-25 and at least $150 million in the 2025-26 budget.
By law, the state must cover that overspending, which state officials have said is tied to higher utilization of health care services by older Coloradans with more expensive health care needs.
Mullica told Colorado Politics it’s been obvious that HCPF is mismanaged.
“As policymakers, we are having to make some really difficult decisions, making cuts to care for some really vulnerable folks,” he said.
The issue of mismanagement has been compounded by fraud, waste and abuse, he said.
“It’s across the board, and it’s in the hundreds of millions of dollars, if not billions,” he said.
Going forward, Mullica said lawmakers have to figure out how to take care of Medicaid, including in the wake of H.R. 1, the Trump administration’s 2025 budget bill, which will mandate low-income recipients either work or attend school at least half-time, or be enrolled in training or volunteering for at least 80 hours per month. In addition, certain Medicaid recipients will be required to be re-certified for benefits every six months instead of once a year, and both requirements could result in loss of coverage.
Supporters of the federal work requirements have argued that they would promote self-sufficiency, reduce government spending, and ensure that welfare programs are sustainable and help those who truly need assistance. Critics said they are unlikely to achieve their purported aims, while cutting off millions of Americans from the help they need.
“I don’t want that hole to be dug any deeper,” and, in the wake of the upcoming Medicaid changes, make the job any harder due to mismanagement by the agency, he said.
“We’re not going to turn a blind eye,” Mullica said. “This isn’t about politics. This is about doing what’s right for the people of Colorado, making sure dollars are best utilized and having accountability.”
He noted mistrust of government, especially when taxpayers think something is being swept under the rug and that their tax dollars aren’t being used properly.
“I hope this is an example that we don’t ignore it,” he said. “And that we take accountability and we take action, no matter the letter next to somebody’s name.”
Those savings, however, have been elusive. Instead, the agency’s Medicaid budget has doubled in the past five years, along with reports of waste, fraud and abuse, and allegations that Bimestefer failed to properly manage the agency.
Maureen Tarrant, an HCA HealthONE vice president and a former hospital CEO, said the lack of oversight points to deeper failures.
“(T)his is the largest line item in the state budget and you have that kind of mismanagement,” Tarrant said during a forum in February. “That’s not fraud, waste and abuse. That’s mismanagement.”
While Medicaid costs are rising nationwide, Colorado stands out for the share of its budget devoted to the program. Only New Hampshire’s share is higher than Colorado.
Last month, federal prosecutors charged two Medicaid transportation providers with fraud and bilking taxpayers of more than $500,000 in proceeds used for luxury vehicles, jewelry and cosmetic surgery. State officials also said they detected $25 million in abnormal billing — a surge that prompted a new state law and the suspension of dozens of providers.
A federal audit also found Colorado made $77.8 million in improper Medicaid payments for autism therapy after program spending for Applied Behavior Analysis (ABA) surged. ABA is a therapeutic approach that centers on managing symptoms by improving social and communication skills.
“Colorado and the nation are battling unacceptable cost increases due to outrageous behaviors and practices by a subset of disruptive and revenue-maximizing ABA providers,” Marc Williams, a HCPF spokesperson, has said.
Meanwhile, the program that covers pregnant women and children illegally staying in the U.S. was assumed to cost only $27 million. Spending blew past that. It is expected to cost $112 million in the next fiscal year’s budget.
Bimestefer, who has not been directly interviewed by a local news organization on the allegations of fraud and runaway spending, previously served for four years as president and general manager of Cigna’s Mountain States Region, where she began as president of the company’s Taft-Hartley and federal business segment in 2001. Her reasons for leaving Cigna are unknown.
She was removed from her role as president and general manager in 2016, though the reasons are unclear.
