Will Federal Medicaid Changes Affect Colorado’s Long-Term Care Medicaid? Here’s the Answer

President Trump’s “One Big Beautiful Bill” (OBBBA) certainly includes far-reaching revisions to Medicaid—cuts to provider taxes, new work requirements, tighter eligibility checks, and billions in savings over a decade. But Colorado’s long-term care Medicaid—covering nursing homes, home health, and other LTSS (long-term services and supports)—has unique state safeguards that ensure it remains insulated from these changes.

1. Federal Cuts Mostly Affect Expansion and Non-Elderly Adults

The OBBBA’s primary targets are Medicaid expansion, non-disabled adults, and children, via work requirements and cost-sharing policies. These reforms are expected to phase in during 2027–2028. In contrast, long-term care beneficiaries—typically seniors and people with disabilities—fall under separate eligibility categories that the bill doesn’t restructure.

2. States Can Shield Long-Term Care Funding

Colorado funds long-term care services through its Medicaid “waiver” system. The OBBBA reduces providers’ taxes and places new caps on expansion enrollment, but it does not limit waivers for nursing homes or home- and community-based services. Even without adjusting, Colorado can preserve funding by prioritizing these essential services over general expansion.

3. Colorado’s Bipartisan Commitment to Aging Services

Colorado has a long-standing commitment to supporting seniors and people with disabilities. In recent years, the state has steadily increased its share of state funds to match or exceed federal contributions, especially for the elderly population. With broad political consensus, any state-level attempt to curtail waivers would be unlikely.

4. Historical Stability Through Waiver Protections

Since implementing the Home- and Community-Based Services (HCBS) Medicaid waiver in 2004, Colorado has used it to support aging in place and reduce institutional costs. These waivers have remained stable across administrations and funding changes. There’s no indication that Trump-era reforms would dismantle this proven framework.

5. National Context Supports Stability

Sources like KFF confirm that while OBBBA cuts the Medicaid expansion rate from 90 % to 80 %, and imposes red tape on enrollment, it does not overhaul LTSS (long-term services and supports). Even health-policy experts acknowledge the targeted nature of the reform—focused on non-elderly groups, not those needing long-term care .

Bottom Line for Coloradans

Trump’s Medicaid changes will significantly affect parts of the system serving non-disabled adults, especially in expansion states. But Colorado’s long-term care Medicaid—driven by federal waivers, state obligations, and a bipartisan mandate—stands apart. Residents’ access to nursing home care, home-based services, and support for people with disabilities is not at risk.