Committee advances opt‑in direct primary care pilot for Medicaid patients with two‑year review and reporting requirement

The House Health & Human Services Committee voted on Feb. 18 to advance House Bill 10‑96 as amended, which permits Medicaid beneficiaries to voluntarily opt into direct primary care (DPC) practices while retaining traditional Medicaid benefits for prescriptions, referrals and specialty care. Sponsors said the measure is intended to improve timely access to primary care in rural and health‑desert areas where appointment wait times can be weeks.

Representative Johnson (sponsor) described DPC as a membership model (often $50–$150 per month) under which patients contract directly with a primary care practice for unlimited or expanded access; under the bill both the DPC practice and the Medicaid patient must affirmatively opt in. Sponsors emphasized that the bill does not require Medicaid to pay DPC fees and that covered services (scripts, referrals) would continue to process through Medicaid.

Opponents including the Colorado Center on Law and Policy and Medicaid plan Colorado Access warned that DPC could fragment Medicaid networks, shift covered services behind an out‑of‑pocket paywall for low‑income patients, and leave plans unable to monitor well‑child checks and EPSDT metrics. HCPF staff said they were present for questions and noted oversight and reporting concerns.

To address those concerns, sponsors offered an amendment (L001) to add a two‑year runway and a required reporting obligation for DPC providers to HCPF on utilization by Medicaid members — data the department and plans said they need to monitor access, quality and network disruptions. The committee approved the L001 amendment and then voted to advance the bill as amended to the Committee of the Whole (vote 9‑3 with 1 excused).

What to watch: The bill’s reporting requirements and the two‑year review will be central during floor debate and any subsequent amendments; health plans and HCPF will monitor whether DPC participation alters Medicaid networks or outcomes for vulnerable children and adults.