Spending by Colorado’s Department of Health Care Policy and Financing reached $16 billion in 2025 — a 101% increase from 2015 — while Medicaid enrollment has returned to nearly its 2015 level, according to an analysis by the Common Sense Institute.

The report points to 182 health care bills Colorado lawmakers enacted since 2019, which it says cost the state $858 million annually. The authors argue much of the spending growth stems from expansive policy choices rather than enrollment or medical inflation alone.

Marc Williams, a Department of Health Care Policy and Financing spokesperson, responded to The Denver Gazette’s request for comment but did not answer any questions.

He previously pointed to the state’s “Medicaid Sustainability Framework,” which argues the program’s growth consistently outpaces revenue growth allowed under TABOR, creating structural budget pressure.

HCPF manages the state’s Medicaid program, which serves about 1.2 million low-income Coloradans, including children, people with disabilities and seniors.

Williams also identified far fewer pieces of legislation with a fiscal impact: 51 from 2019 through 2024.

“One program in particular was/is Cover All Coloradans — the fiscal note was based on data at the time of the bill (2022) but no one knew then how the Biden administration’s open border policy would impact Colorado and this program when it took effect in January 2025,” Williams said in an email to The Denver Gazette.

But what he did not answer: If he agreed with the CSI estimate, how the department could slow spending growth without reducing eligibility or how HCPF justified staffing growth relative to a flat caseload growth.

The report groups recent cost drivers into broad categories, including Medicaid eligibility expansions, new or expanded services, and mental health and telehealth expansions.

Thirty-six percent of the $858 million is covered by federal spending, according to the CSI analysis.

Between 2015 and 2025, HCPF spending grew 101% — compared with 64% growth in the rest of the state budget.

“CSI’s analysis suggests that much of HCPF’s last decade of spending increases could have been avoided in the absence of expansive policy and other nonessential spending,” the authors wrote. “The agency’s total spending growth over that period, 101%, is higher than the combined growth rates of Medicaid enrollment, medical inflation, and obesity (a proxy for public ill-health).

“In the absence of some other nondiscretionary cost driver, this means that HCPF is spending more than is strictly necessary to deliver its services.”

Between 2018 and 2024, Medicaid enrollment rose by 7.6%, while total HCPF employment increased 78%.

“Knowing that TABOR is in place, more concerted efforts should have been made to keep a closer eye on spending and attempt to work within closer confines of a budget,” said Greg D’Argonne, who co-authored the CSI report. “It doesn’t appear this was the case.”