When news broke last week that Kim Bimestefer, executive director of Colorado’s Department of Health Care Policy and Financing, was stepping down, it became clear who was going to bear the official blame for a widespread failure of management and policy on Medicaid. 

But there’s blame to go around.

The nonpartisan Common Sense Institute found the department’s spending surged by 101% in the past decade — skyrocketing from $8 billion in 2015 to $16 billion in 2025, well above overall state budget growth of 64%.

The state Senate was preparing a resolution calling for Bimestefer’s resignation before she stepped down. It cited the “cumulative effect” of her “mal-administration” as costing Colorado hundreds of millions of dollars and shifting “burdens of care to hospitals and other providers.”

Those are legitimate criticisms, of course, and a leadership change was needed. There were unforced errors aplenty under Bimestefer, and confidence had been lost in any event. 

Yet, the brunt of the blame for Medicaid’s extraordinary costs rightly belongs to our legislature and its ruling Democrats, along with Gov. Jared Polis,  who have driven Medicaid’s growth and expansion.

The state’s “Medicaid Sustainability Framework” had attempted to fault spending limits under TABOR, the Taxpayer’s Bill of Rights. But Medicaid’s surge has nothing to do with TABOR — and everything to do with Medicaid itself. As CSI found, the legislature has passed 182 health care bills since 2019, costing roughly $858 million per year.

That reflects poor policy set by lawmakers who insist on tinkering with health care, driving up compliance and administrative costs that have nothing to do with quality of care. CSI found the department could have held spending to $10.8 billion if not for “expansive policy and other nonessential spending.” 

The Gazette recounts how dozens of bills were passed by legislators expanding Medicaid since 2020, with costs ranging from hundreds of thousands to tens of millions of taxpayer dollars.

Among the most glaring examples was “Cover All Coloradans,” a health care coverage program for illegal immigrants that began in 2024. Initial estimates pegged the program at $27 million for 3,600 enrollees.

In reality, it now covers 30,000 women and children and is estimated to cost $112 million in the next budget.

Senate Bill 23-289 allowed the state to provide in-home and community-based services to Medicaid recipients — estimated at a cost of $39 million.

The Gazette identified six other laws that added $40 million to Medicaid spending — including $3 million for “reproductive health” care coverage for people who wouldn’t otherwise be eligible for Medicaid due to citizenship or immigration status and another $7 million to cover copays for pharmacy and outpatient services.

These costs stem from the drip-drip-drip of legislative choices. Are lawmakers considering the cumulative costs of the bills they pass?

HCPF has been beset by allegations of misspending that included $25 million to non-emergency transportation providers and $78 million in improper autism therapy payments. Changes to Medicaid’s reimbursement formula under Bimestefer allowed providers to charge much steeper rates for non-emergent transportation, costing $300 million a year.

Accountability at the management level is critical, so Bimestefer’s departure is certainly warranted, but management failures don’t explain a $16 billion department that should be $10 billion.

Even as Medicaid enrollment has returned to 2015 levels following a 7.6% pandemic-fueled surge, HCPF full-time employment has jumped 72% as administrative spending doubled.

The Gazette’s ongoing reporting, alongside CSI’s analysis, have helped hold leadership accountable.

But Bimestefer’s exit won’t resolve a fiscal crisis of the legislature’s making. Only lawmakers willing to undo their own damage can do that.