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July 26, 2023 SB 23-288
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Final Fiscal Note
Drafting Number:
Prime Sponsors:
LLS 23-0838
Sen. Fields; Buckner
Rep. English; Joseph
Date:
Bill Status:
Fiscal Analyst:
July 26, 2023
Signed into Law
Kristine McLaughlin | 303-866-4776
kristine.mclaughlin@coleg.gov
Bill Topic: COVERAGE FOR DOULA SERVICES
Summary of
Fiscal Impact:
☐ State Revenue
☒ State Expenditure
☒ State Diversion
☐ TABOR Refund
☐ Local Government
☐ Statutory Public Entity
The bill requires the Department of Health Care Policy and Financing to take steps
towards covering doula services and creates a doula scholarship program in the
department. The bill also requires the Division of Insurance to perform a cost-benefit
analysis of doula coverage. The bill increases state expenditures in FY 2023-24 only.
Appropriation
Summary:
For FY 2023-24, the bill requires and includes an appropriation of $200,000 to multiple
state agencies.
Fiscal Note
Status:
The fiscal note reflects the enacted bill.
Table 1
State Fiscal Impacts Under SB 23-288
Budget Year
FY 2023-24
Out Year
FY 2024-25
Revenue - -
Expenditures General Fund $100,000 -
Cash Funds $100,000 -
Total Expenditures $200,000 -
Diversions General Fund ($100,000) -
Cash Funds $100,000 -
Net Diversion $0 -
Other Budget Impacts General Fund Reserve $15,000 -
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July 26, 2023 SB 23-288
Summary of Legislation
The bill requires the Department of Health Care Policy and Financing (HCPF) and the Department of
Regulatory Agencies (DORA) to take steps towards covering doula services, as detailed below.
Stakeholder feedback. HCPF is required to conduct stakeholder meetings in manner that encourages
diverse participation, including providing reimbursement for child care and other costs for
participants. HCPF must also create the Maternity Advisory Committee to provide feedback
throughout the whole process. HCPF will report on their findings as part of the FY 2024-25 SMART
Act presentation. This stakeholder process is exempt from the procurement code.
Doula scholarship program. HCPF is required to create a doula scholarship program to fund
attendance at preselected doula training programs. To be eligible for the funds, students must
demonstrate financial need and begin providing doula services to Medicaid recipients within
six months of completing the program.
Federal authorization for provision of doula services. HCPF must seek federal authorization to
provide doula services by July 1, 2024. However, the bill does not grant HCPF the authority to provide
services upon federal approval.
Actuarial cost-benefit analysis. DORA is required to hire a contractor to perform an actuarial
cost-benefit analysis of doula coverage and present the findings as part of its FY 2024-25 SMART Act
presentation.
Assumptions
It is assumed that the bill, as drafted, only requires HCPF to conduct stakeholder engagement and
seek federal approval for doula services; thus, costs to provide doula services have not been estimated.
State Diversion
This bill diverts $100,000 from the General Fund in FY 2023-24. This revenue diversion occurs because
the bill increases costs in the Department of Regulatory Agencies, Division of Insurance, which is
funded with premium tax revenue that would otherwise be credited to the General Fund.
State Expenditures
The bill increases state expenditures by $200,000 in FY 2023-24 only, including $100,000 in HPCF, paid
from the General Fund, and $100,000 in DORA, paid from the Division of Insurance Cash Fund.
Expenditures are shown in Table 2 and detailed below.
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July 26, 2023 SB 23-288
Table 2
Expenditures Under SB 23-288
FY 2023-24 FY 2024-25
Scholarship Program Service Costs (HCPF) $100,000 -
Cost-Benefit Analysis (DORA) $100,000 -
Total $200,000 -
Department of Health Care Policy and Financing. HCPF will have costs of $1000,000 to implement
the doula scholarship program. Doula training programs cost between $1,000 and $2,000 per
participant. HCPF will distribute the funds to cover a portion of these costs for eligible applicants.
The bill specifies that any funds appropriated to the scholarship for FY 2023-24 may be extended
through FY 2024-25.
HCPF will also have additional workload to conduct a stakeholder engagement process. The
department currently receives an annual appropriation to facilitate this type of stakeholder
engagement and additional appropriations are not required for this work. The cost of administering
these initiatives, reporting findings as part of the SMART Act hearings and seeking federal
authorization is absorbable within current resources.
Department of Regulatory Agencies. Based on projects of similar scope, DORA will have costs of
$100,000 to hire a contractor to conduct the required cost-benefit analysis.
Effective Date
The bill was signed into law by the Governor and took effect on May 30, 2023.
State Appropriations
For FY 2023-24, the bill requires and includes the following appropriations:
$100,000 to the Department of Health Care Policy and Financing from the General Fund, which
may be spent through FY 2024-25; and
$100,000 to the Department of Regulatory Agencies from the Division of Insurance Cash Fund.
State and Local Government Contacts
Early Childhood Health Care Policy and Financing Human Services
Public Health and Environment Regulatory Agencies
The revenue and expenditure impacts in this fiscal note represent changes from current law under the bill for each
fiscal year. For additional information about fiscal notes, please visit: leg.colorado.gov/fiscalnotes.