How Colorado Cut Disability Wait Times from 8 Months to 38 Days

Time is critical for patients and families applying for disability benefits. The national average wait time is eight months—a delay that can mean going without income, health insurance, and essential care. 

A "disability determination" evaluates whether an individual's medical condition qualifies them for benefits and services. Licensed physicians need to review at least two years of medical documentation to assess eligibility for disability income and health coverage. 

A System Under Strain

In 2023, Maryland reported that 30,000 people in the U.S. died while waiting for disability determinations. Former Social Security Administration Commissioner Martin O'Malley responded, "We can and must do better." 

The Challenge

Due to medical disabilities, patients are often unable to work, afford food or housing, pay insurance premiums, or access medical care. They apply for disability benefits to gain access to these lifesaving resources. 

"A disability claimant is waiting for basic income and health insurance. To wait an extra month could be the month in which the untreated, already curable disease kills," said former Social Security Administration Commissioner Martin O'Malley. 

In Colorado, the system faced similar pressure. Staff were overwhelmed and couldn't begin processing applications until they received at least two years of medical records from providers. Manually requesting records from providers listed on disability applications often took months, leaving patients in limbo.

"We were plagued with waiting for medical records for months and months and on average the review for medical records takes 200-230 days."
-Lisa Sterling, Eligibility Team, Colorado Department of Health Care Policy and Financing (HCPF)

The Solution

Colorado saw the 30,000 deaths in Maryland and took action. 

Rather than accepting these national delays as inevitable, the Colorado Department of Health Care Policy and Financing (HCPF) partnered with Action Review Group (ARG), the state-selected vendor responsible for processing Disability Determinations, to help manage its caseload. Recognizing the ongoing challenges, Chris Underwood, Chief Administrative Officer at HCPF, recommended that ARG, which supports HCPF’s Disability Determination Services, gain access to the Contexture PatientCare 360 Portal. This would allow case developers to view patients’ comprehensive, up-to-date medical records and accelerate the determination process. 

Contexture’s Health Information Exchange (HIE) didn’t just streamline paperwork—it enabled ARG case developers to begin processing disability applications immediately. With real-time access to comprehensive medical records through the PatientCare 360 Portal, they could act faster, prioritize urgent cases, and engage more meaningfully with patients. 

“There are significant costs associated with requesting records directly from medical providers,” said Valerie Gallegos, Eligibility Contracts & Site Relations Unit Supervisor, noting that those costs have been reduced by using Contexture to pull only what is needed for a disability determination.

This transformation was made possible through the partnership between HCPF, ARG, and Contexture. “Working collaboratively with ARG, and then having access to the Contexture PatientCare 360 portal, enhances our ability to obtain timely and comprehensive medical information, improving efficiency, and overall case outcomes.” Says Lisa Sterling. Together, they reimagined the disability determination process—and the results speak for themselves.

Key Results

• Processing time dropped from eight months to just 38 days 

• 43% of cases resolved using Contexture’s PatientCare 360 Portal alone 

• • 90% approval rate for those cases 

• 50% fewer manual record requests 

• • Only 10% of cases now require manual record requests 

• Colorado Medicaid’s Disability Determination Services now ranks in the top 20 among 52 offices nationwide
  
  

How it Works

ARG case developers now use Contexture’s PatientCare 360 Portal. This tool gives them instant access to health records from nearly every hospital, lab, and imaging center in Colorado—offering a complete, up-to-date view of a patient’s medical history. 

Instead of waiting months for paper records to arrive from multiple providers, developers can now search for a patient once and retrieve all relevant documentation in seconds. This shift allows them to focus on making timely decisions and supporting patients, rather than chasing paperwork. 

For example, when a child’s urgent case came through, the team was able to access the necessary records immediately and complete the determination within 48 hours — something that would have been impossible under the old system. 

The Real Impact on a Colorado Family 

One Colorado family faced a critical health crisis with their disabled child. Without disability approval, they risked losing stability, access to care, and potentially their child’s life. Thankfully, their story took a different path thanks to Colorado Medicaid’s Disability Determination Services, and the three organizations that support it: HCPF, ARG, and Contexture. 

For that child’s mother, the approval changed everything. It arrived just in time for her child to begin treatment, and her family finally felt supported. Grateful she wrote to HCPF and the ARG team:  

“I cannot express adequately my total appreciation for your support, care, action, and kindness for both myself and my son. You saved my child’s life.”

Now, staff hear these stories more often because they have time to engage with patients. “Instead of staff being bogged down just requesting, requesting, requesting, they’re experiencing more of the human element behind the application,” said David Genaro, Director, ARG. 

To Our Contexture Participants: Thank You 

Your data is making a tremendous difference. 

43% of cases are resolved with just a handful of providers sharing data. Imagine what we could do if more joined.

If you’ve ever considered connecting your data—now is the time. Reach out to getconntected@contexture.org for more information.  

About Contexture

Contexture is a nonprofit, regional organization that provides strategic, technical and administrative support to communities committed to advancing health through information sharing. With headquarters in Denver and Phoenix, Contexture is the largest health information organization in the western United States. Its mission is to advance individual and community health and wellness through the delivery of actionable information and analysis. Learn more at contexture.org.   

About ARG

Action Review Group (ARG) is a trusted provider of Medicaid disability determinations, delivering fast, accurate case development and medical reviews that improve access to coverage and reduce healthcare costs. With decades of experience and proven model that accelerates determinations by more than 80% ARG supports tens of thousands of cases annually across multiple states. Contact us to learn more: Susan Turner, Director of Capture Management – susan.turner@equusworks.com.  

About Colorado Department of Health Care Policy & Financing

Colorado Department of Health Care Policy & Financing (HCPF)’s mission is to improve health care equity, access and outcomes for the people they serve while saving Coloradans money on health care and driving value for Colorado. This means they work to make their members healthier while getting the most for every dollar that is spent. Whether you seek health care, provide health care, or care about health care, we are here to serve you. Learn more at https://hcpf.colorado.gov/.

Hear from Our CEO: Data exchange accelerates Medicaid eligibility decisions

To learn more about how Contexture is advancing healthcare data exchange and supporting state agencies, watch this HIMSS TV interview with our CEO, Melissa Kotrys. In the video, she discusses how Contexture helps Medicaid agencies streamline disability determinations and supports state compliance with evolving federal work requirements.