Clinics across Colorado are facing significant challenges as Medicaid disenrollments have increased the number of uninsured patients, forcing cuts to essential services. Clinica Family Health and Wellness, which operates in Boulder, Denver, Lafayette, Thornton, Westminster, Nederland and Black Hawk, has seen a notable shift in its patient base. Before the pandemic, 45.7 percent of its patients were covered by Medicaid and 37.5 percent were uninsured. Now those figures stand at 37.5 percent for Medicaid and 43.4 percent uninsured.
“We are a canary in the coal mine, but not the only one,” said Simon Smith, CEO of Clinica Family Health and Wellness. “We are hollowing out primary care and prevention services that keep people healthy and save our system money. The safety net, like the health of the people we serve, is fragile. Insurance status may change, but the needs of the human being do not.”
Smith noted that more than 70 percent of those who lost Medicaid coverage at Clinica are now uninsured: “I know there are questions about what has happened to those who have lost their Medicaid coverage,” he said. “At Clinica, it appears that over 70 percent of them are now uninsured. That is thousands and thousands and thousands of newly uninsured patients within our organization.”
As revenue has declined due to fewer insured patients, Clinica has eliminated programs such as maternal health visits and homeless outreach while laying off over 100 staff members—more than 15 percent of its workforce—in two rounds of layoffs.
Colorado lawmakers must reduce state spending by $1 billion next fiscal year because pandemic-era federal funds have ended and state spending growth is limited by TABOR (Taxpayer’s Bill of Rights). Increased demand for Medicaid due to an aging population and changing service use patterns further complicate budget decisions.
Organizations including the Colorado Medical Society have warned against deep cuts to healthcare funding for vulnerable populations.
Health First Colorado (the state’s Medicaid program) provides insurance for low-income residents based on income levels—up to about $45,000 annually for a family of four—and is jointly funded by federal and state governments. Child Health Plan Plus (CHP+) covers children and pregnant women with slightly higher incomes—up to about $81,000 for a family of four.
During the Covid-19 public health emergency (PHE), job losses led many Coloradans to enroll in Health First Colorado; enrollment rose by 45 percent or approximately 550,000 people during this period.
After the PHE ended in May 2023 along with federal continuous coverage requirements, all enrollees had to requalify through a redetermination process lasting until May 2024. HCPF estimated initially that around 325,000 would lose eligibility; however independent research from Kaiser Family Foundation found that by September 2024 more than half a million Coloradans had been removed from Medicaid rolls—a drop from peak enrollment down to roughly one million statewide.
Many individuals lost coverage due to administrative or procedural issues rather than changes in eligibility status—a problem highlighted by Save Our Safety Net Colorado coalition members such as the Colorado Medical Society.
“Over the last 18 months, over 2,000 of our patients have lost Medicaid coverage,” said Dustin Moyer, CEO of Mountain Family Health Centers serving Roaring Fork Valley areas. “One year ago, 38 percent of our patients were uninsured; today that figure is 47 percent.” He added: “The decline in Medicaid coverage has led to barriers to care for our patients who need specialty or hospital services… We have calculated that our total lost revenue stemming from the 2,000 of our patients who have lost Medicaid is $1.5 million on a $25 million budget.”
To manage reduced income Mountain Family cut jobs—including eliminating ten positions—and closed school-based clinics among other cost-saving measures.
A recent study published by The Colorado Health Foundation analyzed economic impacts if large numbers lose Medicaid coverage after expansion under ACA was rolled back: If more than half a million otherwise eligible residents lose insurance due to disenrollment processes or paperwork errors—not eligibility—the state economy could shrink up to nearly one percent with output losses near $4.7 billion dollars plus tens-of-thousands fewer jobs statewide; even smaller-scale disenrollments could result in job losses numbering several thousand (https://coloradohealth.org/insights/economic-impact-medicaid-expansion-and-disenrollment-colorado).
Phyllis Resnick PhD., executive director at Colorado Futures Center explained: “It’s hard to measure things in isolation… but if we could this is what our models tell us… when economies contract everything related contracts… household earnings go down … then as a result … tax revenue generated by state contracts as well.” She added: “The reason everyone should care about disenrollment is that even if you’re not directly affected with respect your health care … when we disenroll we draw down fewer dollars … it does slow [the] Colorado economy.”
Advocacy efforts led by organizations like Colorado Medical Society aim to inform legislators on these consequences so they prioritize protecting healthcare access during upcoming budget negotiations.
“When it comes to Medicaid I think there is commitment by vast majority legislature try preserve protect [it],” Rep Kyle Brown said during a January panel discussion hosted by Colorado Health Institute.“In particular I think there’s concern …that we would use cutting provider rates/services …as way filling hole…Medicaid usually about life death folks…and all things should be chopping block those issues literally life death should be towards bottom.”
Senators Kyle Mullica and Barbara Kirkmeyer wrote jointly last November: “While Colorado has never reached point where every resident has health insurance we’ve done much better ensuring coverage recent years.A return ‘bad old days’ unacceptable.In year ahead must make stabilizing health care safety net restoring Medicaid coverage eligible Coloradans state’s top priority.”
The coalition asks lawmakers not only resist cutting core safety-net programs but also support additional funding strategies like maintaining Primary Care Fund levels ($10 million), improving enrollment outreach especially among eligible-but-unenrolled populations expanding data transparency initiatives,and seeking ways maximize available federal resources.
