Thousands of Coloradans have lost Medicaid coverage over the past year, leaving clinics and health centers struggling to serve a growing uninsured population. At Clinica Family Health and Wellness, which operates locations in Boulder, Denver, Lafayette, Thornton, Westminster, Nederland and Black Hawk, the shift has forced cuts to essential services and layoffs.
“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.”
Clinica’s patient mix now includes 37.5 percent Medicaid recipients and 43.4 percent uninsured patients—a drop in Medicaid coverage by more than 8 percentage points since before the pandemic.
“I know there are questions about what has happened to those who have lost their Medicaid coverage,” Smith 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.”
With less revenue coming in due to these changes, Clinica has eliminated maternal health visits and homeless outreach programs while cutting more than 100 staff positions—over 15 percent of its workforce—in two rounds of layoffs. Executives have reduced their own pay as well.
The state faces its own budget challenges: Lawmakers must cut $1 billion from next year’s budget after losing federal pandemic relief funds. Limits imposed by Colorado’s Taxpayer’s Bill of Rights (TABOR) also restrict how much spending can grow each year (https://leg.colorado.gov/agencies/office-legislative-legal-services/colorado-taxpayers-bill-rights-tabor). These pressures come at a time when demand for Medicaid is rising because of an aging population.
Organizations including physicians’ groups and advocacy coalitions such as Save Our Safety Net Colorado—which counts the Colorado Medical Society among its members—are urging lawmakers to avoid deep cuts to public insurance programs that could harm vulnerable residents.
Health First Colorado (the state’s Medicaid program) offers free or low-cost insurance based on income thresholds; Child Health Plan Plus serves children and pregnant women with slightly higher incomes. Both are managed by Colorado’s Department of Health Care Policy and Financing (HCPF), with most funding provided through a federal-state partnership.
During the Covid-19 public health emergency, Medicaid rolls grew rapidly as job losses led many people to lose employer-sponsored insurance; at one point in 2023, roughly one-third of all Coloradans were enrolled in Health First Colorado according to HCPF data (https://hcpf.colorado.gov/health-first-colorado-medicaid-program).
When continuous coverage requirements ended with the expiration of federal emergency rules in May 2023, all enrollees had to go through redetermination checks—a process completed by May 2024—to see if they still qualified for benefits.
Before this process began, officials projected around 325,000 would lose eligibility; actual figures were higher: By September 2024 about 563,000 individuals had been disenrolled from Medicaid according to analysis from Kaiser Family Foundation (https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-and-unwinding-tracker/) . As a result enrollment dropped below pre-pandemic levels.
A coalition issue brief reported that about two-thirds lost coverage because they could not complete paperwork or faced other administrative barriers rather than no longer qualifying financially.
Dustin Moyer heads Mountain Family Health Centers serving Roaring Fork Valley communities: “Over the last 18 months over 2,000 of our patients have lost Medicaid coverage,” he said. “One year ago 38 percent…were uninsured; today that figure is 47 percent.” He added: “The decline in Medicaid coverage has led to barriers…for our patients who need specialty or hospital services…and a significant financial challenge for Mountain Family.” Lost revenue from disenrollments reached $1.5 million on a $25 million annual budget for his organization alone.
Mountain Family responded by eliminating jobs—including five layoffs—closing school-based clinics and reducing hours at others while freezing hiring and suspending retirement contributions temporarily.
A recent study from The Colorado Health Foundation found that if large numbers lose eligibility—even if they technically qualify—the state economy shrinks overall output by up to nearly $5 billion depending on scenario analyzed (https://coloradohealth.org/reports/colorados-medicaid-expansion-and-economic-impact-disenrollment). Job losses could reach tens of thousands statewide due both directly decreased spending on healthcare services as well as ripple effects throughout local economies.
Phyllis Resnick leads research at Colorado Futures Center which conducted this economic modeling: “It’s hard to measure things in isolation…but if we could…this is what our models tell us…the economy would be anywhere between .2%–0.9% smaller depending on [disenrollment].” She continued: “…even if you’re not directly affected…when we disenroll we draw down fewer dollars…and it does slow [the] Colorado economy.”
Legislators serving on key committees say preserving core public health programs remains high priority despite fiscal constraints:
“When it comes to Medicaid I think there is a commitment by…the legislature…to try to preserve…and protect…” said Rep Kyle Brown chairing House Health & Human Services Committee during a January panel discussion hosted by Colorado Health Institute (https://coloradohealthinstitute.org/blog/human-side-budget-cuts).
Senators Kyle Mullica & Barbara Kirkmeyer wrote jointly last fall: “…we must make stabilizing our health care safety net—and restoring Medicaid coverage for eligible Coloradans—our state’s top priority.”
The Colorado Medical Society supports several recommendations:
– Avoid cutting funding for medical or behavioral health safety-net programs;
– Maintain Primary Care Fund support using tobacco tax revenues;
– Help eligible residents enroll or re-enroll efficiently;
– Improve data sharing so agencies can coordinate solutions;
– Form collaborative committees bringing together stakeholders;
– Seek ways—including maximizing federal aid—to increase resources dedicated toward meeting community healthcare needs.
