Financial crisis looms for dozens of primary care and behavioral health clinics in Colorado
Safety net providers in Colorado say they're losing millions of dollars a year due to uncompensated care and, without help, they'll need to close clinics.
The crisis has been building for years due to changes in Medicaid coverage and soaring health care costs.
Medicaid already accounts for one-third of the state's general fund budget and is increasing by $1.4 billion a year.
Among those looking for a lifeline is Salud Family Health. For more than 50 years it's cared for some of the state's poorest residents, providing medical, dental, behavioral health, and pharmaceutical services to nearly 70,000 patients per year in 13 clinics across the state.
"If you look at Trinidad for an example, we're the only dental office that takes Medicaid," Salud CEO John Santistevan said. "Before we opened our dental practice there, if children needed dental, they had to drive 80 miles to Pueblo."
Santistevan says many of Salud's clinics are the biggest primary care providers in their communities: "We help patients with transportation, food insecurities."
But after decades of helping those in need, Salud now needs help. Santistevan says it's on track to lose $14 million this year after thousands of patients lost Medicaid. At the same time, inflation is driving up costs.
"I've been doing this for 28 years and we always have our peaks and valleys and our challenges," Santistevan says. "But this is the toughest time I've seen in my career here."
It all started in May 2023 when the federal government ended a COVID-era policy that enabled people to stay on Medicaid without proof of eligibility. Suddenly, they had to re-apply. In Colorado, about 550,000 weren't renewed.
Many of them, Satistevan says, were dropped due to errors on their application, not their income. He says 47% of patients at Salud make less than 100% of the federal poverty rate, or about $15,000 for an individual and $31,000 for a family of four.
"We really truly have to look at who are we supposed to be serving," says Republican State Sen. Barb Kirkmeyer, who sits on the legislature's Joint Budget Committee.
She says not only has the state added undocumented residents to Medicaid rolls at a cost of $51 million this year, but it's expanded services for others.
Meanwhile, she says the governor's budget provides no increase in Medicaid reimbursement rates: "We can't keep expanding and we can't keep decreasing Medicaid rates and expect these problems to go away. It's a house of cards that is on top of quicksand and it's just bottoming out."
Kim Bimestefer, executive director of the Colorado Department of Health Care Policy and Financing, which administers Medicaid, says providers have seen a 10% increase in rates overall in the last 10 years on top of billions in federal stimulus money. She says they may need to trim expenses and hospitals she says may need to help.
She says they just received a $54 million bump in federal funding: "The hospitals are often some of the most well-off organizations and so we might have to take a hard look at those dollars we were able to draw down and say where might we be able to repurpose that $54 million and it might be rural hospitals, or Denver Health, or our federally qualified health centers that take care of most vulnerable, the uninsured."
Salud is one of those centers. Santistevan says he's hoping for help but preparing to close some rural clinics in the event it doesn't come in time: "We call it the nuclear option. If we got to do that, it'll be terrible."
Bimestefer says the state may also need to pause some health care programs passed by the legislature that increase Medicaid costs. The state is facing a $700 million budget shortfall and, if lawmakers don't rein in expenses, Bimestefer says, they will need to make more draconian cuts.