Over the last 18 months, the nonprofit Jefferson Center for Mental Health has seen a 50% increase in patients without insurance. They’re people who still need and receive care — only now, the nonprofit center has 75 fewer workers to provide it.
The behavioral health center, like health care providers across the state, has felt the financial strain of more than 500,000 Coloradans losing Medicaid coverage following the end of the COVID-19 public emergency. The so-called unwind hasn’t just cost those individuals vital health care coverage — it’s cut off the flow of federal money that many such safety-net clinics rely on to care for the state’s most vulnerable residents.
The resulting cuts have affected therapists, counselors and administrative roles. The center has fewer people who can travel to meet patients with mobility issues. Technology and physical infrastructure needs have been kicked down the priority list, Jefferson Center President and CEO Kiara Kuenzler said.
“Where we were able to get people in very, very quickly because we had capacity previously, we’ve really had to triage resources and care — and delay other people’s care. Which is not the way we want to meet people’s needs,” Kuenzler said. “It’s just devastating when we get to the point where we can’t sustain the kind of access our community is really needing.”
State lawmakers are hoping a piece of “creative financing,” as one state senator put it, can help ease the building pressure. Sponsors this month introduced a measure, Senate Bill 290, that would create a new stabilization fund to prop up safety-net providers like the Jefferson Center.
The money would be directed to federally qualified health centers, community mental health centers and other safety-net providers that treat rural, low-income or uninsured Coloradans.
The bill, if it becomes law, would seed the new fund with $25 million next year, an amount that backers hope will grow into $200 million over the next two years — all without exacerbating the state’s own financial woes.
“If those (clinics’) doors close, they have nowhere else to go,” said Sen. Kyle Mullica, a Thornton Democrat and an emergency room nurse who’s sponsoring the bill, said of patients. “And that means they’re going to end up in the ER. That means they’re going to get admitted to the hospital, because they’re delaying that care. And that’s just unacceptable.”
Sidestepping general fund, plus help from hospitals
The new fund would take an interest-free loan from the state’s unclaimed property trust fund. That program is a collection of unclaimed assets from individuals and businesses. The bill would explicitly exempt the money from spending restrictions set by the Taxpayer’s Bill of Rights that constrain the state’s budget.
Lawmakers would start with $25 million in the next fiscal year, which starts July 1, and then $20 million the next and $15 million in Year 3. The Colorado Hospital Association has also backed the measure — and promised to raise another $40 million to bolster the safety-net fund. Sponsors said the fund could be leveraged for federal matching dollars.
The bill passed the Senate earlier this week with near-unanimous support. It still needs to be heard in the House, with adjournment set for May 7.
Barbara Kirkmeyer, a Brighton Republican on the Joint Budget Committee, said the hospitals approached lawmakers about finding ways to protect the state’s safety-net clinics. Without them, the hospitals would bear the brunt of uncompensated care as uninsured sick people seek treatment.
Kirkmeyer noted that 25 counties lack maternal health care. To underline the issue, the Arkansas Valley Regional Medical Center in La Junta announced it will close its obstetrics services on Wednesday.
Among the reasons cited: “significant monthly financial losses sustained by the OB program” and “below cost underfunding of OB services by the (Colorado) Medicaid program.”
“Our health care infrastructure is in crisis mode in this state,” Kirkmeyer said. “… These are the people who are low-income, uninsured and underinsured, and (they) don’t know where to go.”
In a statement, Colorado Hospital Association President Jeff Tieman said the bill would create “the framework for a public-private partnership to strengthen the health care safety net.”
“With rising numbers of uninsured patients and growing uncompensated care following the Medicaid unwind, this bill helps a broad set of providers continue to deliver essential care,” Tieman said.
The biggest concern has come from the Colorado Treasury Department. Department officials don’t oppose the aims of the bill, but they warn of dipping too deep into the unclaimed property fund.
It’s been a regular target for lawmakers looking for cash over the years, and the state already owes the fund about $662 million, according to the department. In all, the fund has about $2 billion in liabilities versus about $1.2 billion in cash, testified Leah Marvin-Riley, the legislative liaison for the department, last week.
Marvin-Riley said the department wants “strong guardrails” to make sure Coloradans looking for their money from the unclaimed property program aren’t left empty handed.
Lawmakers responded with an amendment that specified that claims on the trust must be covered by the general fund if the claims exceed its cash holdings.
Parallel effort languishes in House
The Senate bill is one of two efforts this year aimed at shoring up money for the state’s safety-net providers.
House Bill 1174, introduced in February, would do so by reducing how much insurance carriers for state employees’ plans, and then all small-group plans, must pay health care providers.
The state would then use that difference to pay for uninsured patients, a behavioral health safety-net fund and a reserve for the premium costs for state employees. The bill would direct more than $24 million to the state’s primary care fund in the fiscal year that begins in July 2027.
That bill was referred to the House for a full debate nearly two months ago, but it has languished on the calendar since.
Supporters of each describe the bills as trying to get at the same problem in different ways, and not necessarily in opposition to each other.
The Senate bill would provide more immediate relief to cash-strapped federally qualified health centers; the House bill, if it passed, would take precious years to fully kick in, while funding problems worsen.
The Colorado Hospital Association registered opposition to the House bill, while committing gobs of money to the Senate effort. With just a week left in the session, the latter clearly has the momentum in the Capitol.
Cash-strapped federally qualified health centers said they wanted both bills to pass. Like other safety-net providers that care for lower-income patients, the facilities have struggled with the declining Medicaid rolls in recent months.
“I don’t really view (the bills) as competing or dueling proposals,” said Ross Brooks, the president and CEO of the Colorado Community Health Network, which represents the health centers. “As we take a step back, my main statement is I’m really grateful that the House and the Senate and the governor’s office have been trying to creatively solve the crisis that’s been created in the state of Colorado from the Medicaid unwind.”
Brooks said he wasn’t aware of any other effort, in Colorado or elsewhere, that involved hospitals raising money for safety-net providers.
Regardless of the bills’ success, Brooks said he hoped the debate was the start of a broader effort to find a long-term solution for facilities that serve the state’s most vulnerable patients.
Rep. Kyle Brown, a Louisville Democrat, co-sponsored the reimbursement caps bill and later signed on to the hospitals’ preferred approach in the Senate bill.
“Not having a robust safety net is really a huge problem for Colorado,” Brown said. “It means that more people will have to turn to the emergency room for basic primary care, it means that more people will go without care and won’t be able to afford it.”
He acknowledged that SB-290 has “consensus support” and said hospitals’ offer to give $40 million to safety-net providers was welcome and unique. But, he argued, the depth of that investment showed that the industry’s opposition to his first proposal wasn’t about the money it would cost hospitals. It was, he said, “a philosophical objection to rate-setting.”
Kuenzler, of the Jefferson Center for Mental Health, said she appreciated lawmakers’ work on both bills and saw them as complementary. The House bill would create a sustainable, long-term solution that’s not subject to the whims of the federal government. But the Senate bill would address the problem facing her clinic and her patients now.
“I can’t tell you how much it would mean to pass (Senate Bill) 290,” Kuenzle said. “It’s been an incredibly devastating year and a half with the end of the public health emergency and the loss of Medicaid for so many people.”
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