COALITION STATEMENTS

Vision for Health Care Safety Net Support, February 12, 2025

As has been widely reported and acknowledged by state policymakers, including Governor Polis’ administration, Colorado’s health care safety net is struggling in the aftermath of the COVID public health emergency. Colorado experienced steeper and deeper Medicaid disenrollment rates than HCPF projected, which, in turn, sharply increased the amount of uncompensated care furnished by safety net providers, well beyond what any had budgeted for. The Medicaid disenrollment crisis came on the heels of financial challenges presented by the COVID crisis, including steep cost increases for supplies, pharmaceuticals and labor, creating a “perfect storm” of financial hardship for Colorado health care providers.

As a result of all of this, hundreds of thousands of Coloradans have lost coverage, even though many are still eligible for Medicaid, and many are struggling to access care. Additionally, health care providers of all types (hospitals, Community Health Centers, safety net behavioral health providers, community safety net clinics and others), in all parts of the state (frontier, rural, suburban and urban), are struggling with very real financial hardships that are leading to line-of-service closures, lay-offs and other reductions in access to care.

There is no silver bullet solution to the challenges we face. And given current budget realities, we know we cannot “Save Our Safety Net” in State Fiscal Year 2025-26. But we must make a meaningful down payment in 2025-26 and commit to working together in the coming years to rebuild what has been eroded to create a stronger, more functional system that can weather future challenges. We need to both support a broad range of safety net health care providers to maintain access to care for low income and vulnerable Coloradans and invest in Medicaid eligibility and enrollment infrastructure to ensure Coloradans can access the benefits to which they are entitled. The State must make it a priority to meaningfully strengthen and sustain our safety net.

From our inception, we have recognized that SOSN Coalition members do not always agree on policy solutions. With the introduction of HB25-1174, Reimbursement Requirements for Health Insurers (also known as “Support Colorado’s Health-Care Safety Net Act of 2025”) this week, we acknowledge that some members within the SOSN Coalition will support the bill, some will oppose, and some will remain neutral. While the bill serves the interest of some elements of the health care safety net, it disadvantages others. We encourage the Legislature to consider a wide range of solutions following the principles and recommendations below.

We believe that a meaningful step forward in the 2025 session will likely require a package of bills and budget items that will:

Benefit all safety net health care providers and support access to a broad range of health care services for Colorado’s growing uninsured.

  • Invest in the Primary Care Fund to benefit Community Health Centers and some other primary care providers.

  • Establish or revise funding mechanisms to support the safety net providers not eligible for the Primary Care Fund, including comprehensive behavioral health safety net providers and some community safety net clinics, particularly those that provide safety net services that are not full-service primary care, such as dental aid clinics.

  • Ensure CHASE funds adequately support hospital payments and Medicaid expansions and continue work underway to maximize federal funds.

Invest in meaningful technology fixes and human capacity to improve Medicaid eligibility and enrollment function.

  • Simply put: it is too hard to get and stay enrolled in Medicaid today. We must invest in both the technology fixes (CBMS) and human capital (at counties and through community-based sites) to help people get connected to coverage and care.

  • We appreciate the intent behind and support some elements of HCPF’s 2025-26 budget request R-7, specifically including funding for county escalation resolution. However, we have concerns with some elements as drafted, including the Artificial Intelligence elements, and would urge further consideration and refinement as we work toward the shared goal of supporting Medicaid eligible Coloradans to get covered.

One possible approach to achieve this would be to recognize the current safety net crisis as a “ripple effect” of COVID and related stress on health care providers and to use one-time investment of state reserves to safeguard safety net infrastructure, preventing further damage in the short term, and help improve Medicaid eligibility and enrollment functionality.

  • An investment of less than 5% of the state’s reserve – $115 million – could help stabilize Colorado’s safety net infrastructure and help thousands of Coloradans currently eligible-but-not-enrolled in Medicaid navigate back to coverage.

  • We would support exploring the structural opportunity to appropriate these state reserve dollars to a new safety net support fund as an independent fund under the umbrella of the CHASE enterprise to maximize federal match and allow spend-down over multiple years. Critical details, including appropriate governance of such a fund, would need to be worked out, but this is worth exploring.

While our organizations will each engage in direct advocacy on specific proposals, our coalition is working to identify and explore the feasibility of other potential strategies to consider alongside reserve spending and HB25-1174. Given the importance and complexity of this issue, we support efforts to fully evaluate and consider both short and long term funding opportunities to support the safety net. We stand ready to engage in constructive conversation with policymakers and stakeholders to discern the best next steps.

RESOURCES 

Learn more and get engaged

The Safe our Safety Net coalition is committed to helping our community better understand the ongoing challenges thousands of Coloradans are facing in accessing the health care they need as well as the struggles of safety net providers in managing myriad financial pressures while providing this care.

  • October 2024 Update to Policymakers: Colorado’s Safety Net Crisis & Medicaid Disenrollment: DOWNLOAD REPORT >

    CEO’s from Colorado’s Safety Net providers presented to members of the Colorado Joint Budget Committee about the challenges their organizations face as Colorado’s ongoing Medicaid disenrollment crisis continues.

  • January 2025 Report: The economic impact of Medicaid disenrollments: DOWNLOAD EXECUTIVE SUMMARY >

    “Regardless of the scenario, Medicaid disenrollments of those otherwise eligible for coverage results in a smaller Colorado economy, reduced household earnings and fewer jobs than had the coverage continued uninterrupted.” Read the executive summary from the Colorado Health Foundation in partnership with the Colorado Futures Center at Colorado State University.

  • January 2025 Presentation: When the Health Care Safety Net Breaks, Colorado Pays the Price: SEE THE FULL PRESENTATION>

    Representatives of Safety Net providers from across the state recently presented to members of the House and Senate Health and Human Services Committee, helping them better understand the real impacts of the Medicaid disenrollment crisis in Colorado for people who use the program and the providers who serve them.

  • January 2025 Factsheet: Understanding Colorado’s Health Care Safety Net SEE THE FACTSHEET>

    Dive into a deeper understanding of what Colorado’s health care safety net does, who it serves and how it contributes to people and our communities.

  • January 2025 Factsheet: A Critical Component of Colorado’s Health Care Sector & Colorado’s Economy SEE THE FACTSHEET>

    Problems in Colorado’s health care safety net don’t just hurt the people who need it to access health care. Its impact is felt across our state and local economy as well as in escalating health care costs for everyone.