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Colorado’s health safety net — meaning the medical providers and clinics that care for those unable to afford other options — has been heavily stretched in 2020 and many health clinics have been left financially vulnerable, according to a new report from Colorado Health Institute.

According to the nonprofit policy research group’s report, in the years leading up to 2020 and the COVID-19 pandemic, the state’s health care safety net saw several changes at the local, state and federal levels.

CHI’s report notes that safety net clinics of all types, many of which had ramped up capacity over the past seven years to serve newly insured people after Colorado expanded Medicaid in 2013 under the Affordable Care Act, recently saw a statewide decline in Medicaid enrollment, down 11.7 percent from the peak. 

The decline represents over 100,000 Coloradans between May 2017 and March 2020 and, according to the CHI report, “was due to a combination of immigration policies, economic conditions, and administrative changes on the part of Health First Colorado, the state’s Medicaid program.”

The decrease in patients with Medicaid and an increase in uninsured and underinsured patients cut revenue at many clinics. 

They responded in a variety of ways, including making budget cuts, laying off staff, and ramping up fundraising efforts.

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But then came the COVID-19 pandemic.

“Hundreds of thousands of Coloradans have lost jobs and wages, and clinics now are planning for an anticipated surge in patients that may have long-term implications for the safety net,” the report’s authors said.

“This is all while still ensuring that those who already lost access to coverage don’t fall through the cracks.”

The report from CHI explores the dynamics that were affecting clinics at the start of 2020 and the changes that clinics are expecting due to COVID-19.

It includes firsthand accounts and new data from clinics that illustrate how health coverage and care have been affected by an increase in anti-immigrant rhetoric, new administrative policies at the Department of Health Care Policy and Financing, and the changing economy.

“Many safety net clinics reported an increase in the rate of patients with no health insurance that began between 2016 and 2017,” said Jeff Bontrager, CHI’s director of research and evaluation, in a statement accompanying the report. “At the same time, the share of patients with Medicaid dropped. While clinics had a variety of experiences and responses, at some, this dynamic led to budget shortfalls, which led to changes ranging from new fundraising efforts to staff cuts to wait lists for new patients.” 

When COVID-19 arrived, safety net clinics had to shift gears quickly to begin offering new types of care and prepare for an anticipated increase in need for their services.

“Despite the new challenges brought about by COVID-19, safety-net providers remain dedicated to meeting the needs of their patients,” the report’s authors said.

“There are numerous opportunities to shore up the state’s safety net providers in the short and long terms. Strategies include supporting safety net operations, mitigating a backslide on oral health services, and addressing fear and disenfranchisement within immigrant communities.”

See the full report here.

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