Colorado stands out among the 10 states with the highest dropout rates among Medicaid recipients since the U.S. government lifted pandemic-era restrictions on people dropping out of the health insurance plan.
In the Medicaid “rollback” that has been underway since spring 2023, it is the only Democratic-leaning state among a collection of Republican-leaning states with high rates of withdrawal, including Idaho, Montana, Texas and Utah.
Colorado also Policy Elements Medicaid policy analysts at KFF, an independent nonprofit that conducts health policy research, say the program was put in place to cushion the impact of dismantling the program.
However, the cushions do not appear to be deployed.
“In Colorado, there’s a real disconnect between progressive policies and an underfunded and divided administration,” said Bethany Pray, chief legal and policy officer for the Colorado Law and Policy Center, a Denver-based legal aid group.
according to KFF DataColorado experienced a larger net loss in Medicaid and Children’s Health Insurance Program enrollment during the policy wind-down period than any state except Utah.
Health care access advocates, researchers and county administrators, who handle much of Colorado’s Medicaid redetermination, say the main problems are outdated technology and low automatic renewal rates, both of which create barriers to enrollment and undermine the state’s progressive policies.
State officials are more optimistic. They say the decline in enrollment is evidence of the state’s success in recruiting people during the peak of the coronavirus pandemic, and that Colorado’s strong economy means more people can get insurance through work.
“When you have so much unemployment, not many people need safety net programs and we’re proud of that. Our people are growing and thriving,” he said. Kim Bimesteferwho heads the Department of Health Care Policy and Financing and is the state’s top Medicaid official, said her department also says some people don’t fill out eligibility forms because they know their income is too high to qualify.
According to data from the Bureau of Labor Statistics: While it’s true that Colorado’s unemployment rate is lower than the national average, it’s still higher than it was before the pandemic.
State officials say they believe the decline in Medicaid enrollment is because many people have found work, as reflected in the declining unemployment rate. But that scenario happened in fewer than half of the state’s counties, according to a KFF Health News analysis. Notably, 11 counties where unemployment rates stagnated or rose between January 2020 and April 2024 saw a decline in the share of their population enrolled in Medicaid. A lower unemployment rate doesn’t necessarily reduce the need for Medicaid enrollment, because many of those who are employed still earn wages low enough to cover the cost of living. Qualify for the program.
Colorado has increased enrollment in Medicaid and the related Children’s Health Insurance Program by 35% during the COVID public health emergency, a rate that is about 30% higher nationwide and across Medicaid expansion states.
“Higher growth means, logically, more dropouts,” Bimestefer said. “What goes up will come down because the economy is doing well.”
she Department website Initially, Colorado claimed to have seen a greater increase in Medicaid enrollment than any other Medicaid expansion state except Hawaii. According to data from the Centers for Medicare and Medicaid Services Other states, including Indiana, North Dakota, Virginia and Nevada, also saw enrollment increases during the pandemic surpass Colorado’s.
Even the biggest increases are weak, Medicaid policy analysts said, making the argument that what goes up must come down.
“The counterargument to this is that we know there wasn’t full participation in Medicaid before the pandemic,” said Jennifer Tolbert, deputy director of KFF’s Medicaid and Uninsured Programs.
Tolbert said he was surprised by the magnitude of Colorado’s decline in Medicaid enrollment, given that Colorado was the only state in the country that met all of KFF’s criteria for cushioning the impact of Medicaid repeal, including adopting the Affordable Care Act’s Medicaid expansion and automatically processing renewals.
Tolbert is among a number of policy researchers who say they expect the share of Coloradans on the safety net to rise, not fall, even if the unemployment rate returns to pre-pandemic levels.
Allie Sullivan, a spokeswoman for Democratic Gov. Jared Polis, said one thing that complicates Colorado’s system is that it’s one of the few states where counties do most of the eligibility verification work, “which complicates the state’s unlocking process.”
“Colorado is committed to helping Coloradans who lose Medicaid eligibility enroll in alternative, affordable insurance as quickly as possible, and the state is making every effort to do so,” the statement said.
Minnesota is another state that leaves eligibility verification largely up to counties. But it has removed just 26% of Medicaid enrollees in the repeal, well below Colorado’s 48%. Like Colorado, Minnesota is led by a Democratic governor. Minnesota is similar to Colorado in terms of population, pandemic-era enrollment growth, percentage of residents living in wealthy areas, and unemployment rate above the national average. But Bimestefer rejected the comparison.
“I don’t care about Minnesota,” Bimestefer said. “This is Colorado. I don’t care about what Minnesota did.”
Health care access advocates and researchers said a series of technical and administrative issues contributed to Colorado’s high health care dropout rate.
First, the state’s eligibility database, the Colorado Benefits Administration System, is outdated and cumbersome, according to people who use it and those familiar with other states’ systems.
“It’s like still using an old flip phone trying to play the Snake game,” said Sarah Grusin, an attorney with the National Health Law Program. “We have something better.”
Grusin and the Play Organization filed a civil rights lawsuit Several federal agencies said Colorado’s systemic flaws that led to the termination of disability insurance amounted to discrimination.
“It took months to solve what didn’t seem like a very complicated problem,” Pray said.
Biemstefer said her department is working on a plan to improve the system, which is managed by Deloitte under a $354.4 million contract that runs through 2027. A recent KFF Health News survey Widespread problems were found in the Deloitte-managed certification system. In Colorado, Government-commissioned audit In 2020, it was discovered that many Medicaid recipients were sent incorrect notices and deadlines.
Kenneth Smith, a Deloitte executive who heads the firm’s national human resources services practice, said Deloitte is one of many companies that administer Medicaid benefits, and that states own the technology and make decisions about its implementation.
Colorado’s technology problems have also undermined the state’s ability to use a powerful tool in the admissions process: automatic renewals.
Bimestepher said the department last fall had to choose between fixing the system to stop disenrolling children who shouldn’t lose their insurance, or automatically renewing insurance for people with no income or income below the federal poverty level. It couldn’t do both at the same time, he said.
Experts such as Tricia Brooks, a research professor at Georgetown University’s Child and Family Center, say increasing automatic renewals is especially important in states such as Colorado, where most of the renewal work is done by county government employees.
“What happens if you don’t have a high auto-renewal rate? You’re sending out renewal forms,” Brooks said, meaning more unsubscriptions. “They didn’t get the emails. The notifications were confusing. They tried to get help through the call center. There are just too many reasons not to renew.”
In fact, two-thirds of those who dropped out in Colorado did so for procedural reasons, which is about the same as the national average, according to KFF. But given how many people dropped out across the state, 500,000 Colorado residentsThat means roughly 9% of the state’s residents have been disenrolled for procedural reasons — an amount larger than the population of Colorado Springs, the state’s second-largest city.
At least one-third of those who disenrolled were later determined to be eligible for Medicaid.
Officials at Colorado’s community health centers and mental health centers say they’re seeing an increase in uninsured patient visits, a sign that Coloradans being taken off Medicaid aren’t necessarily moving on to better health insurance options.
Fifty-eight percent of those who disenrolled have either rejoined Medicaid or signed up for other insurance, but the state doesn’t yet know what happened to the remaining 42 percent who disenrolled, and said it will conduct an investigation to find out.
KFF Health News is a national newsroom that produces in-depth journalism on health issues.KFF — An independent source of health policy research, polling and journalism.
