Homelessness in Denver increased by 12% in the past year, but for only the second time in recent history, the number of people living outside has decreased, according to the results of an annual count released Wednesday. 

The number of people living in shelters, transitional housing, tents and on the streets of Denver climbed to 6,539 from 5,818 the previous year. In the seven-county metro area, homelessness rose 10% to 9,977 people. 

In Denver, the good news is that there are fewer people sleeping in tents and on the streets after a massive effort to move people indoors. 

Denver Mayor Mike Johnston, who campaigned on a promise to house 1,000 people by the end of his first year in office, said the drop in unsheltered homelessness in the city was among the largest in the nation, in line with Houston and better than Seattle, Chicago, Washington, D.C., and Atlanta.

There were 1,273 people sleeping outside in Denver on the January night volunteers and outreach workers conducted the count, down from 1,423 a year prior. 

And as of Wednesday, there are 117 tents in the city, down from 242 when the “point-in-time” count was taken, the mayor’s office said. The city has cleared 17 encampments and closed 350 blocks of downtown to camping under the mayor’s homelessness initiative. Critics have accused the city of offering people temporary shelter instead of more permanent options. 

“We have always believed that homelessness is a solvable problem, and now we have the data to prove it,” Johnston said in a triumphant news release. “Denverites should be proud to live in a city that responds to homelessness with compassion.”

Not counted in the survey: the 4,300 new migrants from mainly South America who were sleeping in city-funded shelters on the night of the count. 

The Metro Denver Homeless Initiative, which organizes the annual count required by the U.S. Department of Housing and Urban Development, said that leaving migrants out of the count was the best way to determine “the most accurate information of those experiencing homelessness on a single night.” 

The number of people living in shelters in Denver grew by 20% throughout the year, however.

In the seven-county area, the number of people sleeping outside increased by 5.6%, to 2,919. The number of chronically homeless — people who have not had a home for at least a year — rose by 16% and the number of homeless families grew by nearly 50%, to 3,136 from 2,101.

Volunteers spread across the metro area, throughout Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas and Jefferson counties, from sundown Jan. 22 to sundown Jan. 23, tallying and interviewing people in shelters and outside. 

Johnston said the data shows the city needs to work harder at preventing homelessness in the first place, as well as expanding family shelter and permanent housing options. The Denver City Council is scheduled to vote next week on whether to ask voters to approve a sales tax to generate $100 million annually for affordable housing. The Affordable Denver Fund would pay for 44,000 units of affordable housing over the next 10 years, the mayor said.

Larimer County’s community mental health center has abruptly laid off 75 employees, causing a gap in care for some of the most vulnerable patients and increasing concerns about how far the fallout will spread after a seismic shift in Medicaid funding. 

Connor Grogan had 35 clients at SummitStone Health Partners in Fort Collins when he was told at a mandatory meeting last week that he was among those losing their jobs because of a budget crisis. He had to turn in his phone and laptop on the spot, with no opportunity to say goodbye to his patients. 

“It was unethical the way that it was handled,” said Grogan, who had counseled children, families and adults at the center for more than two years. “At the very least, I feel like it is not trauma-informed, which is something that SummitStone had been preaching about for quite some time.”

The community mental health center, one of 18 statewide, is the latest to lay off employees in the wake of hundreds of thousands of Coloradans losing Medicaid coverage after the end of the pandemic public health emergency and a massive change in the way the state Medicaid division reimburses behavioral health providers. 

Mind Springs, the safety-net mental health center for several counties in northwestern Colorado, laid off 49 people, 13% of its administrative staff, this summer. Centennial Mental Health, which serves 10 counties in the northeastern corner of the state, laid off three of its five top executives in June. And Jefferson Center for Mental Health, which serves Jefferson, Clear Creek and Gilpin counties, is dealing with a $5 million shortfall on a $89 million budget, a deficit so large that plans for a merger with Denver’s mental health center, Wellpower, were called off in June. 

SummitStone had to cut $14 million to break even on its $80 million budget. About $9 million of those cuts came from staff reductions. 

“I’m going to be OK,” said Grogan, who is likely to find a job because he speaks Spanish and is a male therapist. “The piece that hurts the most is that I had zero closure with my clients. I lost yearslong relationships in an instant. I couldn’t even say goodbye. 

“I’m devastated for the most vulnerable humans in our community that were getting better. I worry about suicides rising in our community. I worry about overdoses rising in our community.”

Most of the employees who lost their jobs did not work directly with clients and instead were in other departments, including technology, SummitStone CEO Michael Allen said. The 75 jobs were about 10% of the workforce at SummitStone, which has locations in Fort Collins, Loveland and Estes Park. Executives took a 5% cut in pay. 

The first budget problem for the center was that thousands of Coloradans were dropped from Medicaid insurance at the end of the three-year federal public health emergency put in place at the start of the COVID pandemic. In the past year, the percentage of SummitStone clients without insurance rose to 25%, up from 17%.

On top of that, landmark legislation that brought sweeping changes to Colorado’s mental health system — including how mental health providers get paid — went into effect July 1. 

First effects of monumental change 

The Behavioral Health Act, passed in 2022, was intended to break up the monopoly of Colorado’s mental health centers, opening them up to competition with private behavioral health agencies. 

For years, the centers operated under no-bid contracts with the Colorado Department of Health Care Policy and Financing, which includes the Medicaid government insurance program for people with low incomes. The centers received $437 million in tax dollars per year and were required to treat people in their regions. 

Under the new structure, mental health centers don’t get a lump sum. They must bill the state Medicaid program for every service they provide, per person — a reimbursement for an individual therapy appointment, another for a group therapy session, another for a housing consultation. 

Mental health centers warned lawmakers that communities, especially in rural areas, could end up with fewer services under the new payment structure. They worry providers will offer only services that make money, leaving out help with housing and employment. 

This summer, it seems the effects of the monumental change in policy are beginning to take shape. Mental health experts are wondering if the current structure is beginning to break apart, and they hope the new one that forms in its place will end up more robust and capable of serving more people.

Still, the process is painful. 

The three community mental health centers that have had layoffs “likely won’t be the only ones,” said Kara Johnson-Hufford, CEO of the Colorado Behavioral Healthcare Council, the association for mental health centers. 

“Folks have scraped their reserves,” she said. “They are not filling open positions.” 

Not all community mental health centers are struggling, but some have been hit harder by the drop-off in Medicaid rolls, Johnson-Hufford said. In some communities, Medicaid enrollment has shrunk by 35%-60%, she said. 

Colorado had 1.8 million people enrolled in Medicaid during the pandemic, a historic 30% of the state’s population and up from a pre-pandemic 21%. Medicaid enrollment is now down to about 22% after the federal rules were lifted last year. 

Mental health centers tried to budget for the Medicaid cliff, but they were basing their plans on state projections that were not accurate for every region. That drop-off hit at the same time as the payment structure overhaul. And the new bill-per-service structure does not account for the uninsured, Johnson-Hufford said. 

“Significant reform is hard,” she said. “Bring more providers into the safety net, absolutely.” But, she added, Colorado policymakers need to make sure the system’s funding and structure can support mental health providers who want to serve their communities. 

The changes have amounted to the “perfect storm,” Johnson-Hufford said.

“Not all of this is impacting all of our providers in the same way,” she said. “And it’s not just any one thing.”

Mind Springs, which serves Mesa and seven other counties, spent $1.9 million last fiscal year on treatment for people without insurance, CEO John Sheehan said. Services are already taking a hit — the mental health center had to drop its men’s program when it laid off 49 people this summer. 

The new per-service payment structure, at a time when the number of uninsured is rising, “doesn’t make a lot of sense,” he said. 

“And so far it hasn’t done anything but destabilize the system,” Sheehan said. “The provider network is fragile and has been made more fragile. When you lose them, you can’t get them back.”

It’s hardly surprising that safety-net mental health centers are feeling the loss of Medicaid coverage for 600,000 Coloradans in the span of about a year, said Vincent Atchity, president and CEO of Mental Health Colorado.

“It’s an earthquake that takes a segment out of a highway,” he said. “It’s a crisis for sure.” 

Atchity, who advocated for payment reform and more transparency in public spending on community mental health centers, said it’s likely there is “some seismic shifting that occurs when a system is flipping itself as much as this.” 

But it’s unclear this early on in the transformation why some mental health centers are “complaining vociferously” about the new payment system while “others are shrugging their shoulders.”

“I’d love to get to the bottom of what is actually happening,” he said.

Employees got no severance, clients got no goodbye

SummitStone’s CEO summed up the payment reform bluntly: “The pie didn’t get any bigger but the number of folks accessing the slices of pie did get bigger.” 

Allen expects SummitStone will lose 5%-10% of its clients because “our reputation in the community has taken a hit” when so many people lost their jobs and many clients lost their therapists without notice.

“These are hard things,” Allen said. “It’s a hard conversation to tell the community that we are in an opioid crisis and we are in a loneliness crisis and the largest behavioral health provider in the area is laying off 10% of its staff. That doesn’t make sense.” 

Laid-off employees were invited to mandatory meetings in small groups and were told they could not return to their desks or contact their clients, that they would get no severance pay and that their health insurance would last until the end of the month, according to several former workers who spoke to The Colorado Sun. 

It’s a hard conversation to tell the community that we are in an opioid crisis and we are in a loneliness crisis and the largest behavioral health provider in the area is laying off 10% of its staff.

— Michael Allen, CEO of SummitStone

The CEO said the mental health center operated with a deficit as long as it could and that he tried to avoid layoffs by scrapping plans to renovate buildings, cutting travel and catering budgets and staff incentives. But in June, when the center got its rates and contracts for the upcoming fiscal year that started July 1, it was obvious that there was no way to break even without “dramatic” cuts in staff, Allen said.

“This was a last resort,” he said. “Nobody wanted to do this.” 

The center partners with several other Larimer County agencies to provide mental health services and Allen said he is hopeful that those agencies can afford to pay the full salaries of those workers. The partners included Sunrise Community Health, a medical health center that integrates mental health care, and Outreach Fort Collins, a nonprofit that has a mobile mental health response team for people living outside. 

“It all hurts. It’s all terrible. My heart aches,” Allen said. But, he added, SummitStone had to make the cuts in order to continue “to be here for our community.” 

SummitStone has a contract with Larimer County to provide behavioral health care at the Acute Care Center at Longview Campus, which was not affected by the layoffs, county staff said.

As for client care, Allen said clients typically have a care team — including a case manager and a peer specialist with personal experience dealing with behavioral health issues — that will help them through the transition. 

Former employees, however, accused Allen of not being honest with them about the budget crisis and said the layoffs came as a huge shock. Some said they have complained to state agencies, including the Department of Regulatory Agencies, about the way clients were “abandoned” because of the layoffs. 

“We were all shocked by what was happening,” said Katie Rapson-Stecula, a supervisor who also provided therapy for a handful of clients. “Nobody discussed continuity of care for clients. There was no plan that we were able to be a part of as their providers. There were no warm handoffs. There wasn’t even a conversation to say goodbye.”

Rapson-Stecula said she couldn’t stop thinking about one of her clients who has a long history of suicide attempts. “It’s not how we are supposed to treat our clients in any way,” she said. “It’s unethical.”

After 70 kids and teenagers complained in the past year that they were mistreated while locked in detention centers, Colorado’s child protection ombudsman is calling for audio surveillance in the youth corrections system. 

Cameras inside the state’s youth detention centers capture video, but not audio, which means any investigation into the use of restraints or physical force against youth is incomplete, the ombudsman said in a fiery brief issued Tuesday. 

In response, the director of the Division of Youth Services said he’s already working on it. Anders Jacobson told The Colorado Sun that he is making plans to buy tiny cameras that attach to belt loops and discreetly collect video and audio of encounters between employees and young people who are in detention. 

The body-worn cameras, the cost of which is estimated at $610,000 per year for five years, will also detect key words — such as “Will you help me escape?” — that would automatically alert supervisors, Jacobson said. 

While the ombudsman’s brief felt “antagonistic” to Jacobson, he said his agency is in full agreement and has a head start — he’s already had a surveillance vendor in his office demonstrating the belt-loop devices.

“We want audio,” he said. “It aids in the investigation of any allegation. It doesn’t only protect youth, it protects staff as well. It’s not hard to go back and listen to the recording.” 

In her brief, Ombudsman Stephanie Villafuerte called on the Division of Youth Services to overhaul its surveillance system, adding audio capabilities at its 15 youth facilities statewide. The office accused the youth corrections division, part of the Colorado Department of Human Services, of leaving out audio surveillance even as it has built new youth centers and remodeled old ones. 

In reviewing video surveillance, the ombudsman’s office has watched multiple “violent physical interactions between staff and youth,” the brief said. 

“Youth have been pushed into walls, shoved and thrown to the floor, sometimes, by multiple adults,” the office wrote, noting that the incidents have not decreased despite a decade of efforts by lawmakers and advocates. Of the 70 complaints to the ombudsman in the past year, 47 involved excessive force or staff misconduct — a 27% increase from the previous year.

A 13-year-old boy’s face was slammed into a metal door frame as staff attempted to force him to the floor last year, causing a gash that required stitches. Division of Youth Services staff claimed the physical force was necessary because the teen had made verbal threats moments before. 

In another example, a youth who was recovering from a concussion was restrained in 2022 even though medical staff had advised against any physical contact. The boy claimed staff had antagonized him with racist language before he made threats of harm. 

Several youths have told the ombudsman that they were subjected to racial slurs or threats meant to disparage or intimidate them, and have alleged that staff are “aware of blind spots within camera systems” that they avoid. Without audio, the ombudsman cannot fully investigate the complaints. 

“At best, this system provides half the information needed to assess these cases,” the ombudsman’s brief states. “The remainder of the information comes from those who may have the most to lose by being forthright.” 

Tiny cameras would fit trauma-informed approach

Jacobson said he does not want traditional body-worn cameras like the ones that law enforcement officers attach to their chests. Those don’t fit with the Division of Youth Service’s trauma-informed approach to help young people recover from past abuse, and instead could pit kids against staff. 

“It creates the potential of an us-against-them type of environment,” he said. “We are not adult jail. We are not law enforcement.”

Ten of the division’s 15 youth centers, with home-like environments instead of cells, and staff who do not wear uniforms, are certified as trauma-informed by a national agency called the Sanctuary Institute. 

Jacobson said he will likely ask for state funding or look for federal grants that could cover the cost of the tiny cameras. “We don’t have that kind of extra money laying around in the budget,” he said. 

Under state law, the Division of Youth Services is allowed to use physical force in emergencies and after the failure of less-restrictive alternatives. It’s up to staff to determine when an emergency exists and whether the young person poses “a serious, probable or imminent threat of bodily harm to themselves or others.” 

Young people inside youth centers have “unfettered access” to the child protection ombudsman, as well as Disability Law Colorado, with phones inside the facilities that automatically connect to either, Jacobson said.

Use of restraints has increased, data shows 

In a six-month period in 2023, 465 young people were restrained 4,614 times, according to the most recent report of the state’s Youth Restraint and Seclusion Working Group. That was up 34% from the prior six months. The use of mechanical restraints — handcuffs, shackles and belts — increased by 29%.

Black youth were involved in 38% of the restraint incidents, but make up 23% of the population in Colorado’s youth detention centers, which the ombudsman’s office called “particularly troubling.”  

The ombudsman’s office also is requesting that the Division of Youth Services share more data regarding physical restraints, including the number of times a child or teen sustains serious injury, and the youth’s race and ethnicity. 

The state legislature passed a law in 2017 intended to curb the use of restraints and seclusion for youth, a move that came after a report from several advocacy agencies, including ACLU Colorado, called “Bound and Broken.” 

Other states, including Ohio, Louisiana and Wisconsin, have added audio surveillance to youth corrections facilities in recent years and claimed that the technology led to decreased violence, according to the ombudsman’s brief. 

In Ohio, staff at the Indian River Juvenile Correctional Facility began wearing cameras in 2022 after 12 youths barricaded themselves in a school building. Within a year, the center reported a 31% decrease in violence against staff. 

The ombudsman also pointed toward Colorado’s 2020 law that required local law enforcement agencies and the Colorado State Patrol to use body-worn cameras in situations that might include a use of force. With $5 million in state funding, law officers at 200 agencies statewide now have body-worn cameras, the ombudsman said, calling it a “model” for the state’s 15 youth corrections centers.

A brewing disagreement about how to deal with child protection caseworkers who fabricate records has taken an unexpected turn — with one arm of state government charging another $30 per hour to gather information requested under the Colorado Open Records Act. 

The information dispute, which brings up a host of questions including whether that’s the best use of public dollars, is between the Office of the Colorado Child Protection Ombudsman and the Colorado Department of Human Services. 

The two agencies have been working to close a gap in the system that allows caseworkers accused of falsifying records against families or lying about checking on children to transfer to another county, with no requirement to notify the new county or even the families involved. 

Ombudsman Stephanie Villafuerte — whose duties include investigating complaints made by families about the child welfare system — is trying to get to the bottom of how often caseworkers fabricate records, what their supervisors do about it, and whether the families are told what happened. 

So when the Colorado Department of Human Services mentioned in the rulemaking process this summer that it was aware of 11 suspected incidents of falsification in nine counties in a six-month period, the ombudsman asked for more information. 

The ombudsman’s director of client services, Amanda Pennington, requested the names of the nine counties, the time frames in which the falsification was alleged to have occurred, the case identification numbers in the state child welfare database, and details about how the falsifications were discovered. The request was made in a June 7 letter obtained by The Colorado Sun under public records laws. 

The office “consistently hears from clients who believe that false, biased or insufficient child welfare records have negatively impacted them,” Pennington wrote. In addition, the ombudsman “has received several complaints regarding the misconduct of child welfare staff, often including concerns that these staff have falsified records.”

Instead of sending the requested information, the state human services department responded that “child case files and records are highly confidential.” Child welfare officials do not have to release case information to the child protection ombudsman unless the ombudsman provides a specific child or family’s case, the state agency said in a June 21 response. 

A week later, the ombudsman’s office tried again, arguing that state law does not require the ombudsman to cite a specific child’s case in order to access information. In fact, the office “is tasked with not only accepting cases that involve systemic concerns, but it also charges the agency with proactively identifying systemic issues and analyzing such issues,” its letter said.

The ombudsman is currently investigating five suspected falsification cases that expose “systemic failures” by counties and the state, including that families were not told about the misconduct and that staff involved in the misconduct continued to keep working with families, the ombudsman’s office told the state. 

Without more information about the 11 suspected cases the state child welfare division knows about, the ombudsman is “unable to corroborate” whether they are the same ones its office is investigating and “will not be able to effectively determine the scale of the systemic issues alleged,” the letter said. 

When the state human services department again refused, the ombudsman’s office fired off a request under the Colorado Open Records Act, a move normally used by journalists and citizens who are trying to obtain information from government agencies. 

Human services department wants $60 deposit

The human services department responded July 16 that it would charge the ombudsman $30 per hour to research, retrieve and redact the requested documents. A $60 deposit was required, by check, money order or wire transfer. The work was expected to take a minimum of three hours, and the first hour is free, the department said. 

“By law, every state agency is allowed to charge CORA requestors, regardless of who they are, a per-hour rate to research, retrieve and redact responsive records,” human services spokesperson Jordan Saenz said in an email to The Sun on Monday. The agency “applies this policy consistently across requestors so as to make the process fair and equitable to everyone who may request a record.”

The ombudsman’s office has not yet paid the fee because it’s still figuring out how best for one state agency to transfer the money to the other. 

The nature of the relationship between the state’s child watchdog and the state child welfare department is adversarial, but this is the first time the ombudsman has tried to get information from the human services department through the Colorado Open Records Act. 

The ombudsman’s office was created in 2010, the legislature’s response to public outcry after it was revealed that 12 children died from abuse and neglect in 2007 even though they were known to child protection caseworkers. And in 2015, after the ombudsman at the time accused state officials of interfering in a child death investigation, the legislature made the office independent of the state child welfare department.

New policy doesn’t include caseworker decertification

The two agencies have been working to strengthen the laws regarding bad caseworkers after a string of high-profile cases in recent years. 

In Larimer County last year, a child protection worker was accused of lying about interviewing at least 10 families. In Moffat County in 2020, investigators found at least 50 child abuse reports that contained fake details, all written by a caseworker who fabricated stories about checking on children. And in Denver in 2015, a child protection worker lied in her paperwork to make it look like she had checked on a newborn baby born with marijuana in her system. Two months later, the baby was killed by her mother. 

Under state regulations, if there is no criminal case, no one has to know about the past behavior — not the caseworker’s potential new employer or even the children and parents whose records were falsified. Counties aren’t even required to tell the state Division of Child Welfare. 

A new policy approved this month by the state Board of Human Services stipulates that counties must complete an investigation into suspected falsification of records even if the caseworker resigns or is terminated. When there is a confirmed case of falsification, the county must notify the state within three days, law enforcement within 10 days, and the parents or guardians of the child involved within 10 days. 

Some advocates for children and families, including the ombudsman’s office, were critical of the new rules because they do not include a process for stripping caseworkers of their certification, which would prevent them from getting a job in another county.

“I don’t think we’ve gone far enough,” said board vice chair and family law attorney Mychael Dave, the only board member to vote against the new rules. “I think the right direction is for us to pause and actually fix this. My fear is that it won’t get fixed because there is a countervailing push from the counties. The counties’ desire to make sure they get their personnel issues right, which I respect, is secondary to making sure we protect these children and their families.” 

State human services officials were asked to return to the board in six months to report on progress toward developing a caseworker de-certification process.

Colorado stands out among the 10 states that have disenrolled the highest share of Medicaid beneficiaries since the U.S. government lifted a pandemic-era restriction on removing people from the health insurance program.

It’s the only blue state in a cluster of red states with high disenrollment rates — a group that includes Idaho, Montana, Texas, and Utah — in the Medicaid “unwinding” underway since spring 2023.

Colorado also is the only state that had all the policy ingredients in place to cushion the fallout from the unwinding, according to Medicaid policy analysts at KFF.

But it seems the cushion hasn’t been deployed.

“There’s really a divide in Colorado between our progressive policies and our underfunded and fragmented administration,” said Bethany Pray, chief legal and policy officer at the Colorado Center on Law and Policy, a Denver-based legal aid group.

According to KFF data, during the unwinding Colorado has seen a bigger net drop in enrollment in Medicaid and the Children’s Health Insurance Program than any state except Utah.

Advocates for health care access, researchers, and county administrators — the administrators handling the bulk of the Medicaid redeterminations in Colorado — say that the major issues involve outdated technology and low rates of automatic renewals. Both create obstacles to enrollment that undercut the state’s progressive policies.

State officials have a rosier view. They say the drop in enrollment is a sign that they did a good job enrolling people at the height of the COVID-19 pandemic. Secondly, they say Colorado’s economy is doing well, so more people can get insurance through their jobs.

“When we have a really stellar unemployment rate, not as many people need safety-net programs, and we’re proud of that. Our people are rising and thriving,” said Kim Bimestefer, who leads the Department of Health Care Policy and Financing and is the state’s top Medicaid official. Her department has also said that some people choose not to fill out their eligibility paperwork because they know their incomes are too high to qualify.

Bureau of Labor Statistics data shows that while it’s true Colorado’s unemployment rate is lower than the nation’s as a whole, it’s higher than it was before the pandemic.

State officials say they believe Medicaid enrollments dropped because many of those people found jobs, as reflected by the lower unemployment rates. But that scenario happened in fewer than half of the state’s counties, a KFF Health News analysis found. Notably, in 11 counties where unemployment stagnated or increased from January 2020 to April 2024, the share of the population covered by Medicaid shrank. A low unemployment rate does not necessarily mean there is less of a need for Medicaid coverage, because many employed people earn wages low enough to still qualify for the program.

Colorado increased enrollment in Medicaid and the related Children’s Health Insurance Program by 35% during the covid public health emergency, compared with about 30% nationally and among Medicaid expansion states.

“We grew more, which means, logically, we’re going to disenroll more,” said Bimestefer.“We went up higher, we’re going to come down lower, because our economy is stellar.”

Her department’s website initially claimed Colorado’s Medicaid enrollment grew more than any other Medicaid expansion state except Hawaii. But data from the Centers for Medicare & Medicaid Services shows pandemic enrollment growth in other states, including Indiana, North Dakota, Virginia, and Nevada, also exceeded that of Colorado.

Even if it had grown the most, the argument that what comes up must come down doesn’t hold water, Medicaid policy analysts said.

“A counterargument to that is we know that there was never a full participation in Medicaid prior to the pandemic,” said Jennifer Tolbert, deputy director of the KFF Program on Medicaid and the Uninsured.

Tolbert said she was surprised by the extent of Colorado’s Medicaid enrollment losses, given it was the one state in the nation that met all the criteria that KFF expected would cushion the effects of the unwinding. Those policies include adopting the Affordable Care Act’s Medicaid expansion and the automatic processing of renewals.

Tolbert was among several policy researchers who said that even if unemployment returned to pre-pandemic levels, they would expect a higher, not lower, share of Coloradans to be enrolled in safety-net coverage.

Ally Sullivan, a spokesperson for Gov. Jared Polis, a Democrat, said one complicating factor in Colorado’s system is that it’s among the handful of states where most of the eligibility verification work falls on counties, “which added complexity to the state’s unwind process.”

“Colorado is committed to ensuring that Coloradans who no longer qualify for Medicaid coverage are connected to other affordable sources of coverage as soon as possible, and the state is going to great lengths to do so,” the statement said.

Minnesota is another state where verifying eligibility is largely left to the counties. Yet it disenrolled just 26% of its Medicaid population in the unwinding, compared with Colorado’s 48%. Like Colorado, Minnesota is led by a Democratic governor. Minnesota also mirrors Colorado in its population, pandemic-era increase in enrollment, the percent of its residents living in prosperous areas, and its better-than-national unemployment rate. But Bimestefer dismissed any comparison.

“I don’t care about Minnesota,” Bimestefer said. “This is Colorado. I don’t care what Minnesota did.”

Advocates for health care access and researchers said a cluster of technological and administrative issues have contributed to Colorado’s high disenrollment rate.

First, Colorado’s eligibility database, the Colorado Benefits Management System, is outdated and clunky, according to people who use it or are familiar with systems in other states.

“It’s like still using the old flip phone where you’re trying to play Snake,” said Sarah Grusin, an attorney at the National Health Law Program. “We have better stuff.”

Grusin and Pray’s organizations filed a civil rights complaint with several federal agencies saying that the system issues that terminated disabled Coloradans’ coverage amounted to discrimination.

“It took many months to fix something that doesn’t sound that complicated,” Pray said.

Colorado had to pick between keeping kids covered and automatically renewing people

Bimestefer said her department is working on a plan to improve the system, which is managed by Deloitte under a $354.4 million contract that lasts until 2027. A recent KFF Health News investigation of eligibility systems managed by Deloitte found widespread problems. In Colorado, a state-commissioned audit in 2020 found that many Medicaid beneficiaries were sent incorrect notices and deadlines.

Kenneth Smith, a Deloitte executive who leads its national human services division, said that Deloitte is one player among many who together administer Medicaid benefits, and that the states own the technology and make the decisions about their implementation.

Colorado’s technology woes have also weakened its ability to use a powerful tool in enrollment: automatic renewal.

Last fall, Bimestefer said, her agency had to choose between fixing the system so that it would stop disenrolling children who shouldn’t lose coverage, or start automatically renewing people with no income or with income below the federal poverty level. It couldn’t do both, she said.

Experts such as Tricia Brooks, a research professor with the Center for Children and Families at Georgetown University, said it’s especially important to increase automatic renewals in states like Colorado where most of the renewal work falls on county government staff.

“What happens when you’re not getting a high rate of automated renewals? You’re sending out those renewal forms,” Brooks said — meaning more disenrollments. “They didn’t get the mail. The notice was confusing. They tried to get help through the call center. The list goes on as to why people don’t renew.”

Indeed, two-thirds of disenrolled Coloradans lost coverage for procedural reasons. That’s in line with the national average, according to KFF. But paired with Colorado having disenrolled so many people overall, that means more than 500,000 Coloradans, or about 9% of the state’s people, were disenrolled for procedural reasons — more than the population of its second-largest city, Colorado Springs.

At least a third of those disenrolled were later determined to be eligible for Medicaid.

Officials at Colorado community health centers and mental health centers say they’re seeing a rise in uninsured patients coming through their doors — a sign, they say, that Coloradans dropped from Medicaid aren’t necessarily moving on to greener health insurance pastures.

Fifty-eight percent of those who were disenrolled have returned to Medicaid, or now have another form of insurance. But the state doesn’t yet know what happened to the remaining 42% of people who were dropped and said it would conduct a survey to find out.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

For people who can’t afford safe housing or nutritious food, doctor visits and hospital stays can only do so much to fix health problems.

That’s the premise behind a plan to allow Colorado’s Medicaid program, which provides government-funded health insurance for people with low incomes, to cover the costs of housing and nutrition services. 

The outside-the-box idea catching on across the country is a recognition that health care happens beyond the doctor’s office and that taxpayers might actually save money long term if people had the means to stay healthy.

A new law recently signed by Gov. Jared Polis directs the Colorado Department of Health Care Policy and Financing, which includes the Medicaid program, to explore asking the federal government for permission to cover food and housing. The department has already started the process, seeking public comment this month on a proposal to cover those social needs for three groups of people: those who are homeless or at risk of homelessness, people with disabilities who are transitioning out of facilities, and young people aging out of foster care.

Among the agencies watching closely is Project Angel Heart, a nonprofit that delivers about 2,000 meals per week to Coloradans with severe illnesses. Every meal is tailored, on average, 80 different ways. 

Clients who have renal disease shouldn’t eat tomatoes, so those are swapped out for a roasted red pepper blend, for example. Other clients get gluten-free, or vegetarian, or heart-healthy options. 

According to Project Angel Heart’s data, the medically tailored meals — delivered frozen up and down the Front Range — help keep people out of the hospital. Hospital admissions among people receiving meals dropped by 13%, according to a 2018 study. Overall medical costs for people with congestive heart failure, pulmonary disease and diabetes dropped by 24%. 

The meals are free to clients and mostly paid for through donations and grants to Project Angel Heart, which aims to serve 750,000 meals to about 5,000 people this year. As of now, only one to two people per month meet the qualifications for Medicaid coverage of meals — certain people leaving a hospital can get meal services for up to 30 days. 

One Project Angel Heart client in the far southeastern corner of Colorado gets his meals shipped via FedEx. The closest food pantry to him is an hour’s drive away, and it’s only open two hours per month, said Nic Soucy, the organization’s government affairs manager. 

“It just highlights the need,” she said. “It’s important to first acknowledge just how big of a problem that food and nutrition is and especially the role it plays in reducing diet-related illness.” 

The nonprofit delivers down the middle of the state, from Greeley to Pueblo, but could expand to rural and mountain communities and help more people if it were reimbursed through Medicaid, Soucy said. How much Project Angel Heart could expand depends on what is included in Colorado Medicaid’s final proposal and what the federal Centers for Medicare and Medicaid approve, a process that could take several months.

Children are not included in the proposal

At this point, the categories of people who could benefit are quite limited.

Project Angel Heart would prefer that “everyone who is living with a chronic condition” could qualify for medically tailored meals through their Medicaid coverage. But so far, that’s not in the plan. 

Children aren’t mentioned in the health care department’s proposal, either. And that’s bad news for programs like one at Children’s Hospital Colorado that provides fresh fruits and vegetables, meat and milk at an on-site food pantry.

Record numbers of children are losing their Medicaid coverage after the end of the coronavirus national emergency, so it’s even more concerning that the Colorado Medicaid division is implementing the new law “in a way that will explicitly exclude children,” said Children’s Hospital’s vice president of community health and advocacy, Zach Zaslow. 

“We expect that Medicaid will adapt the program to include child health in the future, and we look forward to working with the legislature and the Polis administration on making those vital investments a reality,” he said via email.

Food and housing insecurity lead to higher rates of emergency department visits, missed days of school and missed pediatric checkups, Zaslow said. This year’s law and a related one passed last year that could allow Medicaid to reimburse for community health navigators, which link people to food, housing and utility assistance, have helped “nudge” the Medicaid system in the right direction, he said. 

For now, the Children’s program, called Resource Connect, relies mainly on philanthropic support because health insurers don’t typically cover the services, Zaslow said.

Parents bringing their children to medical appointments fill out a screening form, and if they indicate they need help with food, housing, mental health or even paying their electric bill, they can talk to a navigator from Resource Connect. From there, they can shop in the food pantry, sign up for Medicaid or food stamps, or connect with a nonprofit that provides diapers and school supplies. 

Colorado is among at least 20 states pursuing such a proposal

The state’s proposal to the federal government must be budget neutral to the federal government. At least 20 states have received approval or are working on similar proposals, and under the parameters of the federal waiver, can test out their new idea for five years, using federal match money, to see whether it works. 

States’ innovative proposals started pouring in after the 2022 White House Conference on Hunger, Nutrition, and Health, which linked stable housing and nutrition to overall health and well-being. 

Healthier Colorado, which pushed for Colorado’s new law, said stable housing reduces detoxification services by 65% and nutrition support has been linked to a 62% decrease in inpatient health care costs.

Colorado’s current proposal estimates that Medicaid would provide various levels of housing and nutrition assistance to about 11,000 people per year who are homeless or on the verge of homelessness. About 300 people who have disabilities and are moving out of nursing facilities and into homes would receive services, as well as 100 young people ages 18-25 who are transitioning out of the foster care system. 

Some of those people could receive up to six months of rent. Other benefits would include medically tailored meal delivery, food pantry delivery and nutrition counseling, according to the proposal.

The state department is taking public comment on the proposal until July 10. 

The bill was sponsored by Sens. Robert Rodriguez, a Denver Democrat, and Barbara Kirkmeyer, a Brighton Republican, and Reps. Kyle Brown, a Louisville Democrat, and Shannon Bird, a Westminster Democrat.

An experiment to pay people who were homeless in Denver with no limits on how they could spend the money led to twice as many people in stable housing, according to researchers who released their one-year report Tuesday. 

More than 800 people were selected to participate in the Denver Basic Income Project while they were living on the streets, in shelters, on friends’ couches or in vehicles. They were separated into three groups. Group A received $1,000 per month for a year. Group B received $6,500 the first month and $500 for the next 11 months. And group C, the control group, received $50 per month.

About 45% of participants in all three groups were living in a house or apartment that they rented or owned by the study’s 10-month check-in point, according to the research. The number of nights spent in shelters among participants in the first and second groups decreased by half. And participants in those two groups reported an increase in full-time work, while the control group reported decreased full-time employment. 

The project also saved tax dollars, according to the report. Researchers tallied an estimated $589,214 in savings on public services, including ambulance rides, visits to hospital emergency departments, jail stays and shelter nights. 

The $9.4 million project was funded by a mix of public and private money, including $1.5 million from The Colorado Trust and $2 million from the city of Denver’s pot of federal pandemic relief money. The University of Denver’s Center for Housing and Homelessness Research collected personal stories from the participants and studied the outcomes of the project. (The Colorado Trust funds a reporting position at The Colorado Sun.)

Among the other interesting findings: 

• There was no statistical difference in people’s reported use of illegal drugs. On average, people reported using illegal substances somewhere between zero and four times per month, both at the start and the end of the study. 
• Stress and anxiety levels reported by participants were slightly higher at the end of the study compared to the start, though researchers speculated that participants likely were worried about the end of payments. 
• Parents of kids under 18, however, reported statistically significant improvements in “parental distress” after receiving money for 10 months. 

One participant, a mother of two named Anita, is now living with a family member after previously living in her car or outside. She told researchers the monthly payments she received were a “leg up” and that she now relies on the payments for hygiene items, child care expenses, transportation and other bills. 

Another participant, a single mom who lives with her parents, said she was able to start a new job, buy a car and enroll in school. She also reported that she was able to make more “happy memories” with her children and is looking into moving into her own housing.

Participants were surveyed at the start of the program, after about three months and after about 10 months. Participation in the surveys dwindled throughout the project, however. About 630 of the 807 enrollees took the initial survey, but only about 70% of the 630 participated in the three-month survey and 60% in the 10-month survey. Participation in the survey was not required to receive the money. 

While many enrollees said they were concerned about what would happen to them when the payments stopped, “only two participants mentioned a panic of what they would do when the funds ended,” the study said. 

The study, which began in November 2022 with payments to the first group of participants, has been extended for an additional eight months, until September, and organizers are attempting to raise money to extend it further. New funds include another $2 million from the city of Denver. 

Researchers said they need more time to understand the relationship between the amount and timing of “guaranteed income” and how it affects people who are homeless. 

Mark Donovan, founder and executive director of the Denver Basic Income Project, said his goal is to make the project permanent. 

“We believe the first year of the program established a sense of stability for participants, and the second year and beyond is when individuals can experience an even more profound transformation,” he said in an emailed news release. “We aim to persuade policymakers to establish permanent funding streams for programs like ours.”

Of the $9.2 million spent on the program in 2023, $7.1 million went to participants. The rest went to delivery and fund-raising costs.

The average age of participants was 44, with the youngest 18 and the oldest 86. About 34% participants were white,  27% were Black, and 7% were Indigenous or Native American.

Coloradans are being offered up to $1,100 in monthly stipends to house migrants through the nonprofit Hope Has No Borders. People who wish to participate can call Mile High United Way’s 2-1-1 hotline in the Denver metro area for information.

Hope Has No Borders formed in May 2024. By mid-June, it had placed seven migrants in homes and identified 20 hosts for up to 90 people. Most hosts were offering stays of between three months and a year and asked for a monthly stipend of $200 to $900. 

The group receives no financial assistance from Mile High United Way, Denver or the state of Colorado. The organization said it is funded through donations and is obtaining grants and partnerships to help make more placements.

More than 42,000 migrants have come to Denver since December of 2022, straining the city’s ability to provide housing and other aid.

This fact brief is responsive to conversations such as this one.

Londis Ramirez knew her plan was working when a preschooler making a self-portrait asked her, “Can you help me draw my panza?”

Panza means belly in Spanish, which is not the child’s first language. But a Head Start program tested last year and expanding this fall in Jefferson County is offering preschool in Spanish and English, one of many efforts in the works across Colorado as the state tries to get more Spanish-speaking students into preschool and assimilate new migrants from South America.

It also comes as Gov. Jared Polis signed a new law last week to create a bilingual licensing unit within the state Department of Early Childhood, targeting $360,000 in state funds next year to help Spanish-speaking child care providers get licensed and to expand bilingual preschool options. 

Next fall, Jefferson County Head Start will have three bilingual classrooms in Arvada — for kids who speak Spanish at home and whose parents speak only Spanish, and for English-speaking children whose parents want them to learn Spanish. 

Ramirez, who supervises the county’s bilingual Head Start program, spent the past year building a plan to serve the area’s growing Spanish-speaking population. Several of the families who’ve enrolled are recent migrants from Venezuela and Colombia, she said.

The nonprofit Head Start provides free preschool to low-income families. In Jefferson County, 200 children, from infants to 5 years old, are enrolled in 16 classrooms in Arvada and Wheat Ridge. Until this year, all of the classes were taught in English, which was leaving out a large segment of the community, including parents who speak only Spanish and were unsure how to access the program, Ramirez said. 

When she started working at Head Start three years ago, the program had only three or four Spanish-speaking families. 

“I was like, ‘Why not? Where are these people? Where is the gap?’” she said. 

Ramirez developed a pilot program, which recently let out for summer vacation, and word has been spreading. Jefferson County Head Start now has eight bilingual teachers, plus two bilingual mental health specialists and two bilingual support specialists who help families access food assistance and other human services programs. 

Bilingual teachers use curriculum kits, or daily lesson plans, that come in Spanish and English. Books in the bilingual classrooms are in Spanish or English, and sometimes both at once. On some days, the teachers will speak mainly in English, and on others, mostly in Spanish. 

One bilingual class for the fall is already full with 20 students and a second class is nearly full with just a handful of spots left, Ramirez said. 

Colorado has 77 licensed child care providers who identified Spanish as their primary language, with 25 additional pending applications, according to the state early childhood department. The state did not provide a count of how many of the 297 Head Start providers statewide offer bilingual options. 

About 16% of the population in Colorado speaks a language other than English, including 11% who speak Spanish, according to the latest census. Colorado lawmakers who passed House Bill 1009, recently signed into law by Polis, said they were concerned that the language barrier is keeping kids in Spanish-speaking families from enrolling in preschool programs and keeping Spanish-speaking child care providers from getting licensed. 

The state’s early childhood department had used federal pandemic relief funds to hire three bilingual employees and provide 35 licensing training sessions in Spanish, but those temporary funds will run out in September. The new funding will allow the department to offer child care licensing applications in Spanish and provide translation services throughout the process. 

In Jefferson County, 17 students were in the Head Start program’s first bilingual classroom last school year, including about a dozen who spoke Spanish and five who spoke only English — at least when the class began. 

Ramirez marveled at how easily all of the kids in the class began to incorporate vocabulary in a new language. When the teacher asked who wanted milk, it didn’t matter if she said it in English or Spanish — everyone understood. Many of them were speaking some form of Spanglish, or “code-switching” with a mix of the two languages, by the end of the year. 

“You could definitely see a difference,” Ramirez said. “Children code-switch a lot, which I do, too. Even the kids who were monolingual, they were understanding, too.

When Solid Ground Apartments opens next week in Lakewood, it comes with proof of concept — giving people who are homeless a place to live, no strings attached, not only changes their lives but can save public money. 

The new 40-unit complex is the first permanent supportive housing project in Colorado to copy Sanderson Apartments, which welcomed its first residents in 2017 as a national model in solving homelessness.

Both projects are run by community mental health centers and both invite people who are living outside — the ones burning through taxpayer dollars as they cycle in and out of jail, detox and hospital emergency rooms — to move directly into their own apartments. 

A third, similar project is also in the works, set to open next spring. At the same time Jefferson Center for Mental Health prepares to welcome its first residents at Solid Ground, Denver’s mental health center, WellPower, announced it is breaking ground on a 60-unit project called Sheridan on 10th.

All the construction, funded largely by tax credits and grants, would make it seem that Colorado has turned a corner in how it gets its chronically homeless population off the streets. Have the years since the COVID pandemic, when homelessness was more visible and entrenched than ever, convinced people that government-funded, permanent housing is the solution? 

“I would love to say yes to that,” said Kiara Kuenzler, president and CEO of Jefferson Center. But “I think there is still a lot of stigma, and sometimes the more visible folks without houses are in communities, the more that people can stigmatize and want to push away what is uncomfortable.” 

Bringing neighbors and the public in general around to the idea is “requiring a lot more dialogue — even more dialogue now than when homelessness was less visible.” 

Kuenzler often tells skeptics that people without housing are going to live in their neighborhoods anyway, so “whether they are in a tent or whether they are in an apartment with wraparound services really makes a difference.”

Solid Ground, as well as WellPower’s Sheridan on 10th, will have on-site mental health services, peer support specialists and case managers, all of which are available to residents but not required. Residents don’t have to have jobs and it’s OK if they have criminal records or are not sober or in recovery. Still, the “low-barrier” apartments have some rules — residents cannot cook illegal drugs on site, or start a fire to keep warm in the courtyard, or commit violent acts. 

It’s not a step-up program intended to push people toward jobs and finding their own, independent apartments. The housing is available to them for as long as they want to stay. 

“It means that people have a permanent home from the first day they move in,” Kuenzler said. 

Designed for people used to sleeping outdoors

Both new buildings are designed for people who have grown used to sleeping outdoors, which means light-filled rooms, an abundance of plants, no dark hallways and plenty of outdoor space. At Solid Ground, residents can bring their dogs, and there is a community barbecue for people to use. The laundry room was strategically placed in a corner of the building so it has two walls with windows looking outside, creating a bright, airy feeling uncommon for a typical laundromat. 

“We have heard time and again that laundry rooms are triggering areas,” said Taylor Clepper, Jefferson Center’s director of navigation and housing services and project manager for the complex. People who are homeless have been assaulted in laundromats, gotten into altercations about machines and belongings, and had their tent, cart or other belongings stolen outside while they were doing laundry. 

The entire building is structured to make people feel comfortable and safe, in the hope that it will lead to recovery from mental health issues and substance use. 

“There is a kind of dichotomy on the streets,” Clepper said. “There is safety that is created. There are groups, communities that form and really create safety for individuals and that’s where they feel safest. Conversely, there is a lot of trauma that happens on the streets. It’s a both-and situation, and we are trying to meet people where they are.”

“Trauma-informed” furniture was arriving at Sold Ground this week, including beds made for people accustomed to sleeping on the hard ground. Instead of wooden slats under the mattress, the beds have a wooden platform so people can remove the mattress and sleep directly on the wood. 

Sleeping inside “feels very different than not having four walls around you or feeling the sun come up over your head,” Clepper said. The couches are narrow by design, to encourage people to try sleeping in their beds. Sleeping in the courtyard will not be encouraged, but it isn’t a deal-breaker. Overnight guests are allowed, but with restrictions, because it’s typically not the resident but the resident’s friends that lead to evictions, Clepper said. 

Case managers will be on site, 24-7.

“We are going to work on housing first and then we will work on the rest,” Clepper said. “The goal is not to kick people out if there is a safe way to work with you. This is low-barrier housing and the intention is to keep them housed.”

Proof of public savings

There is evidence, based on years of studying and following up with the residents of Sanderson Apartments in Denver, that it works. 

The Urban Institute tracked people’s usage of emergency services, hospital stays and the criminal justice system before and after moving into Sanderson. 

The national think tank found that the first 250 residents had cost the government a total of $7.3 million per year when they lived outside and in shelters. After they were housed, researchers found a 40% reduction in arrests, a 30% reduction in jail stays, a 65% decrease in detox services and a 40% drop in emergency department visits. 

The reductions made up for half of the cost of the program, which was started with $8.6 million from eight private investors as well as local housing resources. 

The institute’s research also found that 86% of people in the program were still housed after one year, and 77% were still housed after three years.

The 60 units at Sanderson Apartments were originally filled through Denver’s “social impact bond,” a public-private partnership that included selecting the highest-users of the health care and criminal justice systems and inviting them to move in. Private companies loaned money to the mental health center and the Colorado Coalition for the Homeless to build the complex, and the city paid them back with the savings created through decreased arrests, jail time, detox and emergency room visits. 

The Urban Institute said its findings about Sanderson Apartments “disrupt the false narratives that homelessness is an unsolvable problem and that people who experience chronic homelessness choose to live on the street.” Researchers called for expanding supportive housing, arguing it could “end homelessness, break the homelessness-jail cycle.”

Neighbors of the new complex want improved safety along gulch

The $19 million Solid Ground construction was covered mainly by tax credits and partially through grants. Jefferson Center took out a $4 million loan to cover the rest, funds it expects to recoup through rent revenue and providing mental health services to residents who are covered by Medicaid government health insurance. 

Residents will pay about 30% of their rent, possibly through disability benefits, and the rest of the rent is covered through a state housing voucher from the Department of Local Affairs. Jefferson Center selected half of the residents from people who are homeless and receive services through the mental health center, while the other half were referred through a regional coordinated entry system, which prioritizes who is most in need of housing. 

Similarly, half of residents moving into the 60-unit Sheridan on 10th apartments next spring will come from the region’s coordinated-entry system, while the other half will be referred by WellPower’s mental health teams. 

The Sheridan on 10th project will rise alongside two other apartment complexes in the area, which is near RTD’s Sheridan Station. The three-story building for people who were chronically homeless will sit near an affordable housing complex and a market-rate apartment building, projects from the Urban Land Conservancy and Yates Investment Group.

The developers began talking to residents of the surrounding neighborhood a couple of years ago, trying to get a headstart on questions about traffic and safety. Residents requested the developers improve a gulch that stretches alongside the neighborhood and near the light-rail station, complaining that it was too dark and not easily accessible via connecting paths. 

The light-rail station and the nearby Lakewood/Dry Gulch Park are popular camping spots for people who are homeless, and about two years ago, Jefferson Center for Mental Health partnered with RTD to send an outreach worker to the area and to parks near other light-rail stations. 

The station is on the dividing line between Denver and Lakewood. WellPower, the Denver mental health center, is working to improve the trails and lighting along the gulch as part of its effort to act as “good neighbors,” said Stephanie Johnson, the center’s director of community relations and public policy. 

Construction costs of Sheridan on 10th are expected to total nearly $15 million, funded through federal low-income housing tax credits, loans, and grants from the city, state and housing authority. 

Johnson has little doubt that both new permanent supportive housing complexes will fill up quickly. 

Seven years after WellPower opened Sanderson Apartments, there is still a waiting list.