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At Resource Connect, a program started in 2019 at Children's Hospital Colorado, parents can take home fresh produce, meat and healthy pantry items. (Jennifer Brown, The Colorado Sun)

An increasing number of clinics and hospitals in Colorado are trying to address the social issues that affect their patients’ health — lack of warm clothes and school supplies, food scarcity and unsafe housing. 

The problem is, the state’s Medicaid insurance program does not reimburse for that work.

This could change, though, as state lawmakers approved a plan Wednesday that could lead to a $12 million-$14 million annual program to fund the community health work that bolsters traditional medical care. 

The work — linking patients to housing assistance, food pantries, nonprofits that provide school supplies and attorneys who fight unsafe housing conditions — is covered in 15 other states. The bipartisan legislation, now headed to the governor’s desk, directs the Colorado Department of Health Care Policy and Financing to seek federal approval for its plan, which could see its first reimbursements in 2025.

The Colorado plan is based on reimbursing community health work at $39.34 per hour, which is the rate in Nevada and South Dakota. The state and federal government would split the cost of the new benefit. 

Colorado now has about 170 community health workers. State officials estimate that number would grow to about 330 workers by 2026, after Medicaid begins reimbursing for the work and more health clinics hire social wellness workers. Under the proposed law, a community health worker is defined as a frontline public health worker who is a liaison to medical, dental or mental health care, or community programs that “combat social determinants of health.” 

Children’s Hospital Colorado, for example, opened a social wellness center, including a food pantry filled with fresh vegetables and meat, in its child health pavilion three years ago. The program, called Resource Connect, helps patients sign up for food assistance or Medicaid, and connect with nonprofits that provide school backpacks, formula and diapers, or mortgage or rental assistance.

Patients are referred to the center based on their answers to questionnaires given during medical appointments. “In the last 12 months, did you ever worry that your food would run out before you had money to buy more?” they ask.

Since Medicaid does not reimburse for the work, the program has relied on grants, donations and operational funds from the hospital. Under the new plan, Medicaid would reimburse hospitals and clinics for the social wellness work, but not for the costs of food, some of which is grown in the hospital’s garden.

The push for new funding in Colorado is a recognition that people’s health is affected mainly by what happens outside of a medical appointment. A pediatrician can provide vaccinations and give advice about a healthy diet, but that doesn’t matter as much as the fact that a child might live in a house with mold or a family that can’t afford healthy food. 

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Public health experts hope that it’s one day financially feasible for even small doctors’ offices to have a community health worker on staff. 

The Colorado Cancer Screening Program, within the University of Colorado Cancer Center, learned years ago that patient navigators could make a huge impact in getting medically underserved people to screening appointments. The no-show rate at one safety net clinic dropped to 10% from 75% in one year after navigators began working with patients in their native languages, and offering to pay for transportation to screenings, prescriptions or child care. Prior to the extra help, Medicaid patients were not showing up for appointments or showing up without following the instructions, including fasting or taking the bowel-preparation medicine before a colonoscopy. 

Andi Dwyer, director of patient navigation at the screening program, called this year’s legislation a “game-changer.”

“If this was a pill or device, we would have probably seen payment for this 10 years ago,” she said. 


Salud Family Health Centers, a nonprofit that has 13 clinics in Colorado that provide medical, dental and mental health services, has wanted Medicaid to reimburse for community health work for at least 10 years. Salud focuses on low-income and medically underserved people, including migrant and seasonal farm workers, and employs a few “care managers” who work with patients who require the most hospitalizations.

Medicaid funding would allow Salud to hire more care managers to help a broader group of patients, said Jen Morse, Salud’s vice president of development. Finally, health care policy is catching up with research that shows how health outcomes are improved when providers can address “all these additional stressors in their life that really affect health care,” she said.

“The fact that this bill is even getting some feet under it shows that there is some recognition at a policy level,” she said. 

Dr. Hans Elzinga, a family medicine physician at Salud’s Longmont clinic, said it’s “a stereotype in medicine that Medicaid patients are going to be more likely to no-show.” In the past decade, though, health providers have realized that if they can identify patients’ barriers to care, and help them overcome them, they will show up. “We need to identify why those things aren’t happening and then make it possible,” he said. 

Elzinga works with Tania Maldonado, a patient navigator who speaks English and Spanish. In some cases, she said, patients don’t need assistance getting to an appointment, they just need better communication. She has had patients who only spoke Spanish and were having their young children try to interpret and explain medical directions, she said. 

The legislation requires the state Medicaid division to begin covering community health work as soon as the state receives approval from the federal Centers for Medicare and Medicaid Services. Next year, the state is expected to spend about $300,000 as staff seek federal approval, hold four public meetings with community health workers, and lay out the specifics of the coverage. 

In other states, community health work can occur not just in health facilities, but in schools, community centers or patients’ homes. 

Prime sponsors of the legislation are Sens. Kyle Mullica, a Thornton Democrat, and Cleave Simpson, an Alamosa Republican.

Jennifer Brown

Jen is a co-founder and reporter at The Sun, where she writes about mental health, child welfare and social justice issues. Her first journalism job was at The Hungry Horse News in her home state of...