Advocates warn Medicaid reductions will deepen hardships for Colorado patients

After a spinal cord injury in 1992, Oliver Giminaro became entirely dependent on caregivers. When he was living with his parents in Delta, they served in that role for him.

Before the injury, he enjoyed football, camping, hiking, skiing and mountain biking, he said.

Today, he said he would not survive without caretakers who have the specialized training needed to help him. Medicaid has covered those caregivers for decades.

Giminaro later attended college in Pueblo, earned an engineering degree and took a job with a boilermaker, eager to put his education to use. But because Medicaid is the only insurance program that covers the long-term care he needs, he had to leave the job to remain financially eligible.

Unable to work, he now spends his time advocating for other patients. Without Medicaid, he said, he could not live independently at home.

“Medicaid allows me to function … if I didn’t have it would just be devastating,” Giminaro said. “If I didn’t have in-home care, I would have to live in an institution. We’ve all heard the horror stories and we all know that people thrive in community.”

He said the paperwork and administrative hurdles involved in obtaining Medicaid coverage are already difficult for people with disabilities to manage, and some would say the system is built for them to fail.

He added that cuts to Medicaid and limits on care would affect not only him, but also the healthcare workers and hospitals that have supported him for years.

Giminaro and other patients and family members who fear changes to public coverage under federal policy shifts spoke at a roundtable hosted by U.S. Sen. John Hickenlooper at Tepeyac Community Health Center in Denver.

Adam Fox, deputy director of the Colorado Consumer Health Initiative, said the impact of the Medicaid reductions is only beginning, with additional changes set to arrive later. He said the Republican tax and spending package known as H.R. 1 cuts $1 trillion from Medicaid over several years, the largest cut in the program’s history. Colorado is projected to lose as much as $2.5 billion each year through 2032 because of the law, he said.

“As these cuts take effect, Coloradans health, well-being, economic, security and indeed their very lives are being put at risk,” Fox said. “Medicaid is the foundation of our healthcare system, and H.R.1 is a direct attack on that foundation.”

He said more Coloradans will be forced to choose between rent, food and healthcare, while the expiration of enhanced premium tax credits for people buying insurance on the Affordable Care Act marketplace will add further pressure.

Fox also said major healthcare corporations — including insurers, hospitals, drug companies and middlemen — continue to push costs higher.

He said upcoming program changes, including added paperwork and verification requirements, are intended to strip away coverage.

“We know that Medicaid is complicated enough as it is … but these requirements are so onerous, and the state has not had enough time to develop the systems necessary, that we fully expect these changes to bog down our entire Medicaid system, regardless of whether these requirements apply to everybody or not,” Fox said.

According to Fox, Colorado lawmakers had to cut the state budget this year to close a $1.5 billion gap created largely by H.R. 1, and state projections point to more reductions next year. He said Amendment 87, a ballot measure voters will decide on next week that would establish a graduated income tax structure, would help finance healthcare, childcare and education programs.

Doing more with less

Healthcare leaders at the roundtable described the ongoing challenge of serving more people with fewer resources, a problem that is expected to worsen as Medicaid cuts move forward. Pablo Hester, an executive at Tepeyac, said health centers like his will face greater administrative demands as they adapt to changes such as work requirements, and they will need more staff to handle the burden.

Jim Garcia, Tepeyac’s CEO and founder, said community health centers are often the most practical option for preventive care that remains affordable and accessible, but the demand still exceeds the center’s capacity.

Hickenlooper said community health centers are the “last hope” for a health system that works.

“Anti-government forces in Washington are constantly painting pictures of waste and fraud and abuse,” Hickenlooper said. “What I see is constant improvement of efficiency and trying to figure out how to do more with less to still deliver the care that the community needs, and there’s not enough money.”

A denial

Even without the new requirements, Medicaid is difficult to navigate and creates stress for families when care changes. Kari Brauer’s 11-year-old daughter, who has a developmental disability, needs daily help from a caregiver.

Since 2020, Medicaid had approved 5.5 hours of certified nursing assistant care each day, a role Brauer has filled. But that funding ends this week after the state denied her latest request.

The denial letter says Brauer’s daughter does need daily caregiver help, but does not need the specific skills of a nursing assistant because she has no injuries or complications.

“Are we supposed to wait until my daughter gets hurt before the cure that prevents it is considered necessary? The absence of injury doesn’t mean there is no risk,” Brauer said. “It means someone was there to recognize the risk and intervene before something happened.”

Brauer said she will be able to move her daughter into another in-home Medicaid program, but it will not offer the same level of support as the long-term nursing assistant care. She said the logistics of changing care arrangements are a major source of stress, especially while working full time and caring for her daughter.