Leaders of a trade association that represents 21 community health centers across Colorado, including Peak Vista in Colorado Springs, are “still reeling” from last Thursday’s full Congressional approval of H.R. 1, more commonly referred to as the “One Big Beautiful Bill Act.”

“We’re working to understand the final provisions of the bill,” said Polly Anderson, vice president of strategy and financing for Colorado Community Health Network.

The Trump administration says health care will be strengthened under the bill, “by eliminating waste, fraud, and abuse and blocking illegal immigrants from receiving Medicaid.”

Anderson said the association has just started assessing what the changes will mean for patients and services under Medicaid, a joint state and federal health insurance program for low-income singles and families, pregnant women, children and disabled people.

Modifications include requiring able-bodied recipients to work at least 80 hours a month. Free health care for immigrants who are in the U.S. illegally also will be scaled back, and eligibility for health care subsidies for certain legal immigrants, such as people here on work and student visas, will be narrowed. And, according to some analysts, with 60% of nursing home patients on Medicaid, services for such long-term care patients could be scaled back with the cuts.

Colorado’s 240 community health center sites handle 300,000 Medicaid patients, Anderson said. Of those, the association estimates that between 66,000 and 133,000 could lose Medicaid coverage because of complicated or difficult-to-navigate new requirements.

Statewide, the Colorado Hospital Association and state of Colorado project that 150,000 Coloradans may be dropped from Medicaid benefits.

Impacts won’t be felt for a while, Anderson said, as most of the work reporting requirements take effect in 2027, but states must plan ahead for implementation.

“The best way to implement is behind-the-scenes verification online, using wage data, but that’s tough,” she said. “No matter how simple they try to make it, folks are going to have trouble with complying. It’s going to be complicated to set those systems up and for folks to figure out how to navigate them.”

The sign-up process likely will increase from once or twice a year to as much as monthly, Anderson said.

The federal government and individual states each pay about half of the expenses of subsidized health care. Federal funding is contingent on meeting requirements about what populations must be covered and what services or benefits must be offered. States also are responsible for enrollment and monitoring.

Colorado’s General Assembly could hold a special session soon to discuss strategies for fulfilling the new regulations.

The Colorado Department of Health Care Policy and Financing estimates it will cost the state $57 million to get ready to meet the upgraded reporting requirements and require 3,000 additional staff in county governments to work on eligibility.

Officials at UCHealth Memorial in Colorado Springs, which defines itself as one of the largest providers of Medicaid care in Colorado, expect their patients to be “significantly impacted,” said Cary Vogrin, communications and media relations specialist.

“Often, when people lose health insurance, they are unable to access preventive care, prescription medications and behavioral health care, and these patients turn to hospitals’ emergency rooms,” she said.

As people fall off the rolls, the number of uninsured patients will increase, Vogrin said, which in turn will increase uncompensated care expenses for hospitals.

Last year, UCHealth provided nearly $570 million in uncompensated care and served 300,000 unique patients covered by Medicaid, she said.

The costs to community health centers also will be high, Anderson said. About half of patients seen at community health centers receive Medicaid, 25% are uninsured and the other 25% are on Medicare for people ages 65 and older or have private insurance.

People who lose Medicaid coverage still will need to go to a doctor when they’re sick or for checkups or chronic disease maintenance, Anderson said.

“Health centers will try to care for them without the health insurance reimbursement,” she said.

That will create a potential loss of revenue in Colorado between $313 million and $637 million over the first four years, Anderson said, depending on how many Medicaid recipients no longer have coverage.

Catholic Health Association, which encompasses 2,200 health care operations across the nation, including the CommonSpirit Penrose and St. Francis Hospitals in Colorado Springs, issued a statement that called the changes “a moral failure.”

“(This) will harm everyone who depends on a functioning, equitable health care system,” the statement says. “The impact will be felt in every emergency room, clinic and household struggling to access care in an already strained system.”

While many agree that Medicaid needs to be improved, industry leaders do not blame patients for the fraud, waste and abuse that the new requirements seek to reduce.

“Most experts believe the waste, fraud and abuse comes from unscrupulous providers who are billing Medicaid for services they didn’t deliver,” Anderson said. “There’s little evidence of fraud committed on the individual patient level.”

She argues the rules already in place are sufficient to monitor users and safeguard the program.

Since Medicaid is a “major financer” of Colorado’s health care system, as it reimburses expenses for hospitals, primary care providers, specialists, long-term care facilities, nursing homes, funding decreases will cause cost-shifting and contribute to higher insurance rates for private payers, Anderson said.