By Heidi Baskfield

For years, the consequences of a strained and fragmented Medicaid system have fallen on those least able to navigate it — the children with complex needs and the families fighting to care for them. Though policy debates often happen in abstract terms, the reality on the ground has been painfully concrete: children going without care, families navigating broken systems, and providers struggling to meet overwhelming demand without adequate support or coordination.

This isn’t theoretical. The stark reality of Colorado’s broken Medicaid system has a familiar feel regardless of whether you are in Denver or Durango — children waiting in emergency departments for days or weeks because there is nowhere else for them to go. It looks like missed therapy appointments, delayed diagnoses and parents forced to navigate a system that too often feels impossible to access.

As someone who works closely with children and families navigating this system every day, I have seen firsthand how overcoming institutional inertia is incredibly difficult. A recent change in leadership at the department that oversees Colorado’s Medicaid program only came about because a bipartisan group of Colorado senators took the bold step of planning to debate a vote of “no confidence“ in Kim Bimestefer, its executive director. These senators’ willingness to confront these challenges reflects what families, clinicians and advocates have been raising for years: the system is not working as it should, and children are paying the price.

Nowhere has this been more evident than during the unwinding of COVID-era Medicaid protections. As states across the country worked to transition individuals off continuous coverage, Colorado experienced significant administrative failures that resulted in tens of thousands of children losing Medicaid coverage — many not because they were ineligible, but because of process breakdowns. For those families, the consequences were immediate and severe. Children lost access to primary care, missed mental health appointments and faced gaps in treatment that can have lasting effects on their development and well-being.

At the same time, Colorado has been navigating the aftermath of a landmark lawsuit that alleged the state failed to properly implement the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit for children with complex mental health needs. EPSDT is not optional — it is a federal requirement designed to ensure children enrolled in Medicaid receive all medically necessary services to address physical and behavioral health conditions. When implemented effectively, it can be a powerful tool to identify needs early, intervene appropriately and prevent crises.

The state ultimately settled that lawsuit, creating a clear mandate to build a system that better serves children with significant behavioral health challenges. But progress since then has been deeply concerning. Despite a settlement intended to serve tens of thousands of children, fewer than 30 have reportedly received services to date. Meanwhile, the state has repeatedly sought to extend deadlines for compliance.

This is not simply a matter of bureaucratic delay — it is a failure with real human consequences. Every day implementation lags is another day children remain stuck in emergency rooms, separated from their communities, or unable to access the services they need to thrive.

Colorado’s children deserve better than incremental change. They deserve a system that works — one that proactively identifies need, ensures timely access to care and holds itself accountable for outcomes.

The leadership transition now underway presents a critical opportunity to reset. It is a chance to move beyond fragmented approaches and toward a cohesive strategy that aligns policy, funding and care delivery. That means fully implementing EPSDT as it was intended, strengthening oversight and accountability within Medicaid, and investing in models of care that meet children where they are — whether in schools, communities or their homes.

It also means listening to the voices of families and frontline providers, who understand better than anyone where the system is failing and what solutions are needed.

Colorado has the resources, expertise and commitment to become a national leader in youth mental health. But doing so will require urgency, transparency and a willingness to confront hard truths about what has not worked. This moment should not be viewed as the end of a chapter, but as the beginning of a new one — one defined by a shared commitment to ensuring no child falls through the cracks again.

Medicaid is not just a program. For thousands of Colorado children, it is the lifeline that determines whether they can access the care they need to grow, heal and succeed. This moment demands more than a leadership change. It demands a system that finally works. Colorado’s children cannot afford anything less.

Heidi Baskfield is executive director of Speak Our Minds, a nonprofit addressing the youth mental health crisis by working with providers, payors, policy makers and politicians to champion accessible mental health care.