Stethoscope or phonendoscope on a doctor's white desk on cloudy morning. Treatment of cold or flu.

Editor's note: This story has been updated.

The number of Colorado residents enrolled in Medicaid, the quasi-federal health insurance program for low-income and disabled people, is on the decrease.

In July 2019, 1.27 million people — approximately 23% of the population — received coverage through Medicaid. That is down from 1.3 million in January 2018, and 1.37 million in May 2017. The number of people covered today is still double that of 2011, before the General Assembly expanded the program per the Affordable Care Act.

The Colorado Health Institute found that the insurance rate among Coloradans has hovered around 93.5% since 2015, and cites increases in employer-sponsored coverage. 

However, an analysis released on Tuesday from the Colorado Center on Law & Policy did not find a straightforward answer to the enrollment trend, ruling out wage increases and increased employment rates.

Instead, the center pointed to government actions, including the Trump administration’s move to dissuade immigrants from accessing public assistance, missing or misplaced paperwork from counties, and a state policy that drops Medicaid cases if the state receives one piece of returned mail. 

The latter rule was revised from three pieces of mail because counties deemed it “unmanageable.”

“The likelihood that this policy has resulted in eligible individuals losing access to Health First Colorado coverage is high, based on the experience of states that have instituted similar policies,” the report concluded, citing nearly 40% disenrollment in Arkansas due to the Medicaid program’s inability to locate a client.

The center’s analysis did not estimate how large an effect any individual policy may have had on enrollment in Colorado. The Kaiser Family Foundation reported that Medicaid enrollment nationally has essentially flatlined since its peak in 2015, "due, in part, to the tapering of [Affordable Care Act] enrollment growth."

A spokesperson for Health First Colorado, the state's Medicaid program, disputed the report's dismissal of the improving economy as a reason for declining coverage, adding that disenrollment is normal. 

"Many of our members regularly ‘churn’ off and on Medicaid every several months – churn meaning their income frequently fluctuates," said Marc Williams. "One month their income meets eligibility requirements. Two to three months later, their income exceeds income requirements and they’re no longer eligible. Those Medicaid members who may have ‘incomed off’ Medicaid are staying off for longer periods of time."

At the same time, a University of Colorado-Boulder study released on Wednesday discovered that nationally, people enrolled in Medicaid are more likely to build up their savings than low-income households not enrolled.

“Getting Medicaid eases the money squeeze and lessens the worry. Suddenly, a trip to the emergency room doesn’t mean a trip to bankruptcy court,” said Emily Gallagher, the paper’s lead author.

On average, Medicaid-enrolled families saved $102 more than the non-enrolled. The authors pointed out that the amount is notable considering that Medicaid is not an intervention designed to induce any savings behavior.

The study noted that families without health insurance turn to bankruptcy as a solution to unexpected bills. There is a disincentive to save when bankruptcy courts could take away a person’s assets. Enrollment in health insurance alleviates some of that burden.

“It means that the next car breakdown doesn’t send you to the payday loan store, which digs you deeper into the hole,” said Gallagher.

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