This Spring, Michelle Lefco-Rockey, the owner of Creekside Collaborative Therapy in Greenwood Village, said she that got word from the state agency in charge of Medicaid about a possible change in rates. Then, this week, she got confirmation.
“It kind of was a shock on Friday morning to wake up, whatever time I woke up and checked my emails, and that was the first email that I saw.”
The email notification, from one of the companies that manages regional Medicaid reimbursement, said that elevated payments for services like therapy, would decrease, with some exceptions.
Statewide, Colorado’s Behavioral Health Agency has currently approved over 200 Essential Safety Network Providers, a status that allows for enhanced payments for services including outpatient therapy and treatment for substance use. This designation followed a 2022 law designed to improve care in the state; approvals began in January 2024.
As of October 1, rates will drop anywhere from 20 to 34%.
Get top headlines and KUNC reporting directly to your mailbox each week when you subscribe to In The NoCo.
Leftco-Rockey explains why this change is shocking: her organization put a lot of time and money into getting the ESNP certification that made them eligible for higher payments.
In order to qualify, her staff took on additional administrative hours. Lefco-Rocky expanded her Greenwood Village practice beyond clinical work to assist with housing, food and medical care.
Around half of Creekside’s clients are insured under Medicaid.
“We're still going to provide them those resources. We just might not be able to be as hands on because…we have to pay our staff to be able to provide that case management and we won’t have that enhanced funding,” said Lefco-Rockey.
In an email, a spokesperson for Colorado Access, one of the companies responsible for reimbursement, responded to KUNC’s questions about the reason for the change by saying that their goal is to “control costs while maximizing access to care,” and noted that rates for services including opioid treatment and inpatient services will not change.
To become a safety net provider, clinics must accept most clients who walk through their door; they are prohibited from refusing care for ‘priority populations’ including unhoused people and those without insurance.
Andrew Rose is the director of Boulder Emotional Wellness who works with children. He is also the leader of, COMBINE, an association of clinicians and clinics.
“I'm sad about it, and it feels unnecessary,” Rose said of the rate changes, which he believes could have been avoided with more financial transparency from health care organizations.
Rose believes that reduced reimbursement rates will lead to practices leaving the pool of safety net clinics in order to take on more private pay clients.
“You know, in play therapy I have one clinic I can refer to in Boulder County and they're full. My interns are full,” said Rose. “So, having less providers participate, yes, that means there's less access.”
In an emailed statement, BHA Commissioner Danette Smith said the agency is aware of provider concerns and also of fiscal constraints. “We are asking our partners for patience and partnership as we work to find a path forward,” she wrote.
