Colorado clinics could be reimbursed for linking patients to food, housing

Public Notices

BY JENNIFER BROWN THE COLORADO SUN

An increasing number of clinics and hospitals in Colorado are trying to address the social issues that affect their patients’ health — lack of warm clothes and school supplies, food scarcity and unsafe housing.

e problem is, the state’s Medicaid insurance program does not reimburse for that work.

is could change, though, as state lawmakers approved a plan Wednesday that could lead to a $12 million-$14 million annual program to fund the community health work that bolsters traditional medical care.

e work — linking patients to housing assistance, food pantries, nonpro ts that provide school supplies and attorneys who ght unsafe housing conditions — is covered in 15 other states. e bipartisan legislation, now headed to the governor’s desk, directs the Colorado Department of Health Care Policy and Financing to seek federal approval for its plan, which could see its rst reimbursements in 2025.

e Colorado plan is based on reimbursing community health work at $39.34 per hour, which is the rate in Nevada and South Dakota. e state and federal government would split the cost of the new bene t. Colorado now has about 170 community health workers. State o cials estimate that number would grow to about 330 workers by 2026, after Medicaid begins reimbursing for the work and more health clinics hire social wellness workers. Under the proposed law, a community health worker is de ned as a frontline public health worker who is a liaison to medical, dental or mental health care, or community programs that “combat social determinants of health.” e program, called Resource Connect, helps patients sign up for food assistance or Medicaid, and connect with nonpro ts that provide school backpacks, formula and diapers, or mortgage or rental assistance. e push for new funding in Colorado is a recognition that people’s health is a ected mainly by what happens outside of a medical appointment. A pediatrician can provide vaccinations and give advice about a healthy diet, but that doesn’t matter as much as the fact that a child might live in a house with mold or a family that can’t a ord healthy food.

Children’s Hospital Colorado, for example, opened a social wellness center, including a food pantry lled with fresh vegetables and meat, in its child health pavilion three years ago.

Patients are referred to the center based on their answers to questionnaires given during medical appointments. “In the last 12 months, did you ever worry that your food would run out before you had money to buy more?” they ask.

Since Medicaid does not reimburse for the work, the program has relied on grants, donations and operational funds from the hospital. Under the new plan, Medicaid would reimburse hospitals and clinics for the social wellness work, but not for the costs of food, some of which is grown in the hospital’s garden.

Public health experts hope that it’s one day nancially feasible for even small doctors’ o ces to have a community health worker on sta . e Colorado Cancer Screening Program, within the University of Colorado Cancer Center, learned years ago that patient navigators could make a huge impact in getting medically underserved people to screening appointments. e no-show rate at one safety net clinic dropped to 10% from 75% in one year after navigators began working with patients in their native languages, and o ering to pay for transportation to screenings, prescriptions or child care. Prior to the extra help, Medicaid patients were not showing up for appointments or showing up without following the instructions, including fasting or taking the bowel-preparation medicine before a colonoscopy.

Andi Dwyer, director of patient navigation at the screening program, called this year’s legislation a “gamechanger.”

“If this was a pill or device, we would have probably seen payment for this 10 years ago,” she said.

Salud Family Health Centers, a nonpro t that has 13 clinics in Colorado that provide medical, dental and mental health services, has wanted Medicaid to reimburse for community health work for at least 10 years. Salud focuses on lowincome and medically underserved people, including migrant and seasonal farm workers, and employs a few “care managers” who work with patients who require the most hospitalizations.

Medicaid funding would allow Salud to hire more care managers to help a broader group of patients, said Jen Morse, Salud’s vice president of development. Finally, health care policy is catching up with research that shows how health outcomes are improved when providers

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