On Aug. 11, Karen Reinertson, executive director of the Colorado Department of Health Care Policy and Financing, sent a letter to the U.S. Centers for Medicare/Medicaid Services notifying them of the cuts. As a result, low-income pregnant women in Colorado will no longer receive temporary health coverage while they wait to see if their applications for federal Medicaid will be accepted. The waiting time, in many cases, is months.
Reinertson notified the feds of her decision two days before the Medical Services Board -- which advises the Colorado Department of Health Care Policy and Financing -- held a public meeting about the program. The timing has spawned confusion regarding the role and effectiveness of the 11-member governor-appointed advisory board.
"This definitely calls into question what the Medical Services Board is and how the department works outside it to implement what it wants," said Elena Thomas-Faulkner, a policy director for Colorado Community Health Network, which represents health centers across the state.
The Aug. 13 full-day public hearing went on as scheduled, with Thomas-Faulkner, along with others, including board members, unaware that the executive director had already cut the program.
Ultimately, with three members absent and another abstaining, the board voted 4-3 to eliminate the aid -- two votes short of the supermajority six needed.
The role of the board
Board Vice President Steve Tool said he was unclear why the board wasn't notified of the change until after it held its vote.
"That's probably a good question," Tool said. "[Reinertson] probably wanted the support of the board."
The agency director was unavailable for comment early this week. But spokeswoman Rhonda Bentz defended the decision, saying that a 1991 state law had mandated the cuts to "presumptive" prenatal care programs for pregnant women applying for Medicaid. The law, she said, was never adhered to.
However, Sen. Deanna Hanna, D-Lakewood, a retired school nurse, said that since the program was in place for so long and because it is important to so many women, seeking public input though the Medical Services Board was crucial.
"I think this raises questions about the role of the board and public participation," Hanna said.
Bentz said the department hasn't yet calculated how much eliminating the program will save the state. However, it could easily be in the millions of dollars, she said.
Yet the department's tight budget is not why the state chose to make the change, Bentz said. In addition to adhering to the 1991 law, the cuts were necessary because nearly half the applicants failed to meet the guidelines to receive Medicaid -- 6,000 of them illegal immigrants who can't qualify for regular Medicaid, she said.
Unless federal officials intervene, the cuts will go into effect on Sept. 1.
In Colorado Springs, health-care providers are predicting dire consequences.
"It will have a dramatic effect on the Medicaid population," said Bert Hayes-Davis, a spokesman for Peak Vista Community Health Centers. "Suddenly you'll see women with problem pregnancies down the road."
Each month, about 108 pregnant women apply for Medicaid through the Colorado Springs health-care center that serves low-income patients, waiting up to three months to find out if they've qualified.
The presumptive eligibility acted as a safety net, getting women into critical health screenings and tests and providing professional advice before their pregnancies progressed to the second or third trimester, Hayes-Davis said.
Because of the cut, Memorial Hospital anticipates a rise in expensive emergency-room treatment for pregnant women without insurance. Hospital emergency rooms by law cannot turn patients away if they ask for care.
The municipal hospital is already writing off $55 million of uncompensated costs associated with the care of uninsured and underinsured patients every year, spokesman Chris Valentine said.
-- Michael de Yoanna