The Colorado Healthcare Affordability and Sustainability Enterprise (CHASE) is a government-owned business (enterprise) that operates within the Colorado Department of Health Care Policy and Financing (HCPF). It is charged with strengthening hospitals’ ability to provide care for low-income and uninsured Coloradans. The CHASE achieves these aims by distributing funds to those hospitals that provide care for Health First Colorado and CHP+ patients as well as growing enrollment in these and additional coverage options for low-income Coloradans. For a full list of CHASE’s activities see SB17-267 Section 17 25.5.4.402-4.
HCPF recently published its annual report on the CHASE’s work, which highlights concerning dynamics between hospital payments and attention to coverage for Coloradans. Corresponding with other projections, the 2026 report reaffirms an increasing number of Coloradans are losing their Medicaid coverage. In FY24-25, CHASE provided Health First CO and CHP+ coverage to 438,453 Coloradans. This represents a 16% reduction from the previous fiscal year. Reduction in Medicaid enrollment is not only concerning from a patient perspective, but also threatens the bottom line for hospitals. In contrast to uninsured patients, hospitals can still bill for Medicaid care. In the latter case, they receive some reimbursement for services vs none at all for uninsured care. It is in both patients’ and hospitals’ interests to strengthen health coverage enrollment.
While decreasing Medicaid expansion coverage, CHASE increased reimbursement to hospital providers by $483 million for a total of $1.9 billion in supplemental payments to support the cost of Medicaid services and care. CHASE also decreased hospitals’ required contributions to its fund while increasing federally contributed dollars, again freeing up more money for investment in long-term sustainability initiatives. Reimbursement to providers will not stabilize our state health care system and only helps hospitals in the short term. Focusing on expanding covered lives helps consumers, hospitals, and the sustainability of our health care system at large.
Trends in this report also raise concerns for private payers. Privately insured Coloradans are often charged more so that hospitals can use commercial payments to offset the costs of uninsured patients. Indeed, the cost ratio for private payers was the highest in FY24-35 at 1.65, and hospitals made an average profit of $14,883 per private payer. We fear a further drop-off in Medicaid enrollment will raise private payer costs, leaving more Coloradans struggling with cost burdens beyond just those eligible for Medicaid care.
Despite reduction in Medicaid enrollment, an increase in uninsured patients, and impending reductions to federal support for health care expenses, Colorado hospitals made an average profit of nearly $100 off every patient they served. This is an increase of 900% from the previous year in which Colorado hospitals made an average of $11 in profits off every patient. Most hospitals in our state are not-for-profit tax-exempt institutions. While financial sustainability is vital, we strongly question this profit margin that rests on the backs of consumers who repeatedly cite concerns about not being able to pay for needed health care services.
In 2026, Colorado is facing another year of state-level budget cuts for which Medicaid is on the table. Our state is also preparing for further waves of federal attacks on health care that are expected to churn up to 190,000 people off coverage by 2034. As hospitals themselves have repeatedly said, a reduction in Health First and CHP+ coverage WILL threaten the financial sustainability of our health care system. Now more than ever, CHASE must prioritize protecting and increasing enrollment in health care coverage versus shortsightedly lining the pockets of hospitals.
The CHASE 2026 report is just one of many reports HCPF publishes every year. As demonstrated above, these transparency measures are essential for ensuring implementation continues to align with the intent of policy. CCHI will continue to uplift findings from these reports and encourage others to do so as well.
The Colorado Hospital Association has challenged the methodology of the CHASE 2026 Report. We are using the best available data at this time.
1) In 2024, all payers saw an increase in patient volume except Health First Colorado, which saw a decrease of 4.4%.
2) “In SFY 2023-24, CHASE collected $1,310,113,321 in fees from hospitals, which, with federal matching funds, funded 9 Health First Colorado and CHP+ health coverage expansions for 521,678 Coloradans, payments to hospitals, and the CHASE’s administrative expenses.” CHASE 2025 Report Page 24
3) Collected $1,307,736,605 in CHASE fee (vs $1,310,113,321 in 23-34)