But Rural Hospitals Demand Legislative Intervention
Two weeks after the High Country Advocate reported that eight years of Polis policies could cost rural Colorado $500 million in Trump administration healthcare funding, the Centers for Medicare and Medicaid Services announced Colorado would receive $200 million for year one — $100 million above the guaranteed baseline. Governor Jared Polis celebrated. Kim Bimestefer, executive director of the Department of Health Care Policy and Financing, said Colorado should “do cartwheels.”
The same day the HCA article published, the Colorado Hospital Association sent a letter to the General Assembly telling a different story. CHA President Jeff Tieman accused Bimestefer’s department of excluding rural providers from the application process, breaking promises about advisory committee participation, and advancing proposals rural hospitals “actively oppose and believe will harm the communities they serve.”
Tieman demanded legislative intervention. Bimestefer’s team submitted Colorado’s $1 billion application on November 4 without showing rural hospital leaders the contents until after it was filed. Then a post-submission FAQ stated that providers receiving RHTP funding would be prohibited from serving on the Advisory Committee — directly contradicting commitments the state made to CMS in the application itself. The providers the money is supposed to help have no seat at the table.
The application promised an Advisory Committee including rural hospitals with substantive responsibilities: reviewing program progress, guiding policy alignment, advising on priorities, overseeing funding distribution. Bimestefer’s department reversed that after submission.
Tieman identified the core threat: “regionalization.” Colorado’s application proposes up to 12 regional collaboratives and calls for “right-sizing” services. That means certain hospitals would be forced to discontinue service lines and direct patients to a designated facility within their region. Rural hospitals didn’t propose this. Bimestefer’s agency did. Tieman wrote that the concept “fails to account for travel distances, weather and transportation barriers, financial vulnerability, or the essential role of local access in rural health outcomes.”
The application also commits RHTP dollars to Colorado’s Hospital Transformation Program, which ties Medicaid payments to quality metrics. Tieman called HTP “flawed” and “widely viewed as ineffective,” noting it imposes substantial administrative burden on financially fragile hospitals without meaningfully improving quality. Rather than fix HTP’s problems, Bimestefer is using RHTP money as leverage to compel participation.
CMS announced awards December 29. Colorado’s $200,105,604 ranks 26th nationally. The state expects more than $1 billion through 2030.
The celebration obscures ongoing risk. CMS Administrator Mehmet Oz announced his agency will re-score states annually and claw back money if states fail to follow through on proposed initiatives. Half the competitive funding nationally — $12 billion over five years — is tied to Make America Healthy Again priorities including SNAP restrictions on junk food. Arkansas, Iowa, Louisiana, Nebraska, Oklahoma, and Texas have already adopted those restrictions. Colorado has not.
Even if Colorado receives the full $1 billion, the math doesn’t work. The Colorado Hospital Association calculates that Medicaid cuts will cost Colorado hospitals $10.4 billion by 2032. Michelle Mills, CEO of the Colorado Rural Health Center, put it plainly: “This in no way is going to cover the Medicaid cuts.”
While rural hospitals operated in the red, the Polis administration spent up to $21,000 per vehicle on EV subsidies and $150-200 million annually on healthcare for undocumented immigrants. Only when Trump offered federal money did Colorado produce a plan for rural healthcare — and the plan excludes the providers who deliver that care from any governance role.
HCPF is requesting stakeholder feedback on governance by January 7. The cooperative agreement with CMS is still being negotiated. Tieman made the stakes clear: “Absent legislative direction, there is no meaningful mechanism to ensure that RHTP implementation aligns with statutory intent, federal commitments, or the real-world needs of rural health care providers.”
The General Assembly convenes in January. Rural Colorado’s hospitals are asking lawmakers to intervene before Bimestefer locks them into a plan they didn’t write and actively oppose. Whether legislators act will determine if this $200 million helps the 800,000 Coloradans it’s supposed to serve — or becomes another Denver bureaucracy imposing its priorities on communities that never asked.
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