The Salud Family Health Estes Park Clinic faces financial problems that threaten the clinic’s future, according to its president and CEO John Santistevan.
His comments came during an interview with the Estes Valley Voice Tuesday following a roundtable held last week that highlighted the community health center’s work to provide integrated medical, dental, and behavioral health care to medically underserved and economically vulnerable populations in the Estes Valley.
Olivia Smith, a constituent advocate from the Ft. Collins’ office of Rep. Joe Neguse and Travis Machalek, the Estes Park Town Administrator, attended the roundtable to learn about the clinic’s services and the financial challenge community health centers are experiencing.
The Salud Clinic system, which includes 13 clinics in 10 communities throughout the state in addition to a mobile unit that brings healthcare to migrant and seasonal farmworkers and refugee populations, expects a revenue loss of $14 million this year, said Santistevan.
“You know, 14 million is not a hole. It’s a crevice,” said Santistevan. According to Santistevan the Estes Salud clinic is set to lose $1 million this year.
Santistevan identified three factors affecting the Salud clinic finances:
- Federal funding for the nation’s 1,400 Community Health Centers–including 21 centers in Colorado–has not kept pace with inflation.
- The large number of people who have been dropped from the Medicaid rolls means a loss of $6.5 million in revenue to Salud.
- And, $9 million in bonds are coming due and Salud is not in a strong financial position to refinance the bonds.
“As I’ve described this, is there any light at the end of the tunnel? And I’ve been saying this for a year and a half, and there hasn’t been any light yet,” said Santistevan who has been with Salud for 27 years. “Can I maintain this clinic for six months? Twelve months? Yeah, potentially. But if there’s no light at the end of the tunnel, then I’m weakening the organization going forward.”
Under the Public Health Emergency Medicaid “continuous coverage requirement” the number of people who became eligible for Medicaid and the Children’s Health Insurance Program (CHIP, which is known as CHP+ in Colorado) during the public health crisis expanded from 70,685,207 million in January 2020 to 93,876,834 million in March 2023, an increase of 23 million enrollees, according to data from the Centers for Medicare and Medicaid Services.
The “continuous coverage requirement” allowed people to keep their health coverage during the public health crisis without having to go through an annual renewal process, but that changed on March 31, 2023.
Many of the disenrollments are “procedural,” a process that may occur when an individual does not receive a renewal notice because they are homeless, or they have moved, or they no longer have access to the contact phone number or email address they used when they became eligible.
Some procedural disenrollments occur because a person had a communication barrier and did not understand the necessary steps, they needed to take to stay enrolled.
Procedural disenrollments have also happened when Medicaid eligibility workers have been unable to process the necessary documents that someone has submitted before their renewal case is automatically closed.
Other disenrollments have occurred because an individual no longer meets the economic guidelines even though they may still have a low income. To be eligible for Medicaid in Colorado, an individual cannot exceed an annual income of more than $20,783 or 138% of the Federal Poverty Line (FPL). For a family of four, the household income cannot exceed $43,056 per year or 138% of the FPL.
From March 31, 2023, to August 1, 2024, nearly 25 million people nationwide have been “disenrolled” in what is called the “Medicaid Unwind.”
In Colorado, the number of people enrolled in the state’s Medicaid program during June 2024 was 1,165,256 million, or 20% of the state’s population of 5.9 million, a decrease of 604,186 from March of 2023 when there were 1,769,442 people receiving Medicaid in the state.
The roundtable meeting called to mark national Community Health Center week
Doug Frisbie, the president of the Estes Park Salud Foundation and Jack Boatman, a Salud volunteer and a member of the Salud Foundation board of directors, participated in the discussion along with several staff members, including physician assistant Viktoriya Street, PA, dental assistant Denise Liken, behavioral health practitioner MeeMee Lahman, MFTC, MA, LPC; Tanya Trujillo, center operations director, medical records manager Paula Vasquez, Jennifer Morse, VP of Development and Elva Median, VP of Operations.
Morse began the meeting by saying that the Estes Park Salud clinic is a “small but mighty clinic” that served 2,109 patients in 2023 totaling almost 6,600 patient visits, including 4,000 medical appointments, 1,300 dental visits, and 1,300 behavioral health appointments. “For a town that has almost 6,000 residents, serving 2,000 of them is very good,” Morse said.
According to Lahman, many of the behavioral health appointments are done via telehealth which has allowed patients who lack transportation or who might otherwise never seek counseling to have access to care.
Morse provided background about the role of Community Health Centers—or Federally Qualified Health Clinics (FQHC) —in the U.S. and some history of the Salud clinics.
In 1944, Congress unanimously passed the Public Health Services Act which broadened the federal government’s ability to provide public health services. Section 330 of the law established the Health Center Program which funds organizations that offer primary healthcare to low-income, medically underserved populations including people without housing, and migrant and seasonal workers. Today one in 10 people receive their health care from Community Health Centers.
Salud is a registered 501(c)3, and one of the requirements to being a designated FQHC is that the organization’s board of directors is made up of people served by the clinic.
Salud and the Estes Park Clinic
Originally named Plan de Salud del Valle, meaning “the health plan of the valley” in reference to the Platte River Valley, the first Salud clinic began in 1970 in Ft. Lupton to serve migrant agricultural workers.
Over the past five decades Salud has expanded to operate 13 clinics, 10 school sites, and one remote unit that provide integrated family medical, dental, pharmacy and behavioral health care services to more than 67,000 patients a year through more than 279,000 visits. In addition, the clinic provides pharmacy services through the Public Health Service Act 340B Drug Pricing Program that requires drug manufacturers to sell outpatient drugs at a discount to eligible health care organizations.
The Estes Park Salud Clinic first opened in 1992 in a tiny 750 square foot space in the old Range Realty building at 304 E. Elkhorn.
According to Frisbie, the Estes Park Medical Center advocated for the clinic because too many people without insurance and lacked access to primary care were overutilizing the hospital’s emergency room for preventative care. “If Salud were not here, we would be back in the same boat,” said Frisbie.
Five years after the clinic opened, the Estes Park Salud Foundation–the only clinic in the Salud system that has its own foundation– was formed “to educate the community about Salud and to raise funds to support the health center” and to “reduce disparities in health care between insured and uninsured in the Estes Valley.”
The clinic outgrew its space and in 1998 it relocated to 541 Big Thompson, in the Lower Stanley Village. The clinic again outgrew its location, and it moved to a larger space at the Aspenwood Professional Center on Graves Avenue.
Then, after three locations in 15 years, Salud moved to its current location at 1950 Redtail Hawk Dr. in January 2007. The move was made possible by the gift of land by Paul and Kathy Kochevar and by a $1.9 million Quality Healthcare for Everyone capital campaign.
The exterior of the 11,000 square foot building was designed by Roger Thorp of Thorp Associates and the interior was designed by Thomas Beck of TW Beck Architects. In 2015 the clinic “expanded” by finishing off 4,300 square feet of unfinished space.
Over the past nine years, the clinic has done some necessary updating, acquired new pieces of medical equipment, and part of its lower level has been leased to SummitStone, the largest provider of behavioral healthcare services for Medicaid clients in Larimer County.
Financial challenges
Most patients seen at Salud are on Medicaid– known as Health First Colorado–some are on Medicare, and some have Colorado’s Child Health Plan Plus insurance, known as CHP+, said Morse.
The Medicaid disenrollment process has significantly affected Salud’s bottom line according to both Morse and Santistevan. Before COVID, 52% of Salud patients received Medicaid. During the height of the public health emergency that rose to 55%. Now only 42% of Salud patients are eligible because “Each of those percentage points represents a half a million dollars for Salud of lost revenue,” Morse told the meeting participants. “Right now we’re looking at our biggest financial losses we’ve experienced as a system since day one in 1970. It’s a very much of an emergency situation for us,” said Morse.
High disenrollment rates not only mean a loss in revenue, but many people who no longer have insurance are choosing to not seek primary care which then can lead to more expensive medical expenses down the road, said Santistevan.
Many people who have been disenrolled are still eligible for Medicaid, but they have to go through hoops to access what they are already qualified and entitled to receive, said Morse.
Federal grant funding for Community Health Centers has not kept up with inflation, Morse told the meeting participants. “We are really down to the penny in our budgeting and there are some external pressures that are affecting us in a way that is really threatening access to be quite frank,” she said.
The Estes Park Salud Foundation
The Estes Park Salud Foundation, which is funded by grants and donations, helps to underwrite the costs of medical, dental, behavioral health, and lab work on a sliding scale for income-eligible patients who do not have insurance, but it does not provide enough money to close the clinic’s financial gap.
According to its 2023 IRS 990 filing, the Estes Park Salud foundation received $179,834 in grants and contributions and had $12,314 in investment income. The foundation provided $98,902 in financial assistance for individuals who do not meet federal or state insurance guidelines.
Frisbie said the Foundation’s expenditures in 2023 were low because not as many people received dental care coming out of COVID and dental care is one of the most expensive types of care provided by the clinic.
Frisbie expects the number of dental appointments to increase during 2024. The Foundation also wanted to reserve some funds knowing the difficulties Community Health Centers have been having across the board.
Individuals wishing to make an appointment for care should contact the clinic for the following services:
Medical: 970-586-9230: 7:30 a.m. to 5 p.m. Monday through Friday
Dental: 8 a.m. to 5 p.m. Monday through Friday
Pharmacy: 720-322-9445 7:30 a.m. through 5 p.m., Monday through Friday
Telehealth Services: available until 8 p.m., Monday-Friday
Closed: 8 a.m. to 9 a.m. on the 1st and 3rd Wednesdays of the month
Click here to support the Estes Park Salud Foundation with a financial gift.
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