In 2009, high unemployment greatly increased enrollment in Medicaid. In turn, the swelling numbers of uninsured placed unprecedented financial pressures on the already insufficient number of providers who serve them. Although some Federally Qualified Health Centers (FQHCs) received federal American Recovery and Reinvestment Act (ARRA) funds, this money often is earmarked for capital projects and cannot be used to offset operational expenses. Indeed, some Colorado community health centers closed as a result of the economic downturn.

In rural areas, in particular, health care providers are caught between a reduction of privately insured patients and cuts to reimbursement rates for their publicly insured patients. However, Medicaid expansion may well bring some relief to these providers and to safety-net providers that accept both uninsured and Medicaid individuals, such as FQHCs, rural health centers and public hospitals.

To increase the availability of care, The Colorado Trust is supporting several strategies, including:

• Managed by the Colorado Rural Health Center, the Colorado Health Professions Workforce Policy Collaborative brings together policy leaders, health care providers, educational institutions, and economic development and workforce planning authorities to collectively establish a strategic public policy framework for Colorado. This framework is intended to advance health professions' workforce priorities to alleviate provider shortages and strengthen the health care system. Among the initial policy recommendations the Collaborative put forth to state policy leaders were to strengthen the scopes of practice for Advanced Nurse Practitioners, Physicians Assistants and Dental Hygienists; increase clinical placements and preceptor training; increase funding for health professions education; and expand loan repayment opportunities.
• ClinicNET, a coalition of Colorado safety-net clinics and programs that are not designated as FQHCs, is working to build the administrative and service capacity of these clinics in order to secure additional public funding. Such additional support is critical as non-FQHCs are not eligible for dollars through ARRA and rely heavily on grant funding and volunteers. Yet in many parts of the state, these clinics are the only option for care that is available to low-income working families.
• The Colorado Area Health Education Centers (AHECs) and the University of Colorado Denver Health Sciences Center are working to encourage rural and underserved high school students to explore health profession careers. The AHECs are also administering a health care scholars program to graduate students in health professions education and training who opt to practice in rural or other underserved sites. Most significantly, this grant developed and continues to support a multidisciplinary curriculum and training program for rural track health professions students.
• Fourteen diverse organizations are Expanding Children's Access to Care by increasing the number of health care providers available to tend to the immediate needs of publicly insured and uninsured children. Situated across the state, the grantees include community clinics, FQHCs, school-based health centers and local public health departments. Over a three-year period, these organizations anticipate being able to care for an additional 18,000 children.
• Similarly, the Rocky Mountain Youth Clinics is bringing consistent primary, mental and dental health care to children in their communities – particularly for families that have difficulty accessing health care through the traditional system – through clinics, mobile health care vans that serve rural and metro-area counties, and by establishing and servicing new school-based health centers.
• Colorado's Early Childhood Councils are better connecting children and families to resources and quality services in early care and education, health, mental health and family support. To improve health outcomes for Colorado children, The Trust supports the Councils in more effectively integrating health and health care into their efforts.

LOOKING AHEAD, The Colorado Trust is supporting strategies to:

• Strengthen the health professions workforce through policy advancements
• Research future workforce needs to support emerging models of care, such as medical homes
• Expand the ability of health care delivery sites to treat more uninsured and publicly insured Coloradans
• Explore means to ensure adequate reimbursement of primary care providers.

See a list of all grantees receiving support from The Colorado Trust to Increase Availability of Care.