Denver Health recorded its strongest financial results in years in 2025, though its leader says one good year isn’t enough to cushion the region’s safety-net hospital from coming state and federal cuts.
In 2022, Denver Health was on the ropes, losing $35 million. Emergency state funds and donations from other health systems helped offset some of the losses in 2023, and city voters agreed to add a .34% sales tax in 2024, raising about $65 million to pay for uncompensated care and to expand services that aren’t money-makers.
At about the same time that Denver Health reached its lowest point, two of Colorado’s rural hospitals were also publicly struggling: Delta Health on the Western Slope and St. Vincent Health in Leadville. Both are doing better financially, but expect more challenges from the upcoming combination of changes to Medicaid.
Denver Health earned $49 million in 2025, for a roughly 3% margin. For many hospitals, a 3% profit would indicate a tough year, but for a safety-net hospital, any year that ends with a little bit extra to invest in services and take care of deferred maintenance is a good one, CEO Donna Lynne said.
Much of the improvement came from the new sales tax, she said.
Full information on hospital profits won’t be available for a few months, but expenses continued to grow faster than revenues for the industry as a whole, which likely cut into profit margins overall, said Tom Rennell, senior vice president of financial policy and data analytics at the Colorado Hospital Association.
Hospitals have had to staff up to handle increasing numbers of inpatients, and tariffs have pushed up the cost of supplies, he said.
“There’s just a lot of pressure on expenses,” Rennell said. “On the revenue side of things, nothing is getting better at all.”
If current trends continued, Denver Health would likely see similar results in 2026. Instead, Colorado will reduce Medicaid rates to most providers by 2% in the fiscal year starting in July, lowering the system’s revenue by about $15 million, Lynne said.
Lawmakers faced a $1.5 billion budget gap for the fiscal year starting next month and few options to close it without cutting Medicaid.
Almost half of Denver Health’s patients are covered by Medicaid, and it has fewer patients with relatively generous commercial insurance coverage to make up for the shortfall.
“It really hurts Denver Health more than it hurts anyone in the state,” Lynne said. “To do (cuts) across the board may have been expeditious, but it’s not fair.”
Other changes are coming at the federal level.
Starting in October, most legal immigrants without green cards will no longer qualify for Medicaid, which will likely leave at least 1,000 Denver Health patients without insurance, Lynne said. Work requirements under H.R. 1, known as the “big beautiful bill,” kick in Jan. 1, and state provider fee rates must drop starting in October 2027.
Colorado collects the fee from most hospitals, uses it to draw down a federal match, and then divides most of that money between covering the state’s 10% share of Medicaid expansion costs and compensating hospitals that see large numbers of Medicaid patients. The state hasn’t said how it plans to handle the mandated reductions to the provider fee, which makes it difficult to project how much hospitals might lose, Rennell said.
Lynne said she isn’t expecting an immediate surge in uninsured patients when the work requirements kick in, because federal officials allow states to take Medicaid recipients’ word that they met the requirement or qualified for an exemption in the first year.
Over the next five years, though, Denver Health expects about 20,000 patients will lose coverage, meaning they’ll likely only come in when their conditions are out of control, and they need expensive care — a situation that doesn’t benefit anybody, she said.
“I think every hospital in the state is looking at, ‘ Do I have enough (emergency department) staff,'” she said.
At the same time, Denver Health will need to spend more to assist patients with renewing their coverage every six months, and a separate change in the law means the system is less likely to get paid in full for treatment it provided to eligible patients who weren’t yet enrolled in Medicaid, Lynne said.
Overall, Denver Health projects losing about $65 million when H.R. 1 fully rolls out — roughly the same amount the sales tax brings in, she said.
Other hospitals that struggled in recent years also expect financial challenges, but said they’re better positioned to handle them than they were.
Bubba Bartlett, CEO of St. Vincent Health, said 2025 results aren’t finalized yet, but preliminary figures showed the hospital came out ahead by about $1.2 million.
At the end of 2022, Lake County had to make an emergency grant to help the hospital cover payroll. Since then, it has become more efficient and focused on growing the services that are most important locally, and appears to be on track for a similar profit in 2026, Bartlett said.
The number of uninsured patients likely will increase as changes to Medicaid roll out, but much depends on decisions the federal government makes about timelines and policies, he said.
“Like many rural healthcare providers, we are closely monitoring potential changes that could affect reimbursement, insurance coverage, and patient access to care,” Bartlett said in an email.
Delta Health had a tougher 2025, losing about $5 million, but appears to have finally turned the corner, with about a $500,000 profit in the first four months of this year, interim CEO Nicholas Colleran said.
The system saved money by not replacing administrators as they retired and by closing its labor and delivery unit, and is exploring whether it can share back office services with other small hospitals, he said.
Delta Health will face the same challenges as other hospitals, including increased uncompensated care and the need to hire another person to help patients get and maintain Medicaid coverage, Colleran said. But the bigger impact for them is that they’ll have a harder time qualifying for discounted prescription drugs, which are an important subsidy, he said.
The federal 340B program allows certain hospitals to buy medications at reduced costs and sell them at the typical price, keeping the difference. Whether hospitals qualify depends on the share of their inpatients covered by Medicaid, which varies more from year to year for a small facility like Delta Health than a bigger safety net hospital, Colleran said.
If people lose Medicaid coverage, that reduces the odds Delta Health will have enough covered stays to qualify, costing it $3 million to $4 million a year, he said.
Colleran said he hasn’t flagged any other services to possibly close, but can’t rule it out if the hospital is in the red in the coming years. Likewise, while he hopes the hospital remains independent, the most important thing is to keep it open and offering core services, he said.
“You are fighting every day (as a rural hospital) to stay open, not to get ahead,” he said.
