The , or HCPF, which oversees Medicaid, presented a series of eye-popping numbers about the program, which covers more than 1 in 5 residents, to the legislature’s during a Thursday meeting.

HCPF overspent by $157.9 million during the 2025-26 fiscal year, which ended June 30. And officials said the Medicaid program was projected to go $443 million over budget by the end of the current fiscal year in mid-2027.

That represents a sliver of HCPF’s $20.5 billion total budget for this year, about $6 billion of which will come from the state’s general fund. Still, the overspending poses a challenge to lawmakers who already cut millions in Medicaid services this past legislative session.

Lawmakers on the legislature’s Medicaid commission, which was formed earlier this year to probe the department����ap spending and come up with solutions for reining in costs, were aghast at the numbers presented.

“That����ap unacceptable,” said state Sen. Kyle Mullica, a Thornton Democrat.

Compounding factors are contributing to the spending crisis, including rising prescription drug costs and more demand for expensive long-term care, as well as state revenue limits. The legislature has also played a role by passing laws in recent years that have increased or expanded benefits and eligibility.

But health department officials acknowledged that administrative oversights have also contributed to spending overruns, exemplified by recurring multimillion-dollar payment errors.

“The department wants to clearly and boldly take accountability for the cost growth” in both the last fiscal year and in the current year’s projection, said Gretchen Hammer, who took over as HCPF’s executive director in April. Gov. Jared Polis appointed her after the department����ap longtime head, Kim Bimestefer , resigned after nearly every state lawmaker pushed for her removal.

Mullica said that while he appreciated the department����ap transparency, he was frustrated by budget numbers that are confusing and don’t always appear to add up.

State officials said budget forecasts, which are typically based on incomplete data and aren’t fully accurate, had contributed to discrepancies.

‘Significant and dire’

After years of holding steady, Colorado’s Medicaid spending ballooned during the COVID-19 pandemic and has only continued to increase since. Spending on Medicaid within the state’s general fund has now eclipsed K-12 education, which had long been the fund’s single largest cost driver.

Medicaid now accounts for roughly a third of the state’s general fund spending, though the bulk of the program’s funding comes from federal dollars.

General funding spending on Medicaid has increased at nearly double the rate of the rest of state services, even as enrollment has decreased since the height of the pandemic, when Medicaid eligibility was temporarily expanded.

Mark Ferrandino, who leads Polis’ Office of State Planning and Budgeting, noted that Colorado was not an outlier, as many other states have seen their Medicaid costs rise post-COVID. Still, Colorado’s rate of increase has been among the highest of any state, he said.

Without further action to curb Medicaid costs, Ferrandino painted a bleak future budget picture for lawmakers, one in which the state remains mired in chronic $1 billion shortfalls that have already battered the legislature for the past two years. Ferrandino warned that, left unchecked, rising Medicaid spending risks boxing out funding for almost all other government services.

Lawmakers this year passed a suite of cuts to Medicaid for the 2026-27 fiscal year to balance the budget. Those included ending automatic enrollment in adult services for children with severe intellectual or developmental disabilities and limits to billable caregiver hours.

The state will need further spending reductions to ward off the $443 million Medicaid budget overrun that is already projected for the end of the current fiscal year.

“The problems that we are facing are significant and dire,” said Rep. Kyle Brown, a Louisville Democrat. “We are once again faced with trying to, in some cases, choose the best-worst option, or the least-worst option. And that����ap not what I signed up for when I ran for office.”

Trying to avoid broad cuts

Lawmakers said they wanted to do all they could to avoid broad cuts to the healthcare services that many Colorado residents rely on.

State Sen. Barb Kirkmeyer, a Brighton Republican, said the fiscal projections for legislation enacted by the General Assembly to expand Medicaid need to be more heavily scrutinized.

She gave the example of the , which was passed by Democrats in 2022 and took effect in 2025, extending Medicaid-like coverage to immigrant children and pregnant women, regardless of their immigration status.

The program was originally projected to cost the state roughly $14.7 million for the 2025-26 fiscal year. But the true cost was over $104.5 million — a more than 600% increase.

Lawmakers this year already cut the program, adding limits on benefits and enrollment, but Kirkmeyer added: “Maybe those are some of the programs we should be looking at, not just cuts to provider rates.”

State Sen. Judy Amabile, a Boulder Democrat, said she did not want to focus cuts just on long-term services that primarily serve seniors and people with disabilities, even though those services are among the Medicaid programs where costs have increased the most.

“This is also our most vulnerable population,” she said. “I want for us to be taking a broader look at the entire Medicaid program, including administrative expenses. … We are hearing reports of abuse — I wouldn’t call it fraud — but what are we doing to look at that?”

Amabile also asked whether cuts approved by the legislature this year hadn’t had as big of a cost-saving effect as hoped.

Hammer, HCPF’s executive director, said many of those cuts just took effect when the new fiscal year started in July. She hopes those savings will materialize as the year continues and potentially reduce the estimated $443 million spending overrun, which she stressed is a preliminary estimate.

“I think it’s too early to say that the changes that were implemented starting July 1 are not yet effective, in part because we’re trying to do them safely and carefully,” she said.

Medicaid discussions are certain to shape the state’s budget decisions in the coming months as the Joint Budget Committee begins its work, ahead of the full legislature reconvening for its annual lawmaking session in January.

For more than a year, Durango physician Daniel Caplin billed , the state’s Medicaid program, for controlled substances he was not licensed to prescribe, according to the lawsuit filed earlier this month in Denver District Court.

Caplin owned and operated Colorado Addiction Treatment Services in Durango, where state regulators found seven violations in March 2022, the lawsuit stated. Violations included errors in data reporting; missing records, including patient consent forms, progress notes and treatment plans; and inaccurate counts of controlled substance medications, according to the lawsuit.

The clinic was placed on a 90-day probation and, when it failed to submit the required corrective action plan, lost its license in June 2022, according to the lawsuit. It was first licensed in May 2018.

But Caplin continued to treat patients and bill Health First Colorado after the clinic’s license expired, according to the lawsuit. Between June 2022 and November 2023, his clinic submitted 1,704 claims to the program totaling $374,240, the lawsuit alleges. Caplin “voluntarily dissolved” the clinic in December 2023.

State officials approving the claims were unaware that Caplin was unlicensed, the lawsuit alleges.

Colorado’s Medicaid program is funded by the state and federal government to provide health care to low-income individuals and people with disabilities.

“Fraud and abuse targeting Medicaid’s limited resources … prevents the State from providing essential healthcare services for the most vulnerable Coloradans,” the lawsuit stated.

A person who knowingly submits false or fraudulent claims for reimbursement can be liable for up to three times the amount and additional civil penalties under the Colorado Medicaid False Claims Act, according to the Colorado Attorney General’s Office.

“We allege that Dr. Caplin knew his clinic had lost the license needed to provide these services and continued billing Medicaid anyway,” Attorney General Phil Weiser said in a statement. “Providers who accept public funds have a responsibility to follow the law, and we will hold accountable those who defraud Colorado taxpayers.”

Judge Ericka Englert closed the courtroom following opening statements, preventing the public from hearing testimony by doctors who previously offered gender-affirming care. They had asked the court to allow them to testify anonymously, citing fears of threats.

Children’s halted puberty blockers and hormonal therapy for transgender youth in December, citing threats from the Trump administration to prevent any hospital offering that care from billing Medicaid for any services. The hospital, located in Aurora, does not perform gender-affirming surgeries on people under 18.

The families of four transgender girls sued Children’s shortly afterward, arguing the hospital’s ban amounted to discrimination based on gender identity, because it provided the same services to cisgender youth for other diagnoses.

The case reached the Colorado Supreme Court, which ordered Children’s in May to reinstate care. The hospital argued that it complied by lifting its ban, but its providers independently decided not to take the legal risk of offering that care. The plaintiffs countered that the court order wasn’t intended to just change a policy, but to make care accessible.

John McHugh, attorney for the suing families, said in court Thursday that if Children’s can get around state antidiscrimination laws by deferring decisions to its medical providers, it could also claim to be doing nothing wrong if a doctor was only willing to treat white patients.

He asked the court to fine Children’s $50,000 per day until the hospital resumes gender-affirming care.

“The duty to comply always lies with the hospital,” he said.

Elliot Peters, who represented Children’s, said the court order required the hospital to lift its prohibition on providing gender-affirming care, which it has done.

The hospital can’t force its doctors — who technically work for the University of Colorado’s School of Medicine — to offer certain types of care, particularly when they have well-founded fears of federal persecution, he said.

“Children’s Colorado has no say over care by providers it does not even employ,” he said.

The courtroom reopened to the public for the last hour of testimony, when two mothers of transgender children spoke about how their care halted. McHugh focused on their interactions with the hospital, which assigned them a provider after they initiated care for gender dysphoria, while Children’s legal team pointed to providers’ testimony that they made their own decisions.

One mother, testifying under the name Denise Doe, said her daughter’s provider seemed distressed to have to stop care, crying on a call with her. The provider testified Thursday that they decided on their own, but Doe said she remembered their conversation slightly differently.

“They said the decision was made in partnership, I guess, with their peers,” she said.

Stopping gender-affirming care has been a federal priority since President Donald Trump began his second term.

In July 2025, the U.S. Department of Justice issued a subpoena for patients’ records and doctors’ personnel files at Children’s, though that has remained on hold since a federal magistrate judge recommended throwing it out.

In December, U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. said that facilities and doctors who provide gender-affirming care could lose the right to bill Medicare and Medicaid — a massive financial blow.

So far, that provision hasn’t taken effect, but three hospitals have settled with the federal government over their transgender care programs, paying fines and, in at least one case, cutting ties with doctors who offered those services.

The hearing will continue Friday.

The Colorado Attorney General’s Office announced Wednesday that it had reached a after the Colorado Springs company allegedly billed for 123,990 extra lenses since March 2020. Hero DVO apparently didn’t double-bill for frames that would house the lenses.

“Hero DVO perpetrated a scheme designed to bill for unneeded lenses that were never provided to patients,” Attorney General Phil Weiser said in a news release. “Today’s action holds the company to account for its fraudulent conduct that harmed our state’s Medicaid program. We will continue to remain vigilant about protecting Colorado from fraudsters.”

In the settlement, Hero denied any wrongdoing. The company, which the AG’s office says provides vision services to underserved children, will repay the state in quarterly installments over four years. The first, worth $125,000, is due next week.

The settlement comes out to about $65 per lens. If Hero were to go into bankruptcy, Colorado could try to reclaim about $61 million, which is three times the maximum possible damages and the most the state could seek.

The attorneys general argued that when Congress created Medicaid and the Children’s Health Insurance Program, it left most decisions about which services to cover up to the states. The federal government and the states split the cost of covering low-income people through the programs, with Colorado responsible for roughly half of Medicaid costs.

HHS proposed a rule in December that wouldn’t allow federal funding to go toward puberty blockers, cross-sex hormones or certain surgeries for transgender people under 18 covered by Medicaid or under 19 covered by CHIP, known as Health First Colorado and Child Health Plan Plus, respectively.

That rule is .

Children who needed the same treatments for conditions other than gender dysphoria would continue to have them covered by Medicaid and CHIP. Gender dysphoria refers to distress when someone’s sense of their own gender doesn’t align with how the world sees them.

Studies have found that transgender children who receive puberty blockers have a than those who don’t.

“The Trump administration is once again singling out transgender youth, this time by trying to deny them access to medically necessary care simply because they rely on Medicaid,” Attorney General Phil Weiser said in a news release. “Parents, in consultation with trusted medical providers, know what is best for their children, not federal political appointees in Washington.”

Media representatives for HHS didn’t respond to a request that they comment on the lawsuit.

At about the same time it announced the rule, the department said it would cut hospitals and other providers out of Medicaid and Medicare if they provided gender-affirming care to minors.

The Trump administration has also to providers for patients’ information; excluded transgender people from military service; to stop providing gender-affirming care to inmates; and the same sex as someone’s original birth certificate.

Children’s Hospital Colorado and Denver Health stopped offering puberty blockers and cross-sex hormones to transgender children in January because of the risk to their funding.

Families of affected kids sued Children’s, which officially reinstated gender-affirming care in its scope of services following a court order, but none of the Aurora hospital’s providers are offering it. The hospital faces a contempt of court hearing to determine whether it complied with the judge’s ruling.

The rule requires states to either come up with funds to keep paying providers or to stop covering gender-affirming care, the lawsuit said. The Colorado Department of Health Care Policy and Financing said it doesn’t have the money or the legal authority to pay both the federal and state shares. At least one state, , has said it will make up the difference with its own funds.

The states filed the lawsuit, , on Wednesday in Massachusetts.

DeCamp, a professor of pediatrics at the in Aurora, may never know whether it would have worked after the ended her funding two years into a five-year project.

The federal agency makes grants to study . It then compiles the studies’ findings into guidance for all healthcare providers, such as recommendations on how to prevent patients from getting infections after surgery.

In mid-July, the agency canceled 117 grants in 32 states, , a nonprofit focused on research about healthcare delivery and costs.

In Colorado, five grants lost about $4 million in funding, after the federal government had already spent about $2.7 million on them. DeCamp’s $2.5 million project lost about $1.5 million.

Nationwide, the cancellations cut about $140.4 million, after spending about $123.8 million for the initial stages of the projects. In many cases, , effectively putting the studies on long-term pause before they formally ended.

The other canceled grants in Colorado studied how to integrate behavioral health screenings into pediatric primary care; make sure medically complex children are offered seasonal flu shots; link unhoused patients to resources when they visit emergency rooms; and support the workforce in community health centers.

Kids whose parents don’t speak English tend to have worse asthma control and are less likely to get help from a “navigator” than those in families without a language barrier, DeCamp said. (Navigators aren’t clinicians, but are trained to teach families how to use asthma medications and avoid environmental triggers.) She and others on the Anschutz campus designed a trial to determine if proactively connecting those families with a navigator who could speak their language could lead to fewer asthma attacks and emergency room visits.

“We really wanted to close that gap for” those kids, she said. “But we also wanted to save costs for Medicaid. An education session with a navigator is a lot cheaper than an emergency room visit.”

The Trump administration cancelled the research agency’s grants across the board, rather than focusing on politically disfavored topics such as vaccine research and health disparities, as it did when halting grants funded by the National Institutes of Health.

The form letters simply stated that the research doesn’t align with priorities such as studying patient safety and the use of health technology, even when the projects appear to meet those goals, said Dr. Aaron Carroll, president and CEO of .

Professional groups may file a lawsuit at the end of the federal fiscal year in October, but the easier route to reinstate the grants would be if Congress demands that the administration spend the money it appropriated, Carroll said. Even then, many of the studies couldn’t restart because their workers have moved on, he said.

Earlier this week, a group of 30 senators . Congress appropriated about $345 million for the research agency, but it has made only about $15 million in grants this year, and isn’t likely to make any more since .

The funding for the next year of the asthma trial was supposed to arrive in summer 2025. It didn’t come, but delays aren’t unusual, so the research team kept working for about three months, DeCamp said. They heard almost nothing from the federal agency for a year, until a form letter in mid-July said it wouldn’t renew the grant.

The Anschutz campus found a bit of funding to analyze the data she has so far, but it won’t be enough to draw conclusions strong enough to change healthcare practice or convince Medicaid to cover navigators’ services, DeCamp said. At most, it will suggest to future researchers that the question is worth taking up again, she said.

The team members found other work in the Anschutz campus or elsewhere, but DeCamp said she worries about damage to future research projects because participating families lost access to the navigators’ help and learned their efforts were for nothing.

“It was really confusing to tell participants, and I think we lost a lot of trust,” she said. “They felt like they were getting a handle on their kids’ asthma, and it was yanked away from them.”

The goes into understanding diseases and developing treatments, not making the best use of what already exists, Carroll said.

“The (National Institutes of Health) pretty much figures out whether a treatment works,” he said. “AHRQ figures out whether you get it, and if you get it, if it’s safe and you get it without a preventable error.”

Private funding isn’t a substitute, because most health companies have no reason to invest in safety research, Carroll said.

“The research is just going to stop,” he said. “There’s no product at the end of (a study researching) ‘How do we stop kids from getting unnecessary CT scans?'”

About 200,000 low-income Arkansans could see major changes to their health coverage next year after the Trump administration recently informed state officials it will not renew a key Medicaid agreement with the federal government.

The decision by federal officials, citing authority granted under President Donald Trump’s signature tax-and-spending law, suggests the GOP-led state’s predicament could foretell other repercussions in how states are allowed to run the program under federal waivers.

Nearly every state has at least one waiver to run its Medicaid program differently than required by federal law, such as allowing the use of private managed-care plans or expanding eligibility for mental health or long-term care services. Some Medicaid waivers have stretched decades, renewed by presidential administrations of both parties, effectively making the demonstration programs they created permanent.

Arkansas is one of a dozen states with a waiver expiring Dec. 31 that face the additional restrictions the Trump administration has placed on new or renewed waivers.

Though it has yet to finalize its decision, the federal Centers for Medicare & Medicaid Services said Arkansas’ 13-year-old waiver does not comply with new “budget neutrality” rules that take effect in January, said Gavin Lesnick, a spokesperson for the Arkansas Department of Human Services. The rules tighten a policy forbidding Medicaid waivers from increasing federal spending on the program beyond what it would have increased without the waiver.

The state is now seeking a two-year extension after hearing from CMS that its request for a five-year renewal would not be granted. If its Medicaid expansion waiver is not renewed, Arkansas officials have said they will continue offering expanded eligibility through existing Medicaid law, a change that could leave enrollees with access to fewer doctors and other health providers.

Rather than place more people in its traditional Medicaid program serving largely children, pregnant women, and disabled people, Arkansas obtained a waiver to buy Affordable Care Act marketplace policies from private insurers for adults covered by the Medicaid expansion. This “private option” gave enrollees greater choice of doctors and other health providers, because some doctors are more willing to see patients with private coverage, which generally pays more than regular Medicaid.

The move helped cut the state’s uninsured rate by nearly half, but it also ended up costing more than if beneficiaries were covered under Medicaid’s traditional, fee-for-service program.

Critics characterize the new waiver rules as part of a Trump administration effort to dramatically shrink Medicaid, the government program for those who are low-income or disabled, which grew rapidly under Presidents Barack Obama and Joe Biden.

“What we have here is a sneaky way to cut Medicaid expansion and the Medicaid program,” said Nicole Huberfeld, a professor of health law at Boston University.

Medicaid enrollees won’t know whom to blame if they lose coverage because the administration is using arcane regulatory processes to make the changes, Huberfeld said.

At issue are waivers granted by the government that allow states flexibility from existing Medicaid law in how they cover low-income residents, as long as the changes will not increase what Medicaid costs the federal government.

Pivoting from the long-standing practice of checking only retroactively whether states were keeping their budget promises, the Trump administration that it would not renew or approve any waivers unless CMS first certified that they would not increase costs to the federal government.

In its , the agency said the new waiver rules are expected to reduce federal spending.

“Characterizing enforcement of a statutory budget neutrality requirement as a cut misrepresents both the law and this guidance,” CMS spokesperson Timothy Foster said in an email to KFF Health News. The federal waivers are intended “to test innovative approaches to delivering care, not provide an open-ended mechanism for increasing federal spending.”

Other states with waivers expiring at the end of December include Georgia, which has added about 18,000 low-income people to Medicaid under its waiver, and California, which has used its waiver to including food and housing.

California and Georgia Medicaid officials told KFF Health News that they are still working with CMS in hopes of renewing their waivers. The loss of federal waiver approval could cause states to curtail benefits or eligibility expansions.

In Arkansas, it would mean redesigning the state’s Medicaid expansion program.

Arkansas’ initial waiver was granted in 2013, when its Democratic governor at the time worked with a Republican-controlled legislature to adopt a pioneering style of Medicaid expansion under the Affordable Care Act.

It was one of the first Southern states to expand Medicaid, granting coverage to many low-income residents. Forty states and Washington, D.C., have also fully expanded Medicaid to cover more low-income adults under the law also known as Obamacare.

The state’s Medicaid expansion enrollees were already facing a confusing time. Starting in January, they will need to prove they work or meet an exemption to be eligible for coverage under Trump’s law, the One Big Beautiful Bill Act. And one of the state program’s two private health insurers — Centene — announced in July that it was pulling out at the end of the year.

Sam Dubke, a spokesperson for Republican Arkansas Gov. Sarah Huckabee Sanders, told KFF Health News that the Sanders administration is trying to negotiate a temporary extension of its waiver “to ensure impacted Arkansans maintain access to quality, affordable healthcare during this transition period.”

“Looking ahead to the next legislative session, CMS has provided the state with an opportunity for bold, conservative healthcare reform, and the governor will work with her partners in the legislature to build a sustainable model that maintains the same high quality of care and saves taxpayer dollars,” Dubke said.

The Trump administration’s new restrictions on waivers, implemented under the same law that imposes work requirements as a condition of eligibility and reduces Medicaid spending by about $900 billion over a decade, could affect millions of enrollees and billions in spending. About a third of the almost $600 billion in federal spending on Medicaid and the Children’s Health Insurance Program in 2024 supported programs created by waivers, according to CMS.

In a , the Government Accountability Office found that the three-year spending limit the federal government approved for Arkansas’ Medicaid waiver was nearly $800 million more than what the state would have spent through its traditional Medicaid program.

Arkansas is one of several states that expanded Medicaid under the ACA using a waiver, with others including Indiana, Michigan, New Hampshire, and Iowa.

States will have to clear several more bureaucratic hurdles to retain waivers under the new CMS guidance, said Alice Lam, a managing director with consulting and legal firm Manatt. That could lead to fewer benefits or reduce the number of people eligible for Medicaid, she said.

Robert Nelb, director of policy at America’s Essential Hospitals, which represents safety net hospitals, said he and most experts believed when it passed that the One Big Beautiful Bill Act was merely codifying CMS policy on budget neutrality.

But the Trump administration has interpreted the law to restrict states’ use of waivers, he said.

Nelb said many long-standing waivers that have been renewed multiple times are now at risk and that the loss of state waivers could threaten money hospitals rely on to cover uninsured patients and improve care in their communities.

“There is a real concern that this will put added burdens on states up front and slow down new innovations in Medicaid,” Nelb said.

In 2025, the Trump administration told states it would no longer renew Medicaid waivers to help enrollees with job training or to allow continuous eligibility for adults and children for specific time periods without verifying their income eligibility.

©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

Coloradans can’t afford this new, crushing cost on top of last year’s 28% premium increase resulting from Donald Trump and congressional Republicans’ for health care coverage.

Just over a year ago, Republicans under Trump cut $1 trillion from Medicaid in order to give tax breaks to billionaires. This will kick 15 million Americans off their health insurance, according to the nonpartisan Congressional Budget Office. Immediately after the legislation was signed, states began bracing for the substantial pullback of federal support, rural hospital closures, and implementation of burdensome paperwork requirements intended to drive down enrollment.

Months later, congressional Republicans allowed the ACA premium support to expire, which helped hardworking individuals and families afford their health insurance. This lapse will lead to 5 million more people going without coverage.

Democrats in Congress, prominent health care experts and advocacy organizations, hospitals across the nation, and numerous state officials, including our state’s insurance commissioner, warned of the real human toll the cuts would take.

As the top Democrat on the powerful Health Subcommittee, I knew these cuts would be devastating for vulnerable Americans across the country. That is why I led the fight, alongside my colleagues in committee and on the House floor, to block Trump and his congressional allies from ripping coverage away from the seniors, veterans, low-income wage earners, chronically ill patients, and more who rely on Medicaid.

Now, the nightmare we tried to prevent is reality. Millions of Americans are struggling to afford their care or are opting to cancel their coverage altogether, including large numbers of Coloradans. As of July 1, health plan cancellations in Colorado are a staggering 29% higher than they were at this time last year, and insurance premiums will cost Coloradans thousands more.

Even though Colorado created a state-funded premium assistance program in an effort to blunt the harsh federal cuts and support vulnerable Coloradans’ access to care, it����ap not enough to stem the impact. While that program held Colorado to a 7% decrease in ACA enrollments over last year, keeping roughly 28,000 Coloradans insured, our neighbor Oklahoma experienced a staggering 32% decrease in enrollment this year.

And we haven’t even reached rock bottom. For sheer political reasons, many of the Medicaid cuts in last year’s Big Bad Bill were intentionally left partially implemented until after the upcoming midterm election. As CBO predicted, the worst is yet to come.

Congress must act.

First, we have to stop the bleeding and stabilize the health care markets with a sufficiently long extension of the ACA premium support that so many Americans have relied on to afford their coverage. However, stabilizing a fragmented, profit-driven market is only a temporary patch. To truly secure the future of American health care, we must take a hard, uncompromising look at the underlying issues that drive up our health care costs, sparing no one in the industry.

Only by addressing the health care system as a whole and not merely individual parts — such as payers, providers, product manufacturers, and others — can we move toward guaranteeing quality, comprehensive care for all.

U.S. Rep. Diana DeGette has represented Congressional District 1 since taking office in 1997.

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And there is little partisan divide on the matter, recently released polling conducted by the School of Public Policy at the University of Maryland, through its Program for Public Consultation, show.

Well over half of Republicans and GOP-leaning voters in the 8th District said the federal government’s role in healthcare should expand and programs like Medicaid be made more generous. That was generally in line with how Democrats answered the questions.

Specifically, 70% of Republican voters in the district said increased Obamacare subsidies should be renewed, 61% said spending on Medicaid should go up and cover more people and 72% of Republicans said Americans should be able to buy into a “government-run public option,” according to the polling results.

Ninety-one percent of Republicans in the 8th District also favored the government setting maximum prices for drugs sold in the United States, based on what the drugs cost in other developed countries.

“We’re seeing nationally and in the 8th Congressional District a kind of moderating on the question of whether the government should play a role in healthcare,” said Steven Kull, director of the Program for Public Consultation. “The central dynamic is that the cost of things is too high and that the government should do something about it.”

That puts U.S. Rep. Gabe Evans, a Fort Lupton Republican, in a tough spot as he nears the end of his first term representing the district that takes in three counties north of Denver.

Evans, who barely won his first election in the evenly divided district in 2024, voted in favor of President Trump’s massive tax-cutting bill last year, which public health experts have said will cut Medicaid funding in Colorado and tighten up eligibility standards, potentially tossing thousands of Coloradans from the program meant to assist low-income Americans in paying for healthcare.

“These poll results underscore the affordability issue writ large and the fact that inflation has crossed party lines,” independent political analyst Eric Sondermann said.

Evans’ Democratic opponent, state Rep. Manny Rutinel, often highlighted cuts to the federal health program from the tax bill while on the campaign trail ahead of the June 30 primary.

“I grew up on Medicaid,” Rutinel told The Denver Post last week. “So it����ap personal that Gabe Evans voted for Trump’s Medicaid cuts that take healthcare away from over 100,000 Coloradans to give tax breaks to his billionaire donors.”

Last week, the Democratic Congressional Campaign Committee made a “five-figure buy” of ads on Facebook and Instagram targeting 8th District voters over health costs in the lead-up to the November election.

“Hundreds of thousands of Coloradans could lose their healthcare, at least 12 in-state hospitals could close, and virtually every Colorado family could see their health care bills go up because of Evans’ disastrous agenda,” said DCCC spokeswoman Lindsay Reilly.

House Majority Forward, a national group linked to House Democratic leadership, also launched a in Colorado this month targeting Evans over his vote last year. The 8th Congressional District is Colorado’s most heavily Latino.

Evans countered that Democrats “continue to fearmonger and spread disinformation” about the law once known as the One Big Beautiful Bill.

“The reality is this: In 2026 the federal government will spend more on Medicaid than it did in 2025, and it will spend more in 2027 than it did this year,” Evans said.

The tax bill he voted for, he said, puts Medicaid and other human services programs on a “more sustainable path that will ensure these programs are protected for future generations.” That’s largely accomplished, Evans said, by “rooting out waste, fraud and abuse … ensuring that only American citizens can receive these benefits and implementing common sense work requirements.”

Democrats have their own challenges on healthcare spending, which could muddy their messaging as November approaches. Waste and fraud in Colorado’s Medicaid program has been on full display under the party’s leadership.

From a program that provides rides for Medicaid patients to and from medical appointments, which was overbilled by hundreds of millions of dollars, to Medicaid overpayments of nearly $78 million for autism services in 2022 and 2023, Democratic state lawmakers have grappled with how to contain runaway costs.

Kim Bimestefer, who led Colorado’s Medicaid program as head of the Department of Health Care Policy and Financing, announced her resignation in March after state lawmakers called for her dismissal following frustration with how the program was being managed.

The following month, the legislature set aside money to stand up a working group charged with doing a “deep dive” into the state’s massive Medicaid program.

But how voters will weigh money wasted in Medicaid against Trump’s overall cuts to the program could determine who gets to represent the 8th District in the next Congress. A ballooning federal debt usually takes a back seat to benefits in hand, Kull said.

“Once you put something in place, people get used to it and it’s hard to take away,” he said of the Obamacare subsidies that were revoked under last year’s tax bill.

And that will make it hard for Evans even if he has a solid case to make about mismanagement of Medicaid by Democrats, Sondermann said.

“You care about waste and fraud but mainly you want your benefits,” he said of the district’s voters.

And in a district where Democrat Yadira Caraveo won by a razor thin margin in 2022, only to be defeated by Evans in a similarly close contest two years later, every vote counts. That’s especially true of the district’s sizable and crucial unaffiliated voter base, Sondermann said.

“These polling results don’t mean that all Republicans are going to fill the box for Manny Rutinel,” he said. “But there’s an opportunity for Manny to pick off a few of these independent voters.”

The inspector general’s , released last month, alleged that Colorado didn’t process all information about personal care services covered by Medicaid through its electronic visit verification system.

Under the 21st Century Cures Act, , or risk losing part of their federal Medicaid funding. Colorado rolled it out in August 2020.

Most providers of home-based health services have to file a timesheet that also includes the name of the client and the provider, as well as the type of service and where it took place. They can submit that information through an app or web portal, or by calling it in.

The federal auditors took a sample of 160 Colorado reimbursement claims for one or more visits in fiscal year 2024, out of about 1.3 million.

The audit found , with the majority involving someone entering the information manually rather than using an app or calling it in. In a smaller number of cases, data was missing, providers billed for more than 24 hours of care in a day, or the state paid the higher Denver-specific rate in other parts of Colorado.

The report said the state shouldn’t have paid for about $15.7 million in care, with the federal share accounting for $8.1 million.

The report also flagged about $45.7 million in federal spending on claims that didn’t include specific information about the services provided, and advised the state and the Centers for Medicare and Medicaid Services to figure out if Colorado should pay back any of that money.

The Department of Health Care Policy and Financing, which oversees Medicaid in Colorado, said the auditors used a sample that doesn’t represent the overall mix of providers, making its estimates unreliable.

The auditors didn’t say that any providers committed fraud or that patients didn’t receive care, but that they couldn’t verify everything happened correctly with the available data. They recommended Colorado make changes to its electronic systems to avoid paying claims that don’t follow the rules.

The Department of Health Care Policy and Financing described the findings as “isolated documentation issues.” Federal officials held Colorado up as a model for electronic visit verification, and the state has already corrected some of the problems the auditors found, the agency said.

“The audit does not demonstrate that payments were made for services that were not authorized and rendered, nor does it identify fraud or intentional misuse of Medicaid funds,” the department said in a statement.