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The state eliminated minimum payment guarantees for essential providers due to budget constraints.

DENVER — Colorado mental health providers participating in the state’s Essential Safety Net Provider program just got notice of significant reimbursement cuts.

The cuts affect providers who became licensed as Essential Safety Net Providers, or ESNPs, a designation that previously guaranteed higher reimbursement rates in exchange for expanded responsibilities, including serving patients regardless of insurance status and connecting clients to housing, food and other social services.

“I got this email saying that our rates were being cut by 34%,” said Lila Kimel, a clinical psychologist who became licensed as an ESNP this year. “I had given people raises. I was hiring, and I feel really betrayed by this system.”

Cristen Bates, Colorado’s Deputy Medicaid Director, said the state decided to eliminate minimum payment guarantees for essential providers due to budget constraints.

“We’ve decided based on state and federal budget restrictions, increasing costs, and, in some ways, the way that the program rolled out, to no longer require a minimum payment for essential providers,” Bates said.

The cuts specifically target 60-minute psychotherapy services, which Bates said became overutilized.

There are 13,718 unique behavioral health providers, according to Colorado’s Department of Health Care Policy and Financing. There are 131 ENSPs enrolled in Medicaid.

“What happened with ESNPs is we saw a lot of 60-minute psychotherapy services, which is not the area where we need to prioritize our very precious and limited Medicaid funds,” she explained.

Providers said they were not adequately informed that the enhanced payments were temporary. Haley Wise, a therapist with The Compassion Collaborative in Colorado Springs, pointed to a December 2023 fact sheet that stated approved providers would be “eligible to seek enhanced payments” without mentioning time limits.

“It’s not in the safety net fact sheets,” Wise said. “It’s not in anything that I have read.”

“Did I know that ESNP was temporary? No, I did not,” Kimel said.

Bates acknowledged the communication failure.

“They were not told that it was temporary in that communication,” Bates said. “I do wish that we would have been more clear that there was this was not a guarantee for infinite amounts of time.”

Providers are only required to be given 90 days’ notice ahead of rate changes.

“Here we are, July 3, and just a couple of days ago, I found out we were losing all of this,” Kimel said. “Oh, and by the way, this is right before the Fourth of July holiday, when all of them are out of office. There is no one to respond to our messages. This has been a nightmare.”

The cuts will particularly impact providers serving vulnerable populations. Kimel noted that her practice is “one of the very few that can do this speaking Spanish” and serves people with developmental disabilities and co-occurring mental health conditions.

Essential Safety Net Providers are required to accept all patients seeking care, regardless of their ability to pay.

“Basically, what it means is you can’t turn people down,” Kimel said.

When providers cannot accommodate new patients, they must still help connect them to other services.

“We are not only providing sessions and therapy, but also basically assessing do they need help with housing? Do they need help with food? Clothing?” Wise explained. “If we are full, my admin team has to find somewhere else for them to go and set appointments up for them. And if they have housing needs, food needs, occupational needs, we have to set them up with those services directly too, even if they’re not our clients.”