Colorado launched the Behavioral Health Administration in 2022 with the idea that the agency would guide future investments in mental health and addiction care until everyone in the state had relatively easy access.
Three years later, most of the groundwork is in place for those investments, but threatened federal cuts and a state budget crunch mean even maintaining existing services could be a challenge. The BHA had a difficult start, with conflicts over leadership as well as stakeholders saying the state moved too fast and risked making mistakes.
At a mental health summit in late May, BHA Commissioner Dannette Smith said the agency and the rest of the state’s behavioral health system will have to try to get the most benefit for people out of limited resources. Expanding services isn’t an option in the immediate future, she said.
“We’re trying to hold on to what the BHA is doing and funding right now,” she said.
Colorado could lose anywhere from $7 billion to $12 billion in Medicaid funding over the next decade if the “Big Beautiful Bill,” which includes work requirements and limits states’ ability to draw down federal funding, passes Congress in its current form, according to an analysis by the health-focused nonprofit KFF.
The state faces a budget crunch in the coming year, and Gov. Jared Polis has said it won’t have the resources to make up for lost federal dollars.
The BHA doesn’t provide services, but develops rules for mental health and addiction providers in Colorado, while overseeing contractors that develop a network of providers willing to see patients who can’t pay. The agency also runs campaigns to reduce stigma and encourage people who are suffering to seek help.
Part of its intended role was to find out where the safety net has gaps, and to advise lawmakers on how to deploy funds to close them — a task that almost everyone acknowledges would be futile in the short term, given the state’s budget crunch.
Medicaid is separate from funding for the BHA’s programs to pay for care for uninsured people, but if people lose Medicaid coverage, they’ll have to rely on the BHA programs, straining their budgets, said Kim Bimestefer, executive director the Colorado Department of Health Care Policy and Financing.
Signs suggest Colorado’s Medicaid program may already be in retreat. Providers who expanded their behavioral health services, with the promise of higher Medicaid rates, recently found out they won’t get that money, according to the Colorado Sun.
Most people haven’t seen the BHA make a direct impact in their lives at this point, so lawmakers may see it as an easy target for cuts next year, said Vincent Atchity, president and CEO of Mental Health Colorado.
He said he believes the BHA is on the right track, but lawmakers may interpret the long lead time as a sign the agency is failing and should lose funding. The agency missed early deadlines to get regulations in place, though providers and advocates for patients described lawmakers’ timeline for launching a new agency as borderline impossible, given the complexity of the behavioral health system.
“The feeling may be that anything and everything is up for grabs,” he said.
Atchity said cutting funds to the BHA wouldn’t directly damage mental health and addiction care now, but it would eliminate a chance to make the system work better for patients and families.
“At the end of the day, is it going to just be the same care, the same network of providers, and not the full care coordination that was the dream of the BHA?” he said.
When the agency launched on July 1, 2022, lawmakers thought it would bring all of the state’s behavioral health programs under one roof. BHA officials said that wasn’t feasible with the time and money the legislature gave them, and pivoted to an oversight role, with a goal of ensuring everyone had access to care, while reducing duplicative programs.
Overshadowed by controversy
Controversy over the agency’s leadership largely overshadowed its first two years.
The agency’s first commissioner, Dr. Morgan Medlock, held the job for just over a year before Polis fired her in April 2023. She recently sued the state, alleging racial discrimination, while her critics said she failed to address stakeholders’ concerns about whether the BHA would meet their needs.
Her temporary replacement, Department of Human Services Executive Director Michelle Barnes, faced criticism from Medlock’s supporters and from people with behavioral health conditions who thought the state was moving too fast.
Since Smith took over as commissioner in March 2024, communications with the state have improved significantly, said Racquel Garcia, a person in recovery who founded the peer-support group Hard Beauty, which focuses on mothers struggling with addiction. Garcia and other providers who spoke on a panel at the mental health summit said the BHA has stabilized over the last year or so.
“Progress is happening,” said Kara Johnson-Hufford, executive director of the Colorado Behavioral Healthcare Council. “There’s still work to be done, but there is momentum and there’s hope.”
Most of the BHA’s work in 2024 happened behind the scenes: hiring staff, writing regulations, and conducting meetings with patients and providers. Its most public-facing achievements were awareness campaigns and a care-finding website, ColoradoLifts.org, which will launch in July.
The agency also chose two companies to develop provider networks in the state’s four regions.
Rocky Mountain Health Plans, a division of United Healthcare, oversees most of western and southern Colorado, while Signal Behavioral Health has responsibility for most of the Eastern Plains, the Front Range and the eastern edge of the high country. They split about $203.2 million in the first year to build their networks, provide coordinators to help people navigate the system and pay for care to people who are uninsured or underinsured.
Rocky Mountain Health Plans CEO Patrick Gordon said the company is working with providers, the state and community groups to “build a more integrated, responsive behavioral health care system.”
“Our goal is to ensure Coloradans receive high-quality, whole-person care when and where they need it most,” he said in a statement.
‘It’s going to take hard work’
Essentially, the behavioral health administrative services organizations bring together safety-net addiction services and most crisis services, other than the 988 Lifeline, said Daniel Darting, CEO of Signal.
By standardizing the contracts, they can make sure that providers are working toward the same quality metrics, following the same financial management standards and reaching out to the public in a coordinated way, he said.
“It gives us that common frame of reference,” he said.
When fully implemented, the network will make it easier to direct people to the right care, even if they initially reach out to a provider who can’t meet their needs, Darting said. The contractors also can assess where service gaps are, so that lawmakers know where to direct any funds they have to invest — though that isn’t likely to happen in the short term, he acknowledged.
“It’s going to take hard work,” he said. “I’m very optimistic.”
Josh Winkler, senior adviser to Lt. Gov. Dianne Primavera, urged patience while the BHA and its contractors gradually make the system more comprehensive and patient-friendly. The state is still working on improving its long-term care landscape more than a decade after a 2014 report identified shortcomings, he said.
“It can’t be done in one (combined) eight-year term,” he said. “It probably can’t be done in two governors.”
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