Medicaid is a massive part of the state’s health care infrastructure that is now poised for massive changes.
You may think of Medicaid as the government’s health insurance program for people who are impoverished, which it is. But it also provides coverage for people in nursing homes, for children and adults with disabilities, for working families and for students going to school.
Proposed changes at the federal level, as well as looming budget challenges at the state level, have the potential to dramatically shape who is eligible for Medicaid and how it’s all paid for.
In this story, The Sun will explain who Medicaid covers in Colorado so you can better understand these momentous debates.
1,223,788
More than 1.2 million people in Colorado were covered by Medicaid in April of this year. That’s greater than 1 in 5 people in the state.
If the population enrolled in Medicaid were its own city, it would be nearly twice the size of the population of Denver, the state’s largest city.
But Medicaid’s reach is ever greater in certain populations, with the program and a companion program called CHP+ covering 40% of children, nearly half of all births and nearly two-thirds of people in nursing homes. (CHP+, also known as the Children’s Health Insurance Program, provides coverage to children and pregnant people whose families earn just enough that they don’t qualify for Medicaid.)
Medicaid is a bigger deal in some counties than others
Medicaid plays a larger role in some counties — many of them in southern Colorado — compared to others.
As of data collected during the 2024 fiscal year, Costilla County had the highest Medicaid enrollment rate in the state at nearly 55%. Four other counties — Alamosa, Conejos, Otero and Prowers — had at least 2 out of every 5 people enrolled in Medicaid.
On the other end, only two counties — Douglas and Pitkin — had fewer than 1 in 10 people enrolled in Medicaid. Pitkin, which is home to Aspen and other expensive enclaves, had the lowest enrollment rate, at 8.42%.
Same with Congressional districts
Another way to look at this is to divide the state up by Congressional district — something that’s gained a lot more attention in recent weeks as supporters of Medicaid have sought to lobby Colorado’s representatives to reject deep cuts to the program.
The giant dark chunk in the western and southern parts of the state in the map below is the 3rd Congressional District, represented by Rep. Jeff Hurd, a Republican. An estimated 31% of people in the district are covered by Medicaid — which explains why Hurd has been outspoken among Republicans in urging protection for Medicaid. (Hurd still voted yes on House Republican’s version of the spending bill that imposes work requirements and other restrictions on Medicaid.)
The lowest percentages of coverage are in the 2nd Congressional District, represented by Rep. Joe Neguse, a Democrat, and the 4th Congressional District, represented by Republican Rep. Lauren Boebert. Both districts have about 16% of the population covered by Medicaid.
Its enrollment is diverse
Medicaid enrollees span all age groups, but children make up the biggest chunk of people covered.
People who are white make up the largest group of enrollees on Medicaid, but people who are Hispanic and people who are Black are disproportionately represented.
Colorado is 66% white non-Hispanic, according to projections from the U.S. Census Bureau, while it is 23% Hispanic and 5% Black. Medicaid enrollees are 39% white non-Hispanic, 33% Hispanic and 7% Black, according to the Colorado Department of Health Care Policy and Financing, the state agency that administers Medicaid in Colorado.
Medicaid has seen steep growth and decline in Colorado
Medicaid enrollment in Colorado — as in many other states — has grown tremendously over the last 15 years. But it also dropped sharply in the past couple of years.
This is because of two major expansions to the program in Colorado, as well as two changes in federal policy that first swelled Medicaid rolls during the COVID-19 pandemic and then purged them.
Historically, nondisabled adults who were not caretakers for a child or someone who was disabled were not eligible for Medicaid. And even those who did qualify by acting as caregivers couldn’t earn more than a pittance — about a third less than the federal poverty level.
That changed in 2009, when the Colorado legislature expanded eligibility for parents up to the poverty line.
Eligibility expanded again in 2014 when Colorado implemented the Medicaid expansion allowed under the federal Affordable Care Act, the law sometimes still known as Obamacare. This expansion allowed states to increase eligibility for Medicaid up to 138% of the federal poverty level and to open it to anyone who met that criteria. In other words, it allowed childless adults into the program based solely on their income.
The COVID pandemic brought another huge enrollment increase when the federal government barred states from disenrolling anyone from Medicaid. (Medicaid enrollees typically must go through a full check every year to make sure they are still eligible.) The thinking here was that the country didn’t want to risk people being uninsured during a pandemic.
The policy swelled Colorado’s Medicaid enrollment to a high of roughly 1.8 million people, or 30% of the state’s population.
This didn’t last, though. When the feds declared an end to the policy and Colorado began running eligibility checks again, Medicaid enrollment plummeted at one of the steepest rates in the country.
Dr. P.J. Parmar examines Johnny Lun Ring at the Mango House clinic in Aurora, Colorado, on June 24, 2021. His father, Khang Pang (right) watches on. At far right is another of Pang’s children, Noel Nang Shan Dvbe. The clinic caters primarily to refugees and turns no one away, regardless of their ability to pay. Parmar designed the clinic to survive on the Medicaid payments that many doctors across the U.S. reject as too low. (Ross Taylor for Kaiser Health News)How much can you make and still qualify for Medicaid?
As we said, for people who qualify based on their income, Medicaid eligibility generally cuts off at 138% of the federal poverty level. For 2025, that is a little shy of $21,000 per year for a single person and $43,000 a year for a family of four.
(The cutoff is sometimes given as 133% of the federal poverty level, but the federal government by policy “disregards” the first 5% of income, said Emily Johnson, a managing director at the nonpartisan Colorado Health Institute.)
Children and pregnant people can qualify with slightly higher incomes. CHP+ eligibility extends up to 260% of the federal poverty level, or nearly $41,000 a year for a single person and $84,000 a year for a family of four.
All of these fall well below typical income levels in Colorado. The Colorado Division of Labor and Employment estimates the state’s average wage at $39.00 per hour, which, extrapolated to 40 hours a week for 52 weeks a year, comes out to about $81,000.
According to a Massachusetts Institute of Technology professor’s calculations, a living wage in Colorado for a single person is about $53,000 per year. A family of four with two parents working would need to make about $137,000 per year for a living wage in Colorado.
Other ways to qualify for Medicaid
There are other ways besides income to qualify for Medicaid, though they are less common.
Adults and children with disabilities may qualify based on the nature of their disability. These eligibility pathways are sometimes referred to as “waivers” — as in, they waive income requirements to allow people to receive coverage regardless of how much they or their families make.
Colorado currently has 10 waivers for people with disabilities, with names like the “Children with Life Limiting Illness Waiver” or the “Supported Living Services Waiver.”
Another important group of people covered by Medicaid are older adults ages 65 and over who are in nursing homes or other long-term care settings. (Medicare, the insurance program for older Americans, does not pay for nursing home care.)
To qualify for Medicaid nursing home coverage, an individual must pass both an income and an asset test. In general, the cutoffs are no more than $2,900 a month in income and no more than $2,000 in assets.
Some people may also be eligible for only partial Medicaid benefits based on their circumstances and other resources available to them.
While children, followed by adults covered under the Affordable Care Act’s Medicaid expansion, make up the two largest groups of enrollees, they take up fewer resources on a per-capita basis.
People with disabilities and those 65 and older in long-term care account for only 9% of total Medicaid enrollment, combined. But they account for 50% of the program’s spending in Colorado.
Explaining the Medicaid expansion
The Affordable Care Act originally sought to require states to expand Medicaid to people making above the poverty line. But a landmark Supreme Court ruling blocked that, leaving it optional for states to expand.
As of 2025, all but 10 states have chosen to expand Medicaid — the federal government pays 90% of the costs for states that do.
But the expansion has remained politically contentious, with Republicans in Congress often leading efforts to curtail federal funding for it or impose other limitations.
Who would be affected by Medicaid work requirements
The bill the U.S. House passed would impose work requirements on nondisabled adults without children. In other words, it would apply to certain people covered by the Medicaid expansion.
In Colorado, about one-third of Medicaid recipients — around 377,000 people, currently — could be subject to work requirements, depending on the precise rules for the requirements.
“We need the rules to come out on work requirements, and we need to understand … who it would impact, how often we need to apply those work requirements, who is eligible for an exception, and what those exceptions are,” said Kim Bimestefer, the executive director of the Department of Health Care Policy and Financing, which is also known as HCPF. “So, obviously, there is a lot to be determined, but we’re definitely concerned.”
How many people on Medicaid are working?
HCPF estimates that, of the people in Colorado who would potentially be subject to work requirements, 56% are currently working.
This number, however, fails to capture some of the other ways people would likely be able to hang onto Medicaid coverage if the work requirements became law. For instance, the House bill says volunteering or going to school would also count toward work requirements.
People with certain chronic medical conditions — such as substance abuse disorders — or who are caregivers for people not covered by Medicaid — like, say, an older relative — could also be exempted.
The nonpartisan health policy think tank KFF conducted a nationwide analysis of 2023 data to better understand work status for Medicaid members across the country. It limited the analysis to people under the age of 65 and those who are not receiving benefits from various federal disability programs — so it approximated the pool of people who could be subject to work requirements under the House proposal.
It found that roughly 64% of Medicaid recipients nationwide in its study group were working either full-time or part-time. An additional 29% said they weren’t working due to school, illness or disability, or because they were acting as a caregiver for another. The remainder were not working due to retirement, inability to find work or another reason.
A recent report by the left-leaning Center on Budget Policies and Priorities looked at the jobs of people covered by the Medicaid expansion who could be subject to work requirements. Nationwide, it found the most common occupations were low-wage jobs that often do not offer health benefits, such as cashiers, personal care aides or as retail salespeople.
In Colorado, the report found that the top two jobs among those likely to be subject to work requirements were as food servers and retail salespeople, followed by cashiers, cooks and customer service representatives.
What happens when people lose Medicaid coverage
After the Affordable Care Act’s Medicaid expansion took effect in Colorado, the state saw a significant decline in the percentage of people who are uninsured.
Prior to the expansion, the uninsured rate in Colorado hovered around 14% or 15%. After the expansion took effect, that percentage plunged to about 6.5%, according to the Colorado Health Institute’s every-other-year Colorado Health Access Survey.
“Much of this halving of the uninsured rate was in fact driven by Medicaid,” Suman Mathur, a director at the Colorado Health Institute who leads the survey, told the Colorado House Health and Human Services Committee during a briefing in March.
The connection between Medicaid expansion and the drop in the uninsured rate is why Colorado Health Institute analysts project that anyone who loses Medicaid coverage as a result of work requirements or for another reason probably won’t become insured through the private market.
“It’s likely that most of them would become uninsured,” Joe Hanel, the Health Institute’s communications director, told the same committee. “We say that because most of the Coloradans who were uninsured before Medicaid expansion became insured through Medicaid.”
Medicaid and undocumented immigrants
Medicaid is generally open only to U.S. citizens or immigrants with permanent legal status. But there are two ways that Medicaid in Colorado provides coverage to immigrants without documentation or permanent legal status.
The first is through a program called Emergency Medicaid Services and Reproductive Health Care Services, or EMS/RHCS. The program covers emergency care; labor and delivery care; and dialysis. It also provides some coverage for contraceptives, basic fertility assessments and screening for sexually transmitted infections. Every state in the country has some kind of emergency Medicaid program for undocumented immigrants.
To qualify for these programs, a person must meet all of the usual Medicaid eligibility requirements apart from their immigration status.
The second program is called Cover All Coloradans, and it was rolled out at the start of 2025 after lawmakers passed a bill to create it. This program covers children and pregnant people regardless of immigration status.
In May, Colorado covered 36,834 people through emergency Medicaid and had enrolled 21,261 people for Cover All Coloradans, including 16,365 children and 4,896 pregnant women.
That made up about 4.7% of Colorado’s total Medicaid enrollment for the month.
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