Colorado hospitals’ finances rebounded in 2024 after taking a beating in the previous two years, but still haven’t regained their pre-pandemic heights, according to a pair of new state reports.
Expenses grew faster than payments in 2022 and 2023, narrowing hospitals’ margins on patient care, while a stock market downturn cut into the value of their investments. In 2024, the trend reversed, according to the new reports, with insurance payments growing slightly faster than the cost of providing care.
Still, Colorado hospitals say their finances aren’t on a solid footing as the next challenge looms: Medicaid work requirements will kick in Jan. 1, and people who lose coverage will almost certainly become uninsured. Medicaid doesn’t cover most hospitals’ full costs, but they collect little or nothing from patients without insurance.
The state’s hospitals made about $101.6 million on patient care in 2024, up from $11 million in 2023, according to the Colorado Healthcare Affordability and Sustainability Enterprise Annual Report.
That translates to roughly $99 in profit per patient in 2024 — up from $11 per patient in 2023, but far from the pre-pandemic level of $1,367 per patient in 2019.
Counting investment income, hospitals came out ahead by about $1.9 billion in 2024, with most of the profit going to large facilities. Total profits were about $407 million higher than in 2023, but still about $381 million below 2019 levels.
The Colorado Department of Health Care Policy and Financing releases two legislatively mandated reports, which lag by one year, on hospital systems’ finances each January. A third report, on community benefit spending, lags two years, so the data only covered 2023.
The overall profits conceal significant variation.
Out of 85 facilities reporting data, 22 lost money overall, down from 32 in 2023, according to the Hospital Financial Transparency Report. Overall profit margins ranged from a high of 33% at UCHealth Poudre Valley Hospital in Fort Collins to a low of -182% at CommonSpirit St. Francis-Interquest, which opened in Colorado Springs that year.
Smaller and independent hospitals were more likely to lose money.
Hospitals didn’t perform as well without investment income included, however.
When looking at patient care and related operations, 45 hospitals lost money, and only 28 made 4% or more, which the Colorado Hospital Association considers a sustainable profit margin.
Which method generates a better picture of hospital finances is a perennial bone of contention. State officials describe reserves and investments as important for understanding facilities’ total wealth, while the hospital association likens them to retirement accounts that no one wants to tap for daily expenses.
Kim Bimestefer, executive director of the Department of Health Care Policy and Financing, described 2024 as a time of stabilization for hospitals, because payments started growing faster than expenses for the first time since 2021. Both have roughly doubled over the last decade, she said.
“At the other side paying all of this are consumers and employers, so we’ve got to recognize the sustainability of that, how do we work together to get it down, but also recognize where the hospitals are struggling,” she said.
Complete data from 2025 isn’t yet available, but the numbers from the first nine months of the year suggest hospitals continued “treading water” last year, said Tom Rennell, senior vice president of financial policy and data analytics at the hospital association.
Inflation remains high and the cost of uncompensated care is increasing, so 2024 was a challenging year, he said.
“Everyone’s just kind of hanging in there,” Rennell said.
Uncompensated care, which is the sum of charity care hospitals provide and bills they can’t collect, increased by about $171.7 million, or close to one-third, from 2023 to 2024.
The department attributed the increase to the end of the COVID-19 public health emergency, when states had to start verifying Medicaid eligibility again and recipients lost coverage. The Census Bureau estimated the uninsured rate in Colorado rose from 6.7% in 2023 to 7.9% in 2024.
Denver Health, the city’s safety-net hospital, provided $174.7 million in uncompensated care, or about one-quarter of all unpaid services in the state, followed by UCHealth University of Colorado Hospital, in Aurora, at $76.1 million and UCHealth Memorial Hospital Central, in Colorado Springs, at $24.4 million.
The cost of uncompensated care will almost certainly increase in the coming years.
Medicaid work requirements under H.R. 1 — known as the “big beautiful bill” — will take effect in January 2027, and people who can’t navigate the process won’t have another option for health insurance, said Jennifer Tolbert, deputy director of the Medicaid and uninsured program at KFF, a nonprofit that does health policy research, polling and journalism.
States will have some control over the resources they put into finding data so that fewer people have to file their work hours manually, but an increase in the number of uninsured people is inevitable, she said.
“Regardless of how much data-matching states are able to do, people are going to fall through the cracks,” Tolbert said.
Donna Lynne, CEO of Denver Health, said the state’s plans to hold Medicaid rates flat for the next few years, combined with cuts under H.R. 1, will force difficult choices in hospitals that serve large numbers of low-income people.
Colorado faces a budget gap approaching $1 billion, and Medicaid accounts for one-third of state spending.
“We’re not crying wolf. The bottom is going to fall out,” she said during a webinar with state officials and other hospital CEOs on Feb. 11. Denver Health lost about $20.5 million on patient care and related services in 2024, and had a 0.2% profit margin with investments.
The coming increase in the uninsured rate means that hospitals will need to do more to help patients navigate the Medicaid enrollment process and to provide the assistance their communities need most, said Sophia Hennessy, policy and research lead coordinator at the Colorado Consumer Health Initiative.
Federal law requires nonprofit hospitals, which are exempt from most taxes, to spend money on “community benefit,” which can include free care, health-promotion programs and medical research, among other things.
The state’s community benefit report showed nonprofit hospitals spent about $1.4 billion on community benefits, exceeding the value of their tax exemptions.
Training and recruiting providers, mostly at the University of Colorado School of Medicine and UCHealth, accounted for the largest share, followed by charity care and unspecified other programs.
“Hospitals are, net, doing strong, and we want to see more of an investment in Coloradans,” Hennessy said.
Rennell disagreed that hospitals’ overall position is strong. Most are financially shaky and expect the situation to get worse as more patients lose their insurance next year, which could force some to close or reduce services, he said.
“Our hospitals are taking that seriously, yet feeling the road ahead is going to bring difficult choices,” he said.
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