Mountain Family Health warns Medicaid unwind, high uninsured rates threaten Basalt clinic finances

Mountain Family Health Centers CEO Dustin Moyer told the Pitkin County Board of County Commissioners on Jan. 14 that the organization is facing substantial revenue losses after the state’s Medicaid redetermination effort removed coverage for tens of thousands of Coloradans and that local partnerships are essential to keep the Basalt hub clinic solvent.

Moyer said Mountain Family serves about 2,600 unique patients at the Basalt hub with roughly 10,000 patient visits per year and that the clinic’s annual operating budget is approximately $3.5 million. The organization’s regional payer mix is unusually weighted toward uninsured patients: Mountain Family’s encounters show roughly 48 percent uninsured, placing the clinic among the highest-uninsured community health centers in Colorado, Moyer said.

Moyer told the commissioners that the recent end of the federal continuous-eligibility policy for Medicaid prompted a state-led redetermination that resulted in 575,000 Coloradans statewide losing Medicaid coverage; Mountain Family estimated about 2,000 of its own patients lost coverage during the unwind and that the change has cost the organization about $1.5 million in revenue on a roughly $25 million annual budget. Mountain Family and its statewide association estimate roughly 39,000 of the 44,000 community-health-center patients who lost coverage statewide should still be eligible if the state can reach and re‑process their applications.

Moyer described how geography and local wages create a coverage gap: in resort communities higher wages can exceed Medicaid eligibility thresholds but still leave households unable to afford exchange plans. He outlined Mountain Family’s Basalt funding structure: Pitkin County provides approximately $90,000 per year in rental subsidy, Eagle County about $40,000 and Aspen Valley Hospital (AVH) about $135,000; the partners also contribute a per-member-per-month subsidy for uninsured patients (about $30 PMPM) split with AVH bearing 51 percent, Pitkin 34 percent and Eagle 15 percent.

Moyer said Mountain Family closed two Basalt school-based health centers in December because of sustainability concerns and consolidated those services into the Basalt hub; school-based centers had provided a convenient access point but lacked sufficient daily patient volume to sustain separate, full staff. The Basalt hub continues to expand pediatric capacity to serve students and is coordinating with the local school district to maintain student access.

Mountain Family described its blended funding model: patient-service revenue (Medicaid and commercial claims) is the largest revenue source; federal community health center base grants account for about 11–12 percent of total budget; state primary care fund dollars, pharmacy (340B) revenues, county contributions and philanthropic and individual donations make up other portions. Moyer said Mountain Family is stepping up private fundraising and working with county partners to shore up support while the organization helps affected patients re‑enroll in Medicaid where possible.

Commissioners asked about translated services and outreach; Moyer said roughly 30–40 percent of Mountain Family patients prefer Spanish-language care and that the organization invests in bilingual staff and incentives for providers who attain Spanish proficiency. Commissioners discussed county funding mechanisms and the structure of the Basalt intergovernmental agreement that helped fund facility purchase and the ongoing rent subsidy.

Commissioners thanked Mountain Family for its work and encouraged continued coordination on Medicaid reenrollment, legislative outreach and use of the state primary care fund. Moyer said the organization is tracking state policy proposals and will seek increases in the primary care fund and other matched funding mechanisms that could expand support for clinics serving high numbers of uninsured patients.