AURORA, Colo. — As members of Congress continue to draft a bill seeking $1.5 trillion in tax cuts to federal programs, those serving Colorado's children are concerned about the impact on Medicaid.
More than a million people were enrolled under Colorado's Medicaid Program — Health First Colorado — covering one in four Coloradans, as of March 2025.
Members of Congress are looking to make cuts across federal government health, food stamp and other programs, to offset the revenue lost for some $4.5 trillion in tax breaks.
According to the state, if there were significant federal Medicaid cuts, Colorado cannot raise taxes or borrow money to cover the loss of federal funding.
Children's Hospital Colorado reports that roughly 50% of their patients use Medicaid for treatment. One of those families is Rachael MacPhee and her 8-year-old son, Jonnie, who live in Arvada.
When Jonnie was 3 months old, he came down with a respiratory illness and their primary care physician sent the family to Children's Hospital Colorado. It was the first of many visits.
"We call him a frequent flyer," Rachael said with a smile. "We found out he had a heart condition during that time, and that just started a long process."
Jonnie has a rare condition called Multisystemic smooth muscle dysfunction syndrome (MSMDS), and had his first heart surgery when he was only 6 months old.
"His heart condition is a part of a full systematic genetic condition that affects his smooth muscles, which are the muscles inside your body that help your hollow organs or your vascular system contract and relax. So, his body doesn't have the correct proteins to do that well, and it affects every system," Rachael explained. "He's feeding tube dependent and catheter dependent. We take a lot of medications every day. So, most of his disabilities are currently invisible, but they'll continue to escalate over time."
The MacPhees said Children's Hospital Colorado has saved Jonnie's life several times, but the treatments are expensive. When Jonnie was diagnosed, Rachael applied for Colorado's Children's Home and Community-Based Services Waiver (CHCBS), which is an extra set of benefits from Colorado's Medicaid program. Jonnie qualified for the waiver rather quickly, according to his mother.
"When he qualified for the waiver and we found out that the waiver would also basically replace my income for what I was already doing, which was caring for Jonnie, it changed our whole lives," Rachael said. "Medicaid has given me a window of time to just be present with him. And since we know that time is not guaranteed for him, that feels like a huge gift."
It was important for Rachael to tell her story and provide an example of a family who relies on Medicaid, she said.
"It's just not very common for people to have a face to Medicaid and the impact it has on families, especially white, middle class Arvada families," Rachael said. "I think people can sometimes have a perception of who utilizes Medicaid or who it helps, and I don't know if that perception is always accurate."
Another Colorado family out of Frederick feels the same way. Charles and Abby Bohall said they are dependent on Medicaid for their 13-year-old son's cystic fibrosis (CF) treatment.
"There is a misconception that people are on Medicaid because they have low income. While that is one way that people qualify for Medicaid, it doesn't encompass the entire range of why people access Medicaid," Charles said.
Their son with CF, Walter, said the treatments have become part of his every day life. Still, they require lots of time, care and coordination — in addition to being expensive.
"It's been a blessing to not have to worry about, like, 'Oh, can we get a refill now? Can we afford this additional medication that's being recommended?' Just we know it's been covered," Abby said.
The family said they do not know what they would do if their coverage was cut.
"My imagination kind of runs off with the worst case scenario, and some of those are pretty bad. Those would be, we'd have to change careers. We'd have to change probably locations," Charles said. "A lot of uncertainty and anxiety about it, because it is a big part of how we care for Walter."
Those concerns are shared by the experts at Children's Hospital Colorado.
Dr. Monica Federico has worked with children for more than two decades, and currently serves as the medical director of population health at the hospital while doubling as a pediatric lung doctor.
"My job's a privilege," Federico said. "It's a privilege to work with children and walking down the hall and hearing kids sing songs out of their room or play with their parents. It makes the hard parts easier."
Dr. Christopher Stille also works at Children's Hospital Colorado as the section head of general academic pediatrics, overseeing primary care services as a general pediatrician.
"I love taking care of the kids and their families, especially the kids that have more complex medical and behavioral needs," Stille said. "I love to work with them. I learn from them every single day, and I love to share that learning with the future doctors that we train here."
Stille said their mission is to take care of every child who comes into the hospital, providing services they may not be able to receive in other settings.
"We work really hard with a lot of families with a lot of needs to provide the best care we can every single day, and if we can't do that, that's really hard," Stille said. "Medicaid is, more than anything, a kids' program statewide."
"If we can't serve them the way we want to serve them, or any other child that comes in, it starts to feel very unfair and very much like we can't do what we were trained to do, which is just make children healthier, put a smile on their face and send them home with their families," Federico said.
While cuts to Medicaid are not official yet, the doctors said the prospect is overwhelming.
"None of us want an inefficient system," Stille said. "We strive for as much value as we possibly can, so that every dollar that gets spent gets put to a good use for kids... We're with them when it comes to value for sure, and I think our job is to convince them that the value is continuing to be there."
Federico and Stille acknowledged there may be places within Medicaid where costs can be adjusted or cut — but they would like the healthcare industry to be involved in examining any potential changes to the program.
"I really want to keep doing my job without worrying that somebody else who is not in the exam room with me tells me how to do it and what I can and cannot offer them," Federico said. "We all love our children, and we all want to take care of them, and healthy adults can take better care of children, and healthy adults can create healthy families. Having children be healthy in schools is going to create a better society. So, I think we all want that."
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