Community health centers serving low-income Coloradans will face a reckoning if the government shutdown goes on too long — but right now, they can’t be sure when “too long” will be.
The federal community health center fund, which pays about $111 million annually to Colorado clinics to cover care for uninsured people, lapsed at the end of September, though centers can continue to draw down money as long as their grants last, said Ross Brooks, president and CEO of the Colorado Community Health Network.
Not all centers operate on the same cycle, so some might have six months left in their grants, while others only have one or two months, he said.
“I’m hopeful that the federal government’s going to come to a resolution on it,” he said. “If it goes more than two to three months, I think we’re in a pretty tough spot.”
A long shutdown could also jeopardize other programs supporting health centers, such as loan repayment for doctors working in underserved areas, Brooks said. The longest shutdown in history lasted 34 days, from December 2018 to January 2019.
Community health centers in Colorado run about 250 sites, which treated about 850,000 people in 2024.
Donald Moore, CEO of Pueblo Community Health Center, is worried that centers could face financial difficulties sooner than Brooks anticipated.
While his center can legally draw down reimbursement, no one is sure whether the workers at the U.S. Department of Health and Human Services are on the job to process the payments, he said. The center receives about $5.4 million in federal funds annually, accounting for roughly 15% of its budget.
HHS furloughed about two-fifths of its workforce in response to the shutdown. The agency sent a form response to The Denver Post’s questions about whether the payment workers were on furlough, which stated that answers to media questions could be delayed during the shutdown.
Community health centers generally have bipartisan support as an affordable way to provide preventive care to low-income people, Brooks said. Technically, Congress could extend funding for community health centers without solving the overall budget impasse, but that doesn’t seem likely, he said.
As of Wednesday, congressional Republicans and Democrats remained at an impasse, with Democrats saying they would only agree to a budget deal that extended enhanced tax credits to buy health insurance on the individual marketplace, and Republicans countering that they would only consider an extension after funding the government.
Republicans control both houses, but don’t have enough votes in the Senate to pass a budget bill without Democratic support.
President Donald Trump appeared to express willingness to talk about the tax credits Monday, then said he would only consider negotiations after the shutdown ends. Open enrollment for the individual marketplace begins Nov. 1, with coverage starting Jan. 1, meaning the window to extend tax credits is rapidly closing.
While community health centers have traditionally had bipartisan support, the president’s budget calls for cuts to the Health Resources and Services Administration, which distributes their federal funding, Moore said.
The proposal doesn’t specify which HRSA programs should shrink, but community health centers were already struggling with funding that increased about 1.7% annually, well below the rate of medical inflation, he said.
Even without further cuts, the coming years will be challenging as Medicaid changes take effect, Moore said. If patients lose Medicaid coverage because they can’t comply with the new work requirements, they’ll likely keep coming to health centers even if they can’t pay, he said. Community health centers have a sliding fee scale, sometimes charging only a few dollars to people without insurance.
“If the uninsured numbers increase in the future, that’s the straw that can break the camel’s back,” he said.
About two-thirds of community health centers in Colorado had negative operating margins in 2024, requiring them to dip into reserves or take steps such as consolidating clinics, laying off employees or freezing hiring, Brooks said. While none of the clinics are making additional cuts because of the shutdown, they might eventually have to if the money doesn’t come through, he said.
Even if the Pueblo center can’t draw down its reimbursement at the end of the month, it will continue seeing patients in the expectation that the money will come after a budget deal, Moore said. If the shutdown drags on for months, the health center could have to stop taking new patients, and possibly shut down the prenatal care clinics it holds monthly in rural parts of southern Colorado, he said.
“Hopefully, they won’t break their record,” he said.
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