Access to Health Care
In Colorado, the healthcare safety net acts as the primary health care resource for uninsured and underinsured Coloradans. According to The Colorado Trust and the Colorado Health Institute, its reported that nearly 800,000 Coloradans are uninsured. Currently, Colorado’s uninsured and underinsured total more than 1.5 million people, or nearly 30% of the state’s population. Even with implementation of the Affordable Care Act, many Coloradoans who are currently uninsured will be enrolled in Medicaid, or will remain uninsured, placing an ongoing dependence on our safety net. Moreover, many Coloradans live in rural or frontier areas, where access to health care is severely limited. Colorado’s safety net includes Federally Qualified Health Centers, community mental health centers, community-based dental clinics, community-funded safety net clinics, Critical Access Hospitals, hospital emergency departments, public health departments and public nursing services, Rural Health Clinics, and school-based health centers, and is critical in ensuring access to high quality medical, dental, and mental health care.
Access to primary medical, oral and behavioral health care is an important requisite for good health. Over 1 million Coloradans live in a community with less than half of the primary health providers needed to optimally deliver primary health services. Lack of primary health providers creates high barriers to access for low-income, publicly insured, uninsured and geographically isolated Coloradans. The Primary Care Office is charged with lowering the barriers that prevent Coloradans from accessing adequate high quality primary health services in their community. Some of the known barriers to health services access in Colorado include:
Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community (Institutes of Medicine, Committee on the Future of Primary Care).
The Primary Care Office focuses on assessment for primary health professional workforce needs throughout the state and on directing incentives to those qualified professionals and clinics willing to care for medically underserved people in areas determined to have a provider shortage.
Community support, assessment and evaluation of health care professional shortages in Colorado. The activities include:
Assessment and designation of health professional shortages (See 'Shortage Area Designation' section)
Colorado Health Service Corps - loan forgiveness for health professionals
National Health Service Corps - loan forgiveness for health professionals
International Medical Graduate Waiver Programs
Shortage designation is the primary means by which a community can communicate health care needs to the state government, the federal government, and some private foundations that make grants to communities for the development of health care service capacity. There are two broad categories of shortage designation, each serving a different purpose. Health Professional Shortage Areas (HPSA) tend to describe the needs of the community in terms of the numbers of providers available to the population or a subset of the population. Medically Underserved Areas (MUA/MUP) tend to describe the health status and health needs of a population or subset of the population. Once an area or population group has been designated, the benefits of that designation are available to anyone in the area.
Nearly all Colorado counties have some part of the county designated as having a shortage of health care providers. Some counties have few or no doctors, dentists, or mental health providers. Also, people without health insurance, with low incomes, or with language barriers may experience added difficulty accessing basic health services, even in areas where health care providers are more available generally. The Colorado Rural Health Center and the Colorado Health Institute have additional data available on the health services capacity needs of Colorado.
To receive a federal shortage designation of any kind, an application describing how an area or facility meets federal shortage criteria is required. A shortage application is typically prepared at the local level, in consultation with the state Primary Care Office, and then submitted to the federal Shortage Designation Branch for approval. The complete application and approval process typically takes from three to nine months. Because of the length of time required to complete a designation, communities are well advised to begin the application process as soon as a health care provider shortage is recognized.
Step 1: Is your community already designated as a Health Professional Shortage Area or Medically Underserved Area?
Step 2: Review the one page 'Shortage Designation Overview' or the 'Community Application Guide' to get a sense of what is required.
Step 3: Contact the Primary Care Office at 303-692-2298. The Primary Care Office can:
Step 4: Collect provider survey data in consultation with the Primary Care Office.
Step 5: Submit the survey data and rationale for the service area to the Primary Care Office for review and analysis. The Primary Care Office will further develop your application and submit it to the federal Shortage Designation Branch at the Health Resources and Service Administration.
Benefits of HPSA or MUA Designation
Once an area or population group is designated, the benefits of that designation are available to any organization or person in that area. More than 34 federal and state programs depend on shortage designation to determine program eligibility or funding preference. Below are select examples:
About the NHSC
The National Health Service Corps (NHSC) helps bring health care to those who need it most. Since 1972, they have been building healthy communities by connecting primary health care providers to areas of the United States with limited access to care.
More than 40,000 primary care medical, dental, and mental and behavioral health professionals have served in the National Health Service Corps since its inception.
Today, there are more than 10,000 NHSC members providing culturally competent care to more than 10.5 million people. They provide this care at more than 14,000 NHSC-approved health care sites in urban, rural, and frontier areas, 177 of those in Colorado alone.
The NHSC is a Federal government program that is part of the U.S. Department of Health and Human Services (DHHS). Specifically, the Corps is administered by the Health Resources and Services Administration (HRSA), Bureau of Clinician Recruitment and Service (BCRS).
All those involved in the Corps:
are dedicated to:
The Primary Care Office at the Colorado Department of Public Health & Environment serves as Colorado's official liaison to the National Health Service Corps, thereby providing a full range of technical assistance and site designation support to all Colorado sites and particpant members of the NHSC.
The Primary Care Office plays a critical role in reviewing and assessing NHSC site and participant eligibility. All NHSC sites must meet the basic criteria listed below:
1) Must accept all publically insured patients (Medicare, Medicaid, and CHP)
2) Must accept uninsured and underinsured on a sliding fee scale
3) Must be located in a federally-designated Health Professional Shortage Area (HPSA)
4) Must provide comprehensive outpatient primary care (including mental & dental) services
If you believe your site meets these requirements, please access the NHSC Site application to begin the review process. If you have any additional questions or would like to request site designation support, contact the Primary Care Office directly at 303-692-2466.
The goal of the Colorado State Health Workforce Development Strategy is to improve the health status of all Coloradans by developing the health workforce, emphasizing the primary care access needs of vulnerable, low income and geographically isolated communities. Colorado's Health Workforce Development strategy was affirmed by the members of the Colorado Health Care Professions Workforce Policy Collaborative in September of 2011 with a subsequent revision completed in the summer of 2012. Through consultation with many of Colorado's innovative thought leaders in the health workforce community, key recommendations emerged. The Colorado Health Workforce Development Strategy groups these recommendations under four heading Organize, Educate, Retain and Advocate.
Related Colorado Programs
Primary Care Office
Colorado Department of Public Health and Environment
4300 Cherry Creek Drive South
Denver, CO 80246-1530
303-692-2466 or firstname.lastname@example.org