After the rhetoric, Colorado secures $200 million for rural health care

By Jen Schumann | Rocky Mountain Voice

“People will die—tens of thousands, perhaps year after year after year—as a result of the Republican assault on the health care of the American people.”

That’s what House Minority Leader Hakeem Jeffries said on July 3, during the longest speech in House history, in an effort to delay passage of H.R. 1—a.k.a. the One Big Beautiful Bill (OBBB)—before it was sent to President Trump for signature.

The eight-hour-plus speech set a tone, framing the bill as “a crime scene.” The 43-day shutdown fight came with its own healthcare messaging. “Republicans have tried to stick us with a partisan CR that fails to protect Americans’ healthcare,” the Democrat leader said on the Senate floor.

With the performative politicking now in the rearview, Colorado’s experience tells a different story.

Colorado is set to receive $200,105,604 for rural health care. 

How the approval unfolded

The approval followed a months-long process of stakeholder meetings that began in early fall. Colorado submitted its Rural Health Transformation Program (RHTP) application to the Centers for Medicare and Medicaid Services (CMS) on Nov. 5, ahead of the federal deadline.

The awards were announced by CMS on Dec. 29, part of a $50 billion push into rural health care nationwide.

“More than 60 million Americans living in rural areas have the right to equal access to quality care,” said Robert F. Kennedy Jr. “This historic investment puts local hospitals, clinics, and health workers in control of their communities’ healthcare. Thanks to President Donald Trump’s leadership, rural Americans will now have affordable healthcare close to home, free from bureaucratic obstacles.”

In Colorado, the emphasis was less on the announcement and more on the work that led to it.

“We thank the many stakeholders who worked with our Department in a shared effort to bring home $1 billion in federal grants over five years in support of our rural communities,” said Kim Bimestefer, executive director of the Colorado Department of Health Care Policy and Financing.

Rural providers said the funding fills immediate needs on the ground. “These funds will allow us to strengthen the care we provide to our rural community by sustaining essential services and expanding access where it’s needed most,” said Kay Whitley, president and CEO of Spanish Peaks Regional Health Center.

Who built Colorado’s plan

The application came out of the Department of Health Care Policy and Financing, which runs Health First Colorado. 

The priorities were clear. Keep rural hospitals stable. Strengthen emergency response. Expand telehealth and mobile care. Build and keep a workforce. Address chronic disease and behavioral health needs closer to home.

The plan limits how much can be spent just to run the program. Administrative costs are capped at 2.98%, leaving most of the funding for hospitals, clinics and care delivery.

The application materials document a formal stakeholder process that included rural hospitals, community health centers, behavioral health providers, emergency medical services organizations, tribal health partners, public health agencies—and workforce and technology partners. 

Support across party lines

Colorado’s application was accompanied by a letter to CMS Administrator Mehmet Oz urging approval.

Sens. Michael Bennet and John Hickenlooper signed the letter, along with Reps. Brittany Pettersen, Jason Crow, Joe Neguse, Diana DeGette, Lauren Boebert, Jeff Crank, Gabe Evans and Jeff Hurd.

In the letter, the delegation wrote that “we are grateful to CMS for this opportunity for meaningful change for our rural communities to support sustainable and innovative health care access statewide.” They also said the funding would “allow the state to strengthen its infrastructure to support preventive health initiatives, health outcomes, and affordability.”

Gov. Jared Polis also submitted a formal endorsement letter backing Colorado’s plan on Nov. 4. 

Back in August, Polis’ office was warning that H.R. 1 would drive up health care costs and put access at risk, especially in rural areas. That release included warnings from Colorado Democrats. Sen. John Hickenlooper said the bill would “gut health care” and “crush rural hospitals.”

But in his Nov. 4 letter, Polis wrote, “I am pleased to provide this letter of endorsement for the Rural Health Transformation Plan… in response to the One Big Beautiful Bill Act. I fully support and commit to this Rural Health Transformation plan to fuel a creative and impactful transformation of health care for rural residents across our state.” 

How this funding works differently

The RHTP is not an insurance expansion.

The funding comes with hard limits.

It cannot be used for major construction, routine care already covered by insurance, lobbying or to patch existing state budget gaps.

Provider payments are capped and tied to filling real gaps in care or testing new delivery and payment models.

The money does not run through insurance companies or pharmaceutical reimbursement channels.

CMS awards the grants to states, which then pass them on through competitive processes to rural providers. It’s not about billing codes or reimbursement. The focus is workforce, infrastructure and technology that make rural care sustainable where it already operates.

What state officials said about the scale

The award also came in higher than state officials had initially hoped for, according to The Colorado Sun.

Bimestefer said during a webinar this fall that if Colorado received its full allocation, “we should all do cartwheels.”

The state ultimately received slightly more than the amount officials initially expected.

From approval to implementation

This is not a one-year infusion. The program is funded from 2026 through 2030.

CMS must first finalize cooperative agreements with the state. Colorado will then open application processes for eligible providers, including critical access hospitals, rural hospitals, community health centers, emergency medical services organizations and tribal health facilities.

Funding levels will be reviewed annually, with continued payments tied to implementation and performance.

What Colorado’s outcome shows

The debate over the OBBB was dominated by dire predictions and high-profile floor speeches. 

Since then, what’s become louder is the discovery of healthcare fraud to the tune of billions. 

A senate finance committee fact sheet for the RHTP touches on this after pointing out that “since 2005, approximately 112 rural hospitals have closed.” It states that the OBBB doesn’t change any of the federal special reimbursement program or payment enhancements, but that it does “make reforms to prevent states from exploiting sources of federal Medicaid revenue.” 

And that the “reforms require states to refocus their Medicaid programs on the truly vulnerable patients for which the program was intended.” 

Without using a term that the Colorado state government has an affinity for, the fact sheet also states, “the RHTP is designed to help all rural hospitals, not just those in states that have been gaming the system.”

Colorado’s approval under the RHTP has gone through a process, and as has been shown, one that’s been transparent and publicly accessible along the way. 

It followed months of planning, bipartisan support for the state’s application—and a funding approach that puts dollars directly into rural providers for workforce, technology and access.

The real test now is not rhetoric. It’s whether Colorado delivers results—and whether those results hold up each year when the state applies for continued funding.