Lindsey Toomer, Colorado Newsline
Before the injury, he loved playing football, camping, hiking, skiing and mountain biking, he said.
Now, if he didn’t have access to caretakers with the specialized skills required to help him, he would die, he said. Medicaid has paid for those caregivers for decades.
Giminaro went to college in Pueblo and earned an engineering degree. He got a job working for a boilermaker and was excited to contribute to a workplace with his education. But since the only health insurance program that pays for the type of long-term care he needs is Medicaid, he had to quit his job so he would financially qualify.
He is unable to work and now spends his time advocating for patients like him. But if he didn’t have Medicaid, he wouldn’t be able to live independently at home.
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“Medicaid allows me to function … if I didn’t have it would just be devastating,” Giminaro said. “If I didn’t have in-home care, I would have to live in an institution. We’ve all heard the horror stories and we all know that people thrive in community.”
The administrative processes patients have to go through to receive coverage under Medicaid are not set up for people with disabilities to successfully navigate. Some would argue that the system is designed for disabled people to fail, Giminaro said.
Cuts to Medicaid and caps on care would drastically affect not only Giminaro, but the healthcare workers and hospitals who have helped him for so long, he said.
Giminaro and other patients and family members who fear cuts to public healthcare coverage under federal policy changes talked at a roundtable that U.S. Sen. John Hickenlooper hosted Tuesday at Tepeyac Community Health Center in Denver.
Adam Fox, deputy director of the Colorado Consumer Health Initiative, emphasized that Medicaid cuts are only just starting, with more coming in 2027. The Republican tax cut and spending bill known as H.R. 1 cuts $1 trillion from Medicaid over several years, making it the largest cut to the program in history, he said. Colorado is estimated to lose up to $2.5 billion annually until 2032 because of cuts the law made.
“As these cuts take effect, Coloradans health, well-being, economic, security and indeed their very lives are being put at risk,” Fox said. “Medicaid is the foundation of our healthcare system, and H.R.1 is a direct attack on that foundation.”
More Coloradans will continue to be stuck deciding between paying rent, buying food and seeking healthcare, he said. The end of enhanced premium tax credits for people who purchase health insurance through the Affordable Care Act marketplace continues to increase costs, too.
“This also comes at a time when we’re seeing large healthcare corporations, whether it’s the insurers, the hospitals, drug corporations, or the various middlemen in our healthcare system, drive costs even higher,” Fox said.
Program changes that will start next year, like additional paperwork and verification requirements, are “designed to rip away” coverage, Fox said.
“We know that Medicaid is complicated enough as it is … but these requirements are so onerous, and the state has not had enough time to develop the sstems necessary, that we fully expect these changes to bog down our entire Medicaid system, regardless of whether these requirements apply to everybody or not,” Fox said.
Colorado legislators this year had to make cuts to the state budget to close a $1.5 billion budget gap created largely as a result of H.R. 1, and state analysis projects more budget cuts next year, Fox said. Amendment 87, a ballot measure Coloradans will vote on next week that would create a graduated income tax structure, would help fund healthcare, childcare and education programs, Fox said.
How to do more with less
Healthcare officials at the roundtable talked about their constant need to help more people with fewer resources, and that dynamic will worsen under upcoming cuts to Medicaid. Pablo Hester, an executive at Tepeyac, said health centers like Tepeyac will have to take on an increased administrative burden as they adjust to the changes to Medicaid such as work requirements, and they need more staff to do that.
For many people, community health centers are the best option for preventive care that is affordable and accessible, Jim Garcia, Tepeyac CEO and founder, said. But the need continues to exceed the center’s capacity.
Hickenlooper said community health centers are the “last hope” for a national health system that works.
“Anti-government forces in Washington are constantly painting pictures of waste and fraud and abuse,” Hickenlooper said. “What I see is constant improvement of efficiency and trying to figure out how to do more with less to still deliver the care that the community needs, and there’s not enough money.”
A denial
Even without the upcoming requirements, Medicaid is hard to navigate and stresses families when their access to care changes. Kari Brauer’s 11-year-old daughter, who has a developmental disability, requires daily assistance from a caregiver.
Since 2020, Medicaid authorized 5.5 hours of certified nursing assistant care each day — a role Brauer has filled. But funding for that care ends this week since the state denied her most recent request.
The denial letter acknowledges that Brauer’s daughter requires daily caregiver assistance but says she does not need the specific skills a nursing assistant provides, citing a lack of injuries or complications.
“Are we supposed to wait until my daughter gets hurt before the cure that prevents it is considered necessary? The absence of injury doesn’t mean there is no risk,” Brauer said. “It means someone was there to recognize the risk and intervene before something happened.”
Brauer will be able to find another in-home Medicaid program for her daughter to enroll in, but it won’t provide as much support as the long-term nursing assistant funding did. The logistics of coordinating changes in care is a major stressor for Brauer, who works a full-time job on top of caring for her daughter.
Lindsey Toomer covers politics, social justice and other stories for Newsline. She formerly reported on city government at the Denver Gazette and on Colorado mountain town government, education and environment at the Summit Daily News.
