It's been about a year since the official end of the COVID public health emergency - which has led to a significant drop in Medicaid enrollments and a rise in uninsured individuals in Colorado.

This poses challenges for community mental health centers, like the Jefferson Center for Mental Health, where the rate of Medicaid enrollee decline has surpassed earlier predictions. It has remained below pre-pandemic levels since January.

Dr. Kiara Kuenzler, president and CEO of the Jefferson Center for Mental Health, said it's now facing a daunting $6 million shortfall.

"The people that we're serving are just in extreme stress, struggling to deal with regaining health-care benefits. That impacts not only their access to behavioral health care, but all of their health-care needs," she said.

The nonprofit KFF recognizes the need for behavioral health at an all-time high in its 2023 Colorado fact sheet - identifying more people than ever reporting mental health and substance use challenges.

Kara Johnson-Hufford, Colorado Behavioral Health Care Council CEO, emphasized the urgent need for support for these clinics. She noted a projected shortfall of $24 million to $29 million for these centers overall could mean a risk of reduced services, longer wait times and compromised care.

She added many individuals who have lost Medicaid coverage and now have private insurance are also seeking treatment less frequently - or discontinuing it altogether - due to co-pays and deductibles.

"More people than ever are now going without insurance. No longer qualifying for Medicaid, but cannot afford private insurance - or they may be giving up on Medicaid altogether because of the emotional toll of the enrollment process just being too great," she continued.

Johnson-Hufford predicted if reimbursement mechanisms don't keep pace with the need, programs will close. Despite efforts to address the issue, such as helplines and complaint processes, she said the gap in funding remains a critical concern.

Columbia County, New York, is developing a new center to help people with mental illness and substance use disorder.

The Wellness Hub stems from a county study showing the best ways to fill gaps in care for people. It will provide emergency housing for people with mental health and substance use disorders.

Cheryl Roberts, executive director of the Greenburger Center for Social and Criminal Justice, said not many places offer services for populations in need.

"A lot of the emergency housing is nothing more than motels that are often located far from services," Roberts pointed out. "No food in the area, no other services, and that's the case in Columbia County. There's one hotel that provides services, but most do not."

The hub will have a ground flood-safe haven shelter with 25 single-room occupancy units. The hub will also have 35 units of permanent supportive housing and up to 14 120-day supportive housing units staffed with clinicians. Additional funding would be spent on a welcome center with space for peer-support services, a commercial kitchen to train people in culinary arts and other amenities for homeless people in the area not staying at the hub.

Early feedback has been overwhelmingly positive. The hub has become more necessary since the pandemic exacerbated mental health issues and homelessness. Roberts notes the Wellness Hub will work hand-in-hand with the county's mental health court. She said the 35 units of permanent housing can provide added resources for people in the criminal justice system.

"Half of it will be set aside for people with serious mental illness," Roberts outlined. "A quarter of it will be for people who are justice-involved, so coming out of incarceration or may be in the midst of the justice process where they might be taking a plea in the treatment court and being required to follow a treatment protocol."

One of the biggest challenges for maintaining the Wellness Hub is the ongoing shortage of mental health professionals. Reports show the number of New Yorkers with a mental illness has grown since the pandemic. The Health Resources and Services Administration found there are 192 designated mental health professional shortage areas, leaving more than 3.5 million people without access to mental health services.


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As the school year begins, experts are advising schools on how to preserve students' mental health but politics in states such as Wyoming limit policies that could help.

The youth suicide rate in Wyoming is increasing and has led the national rate for at least the past decade, according to Wyoming Department of Health data. Experts said K-12 schools can be good points of contact for student mental health but there are barriers for schools.

Rep. Dan Zwonitzer, R-Cheyenne, is on the state's Mental Health Task Force and said suicide prevention and mental health treatment can be challenging in rural areas.

"Just due to our lack of population and the rural nature, it's really tough to recruit and find individuals in this space to come in and work with the kids in many of our areas," Zwonitzer pointed out.

He and other members of the state Legislature tried to change it this year with House Bill 119, which would have made funding available for school districts to supply additional mental health providers for students. In a break from typical practice for interim session bills, it was voted down for introduction to the House.

Gov. Mark Gordon has prioritized the expansion of mental health services while in office. But Zwonitzer pointed out there is a lot of ideological diversity across the state.

"There's just a large segment of Wyoming, at least in their legislative representatives, don't believe that we need to be spending more money for the schools to deal with mental health challenges; that should be in the churches or nonprofits or within the family," Zwonitzer explained.

Zwonitzer and experts agreed schools are a critical place to identify student mental health problems or patterns.

A school checklist from the mental health advocacy organization Inseparable includes age-appropriate mental health education for students, engagement with families and community partners and a recommended professional ratio of one social worker and one counselor for every 250 students.

Caitlin Hochul, vice president of public policy for Inseparable, said schools provide the best opportunity to reach students in need of help.

"When we talk about access issues, we know that most kids are not receiving the care that they need. Schools are such a critical component to improving youth mental health because that is where students spend most of their time."

Transitioning back to school can bring as much stress as excitement for many students and a new checklist created by the group Inseparable aims to help parents and educators ensure children are getting the mental health care they need.

Sen. Dafna Michaelson Jenet, D-Commerce City, said it is important for services to be available where children spend the biggest part of their day.

"They are more likely to participate in a mental health assessment or intervention at school than they are outside of school," Jenet pointed out.

Half of students between the ages of 12 and 17 experiencing depression are not getting treatment, due to stigma, cost, transportation and other barriers. The checklist includes training teachers and staff in mental health, substance use and suicide prevention; the ratio of on-site mental health professionals to students; regular mental wellness check-ins; teaching kids relationship and other life skills, and mental health literacy.

Colorado lawmakers recently passed House Bill 1406, which creates a new School-Based Mental Health Support Program expected to serve up to 400 public schools by the start of the 2027-28 school year.

Matt Holtman, children and youth intergovernmental liaison for the Colorado Behavioral Health Administration, said the program will emphasize supporting rural schools and other areas where students do not have equitable access to mental health care.

"That includes classroom-based mental health wellness and resiliency, a cognitive behavioral and mindfulness skill building training," Holtman outlined. "Also resources and training for the schools to manage suicide risk and coordinate care."

Jenet pointed to Colorado's I Matter program as another option for parents and educators. After filling out a short online survey, students can access free therapy sessions. Because children are more willing to open up to people who understand their situation, she added it is important for schools to recruit mental health professionals reflecting the state's diverse residents.

"I had an African American mom who reached out to me in crisis," Jenet recounted. "I suggested she try the I Matter program, and she was able to get therapy that evening for her child from an African American therapist. And that meant a lot to their family."


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