Grand River Health (GRH) in Rifle is not closing. That’s the word from CEO Jim Coombs in a July 11 letter to The Sopris Sun. Coombs said media coverage, at the time of proposed Medicaid cuts included in the Big Beautiful Bill Act (BBB), was incorrect. “The criteria used to identify at-risk hospitals included having negative operating margins for the past three years,” he wrote. “Grand River Health does not meet this criterion — we have maintained positive operating margins during that period.”

It all started in early June when U.S. Senators Ed Markey (D-MA), Ron Wyden (D-OR), Jeff Merkley (D-OR) and Chuck Schumer (D-NY) formally asked the Cecil G. Sheps Center for Health Research at the University of North Carolina for information about the budget reconciliation bill and potential impacts to rural hospitals. 

The Sheps Center report pointed to six hospitals in Colorado — GRH in Rifle, Delta Health Hospital in Delta, San Luis Valley Health Conejos County Hospital in La Jara, Prowers Medical Center in Lamar, Southwest Memorial Hospital in Cortez and the Arkansas Valley Regional Medical Center in La Junta — that could close if Medicaid cuts were passed. President Donald Trump signed the BBB into law on July 4 with almost $1 trillion in Medicaid cuts over the next 10 years. 

In Colorado, one out of every four people receive Medicaid, according to the Colorado Department of Health Care Policy and Financing (CDHCPF). Some BBB Medicaid changes do not take effect until December 2026, including an increase of eligibility renewals from once a year to twice a year and adding new work requirements for Medicaid recipients. 

The big financial blow could come in October 2027 when provider fee decreases and related federal funding cuts take effect. This is where revenues to cover Medicaid and the Child Health Plan Plus program would decrease, says the CDHCPF.

But Colorado put a state-funded program in place eight years ago. The Colorado Healthcare Affordability and Sustainability Enterprise Act of 2017 created the Colorado Healthcare Affordability and Sustainability Enterprise (CHASE). Through this program, hospitals pay a fee which is matched with federal Medicaid funds. These funds increase state Medicaid and Colorado Indigent Care Program (CICP) payments to hospitals and expand health care coverage in the state Medicaid and Child Health Plan Plus programs among other things. CICP covered the gap when Medicaid costs outpace Medicaid payments. The state has other options such as hospital discounted care or individual clinic programs, but CICP sunsetted on July 1.

GRH’s total net income last year was over $20 million, according to the 2024 Community Report. Coombs states that the hospital district has maintained positive operating margins going back to 2021, contrary to the Shepp report criteria of negative operating margins for three years. He also stated that 17% of GRH’s patients are on Medicaid, which is lower than the state average of 25% and the national average of 20%. 

He said “2024 was a record year” for GRH and that the hospital is “well-prepared to navigate” reduced property taxes. But Coombs does not mention that GRH did not receive payments from government programs such as Medicaid and Medicare, according to the 2024 report, to the tune of $59,379,500. Medicare patients make up 39% of GRH’s overall patient population. That means 56% of GRH’s patients are dependent on federal programs with 17% in danger of losing that coverage.

Only 10% of GRH funding comes from tax revenue, including property tax; 90% comes from payments for patient care, including self-pay, private insurance and state and federal government programs. Coombs has yet to respond to The Sopris Sun’s request for comment.

How will GRH cope with the loss of CICP combined with Medicaid cuts down the road? One option could be the State Directed Payments (SDP) Program Proposal, which was submitted to the federal Centers for Medicare and Medicaid Services in June. According to the proposal, SDPs are used in 40 states and bridge the gap between low Medicaid rates and the actual cost of healthcare. Perhaps this is one of the sustainable solutions Coombs urges lawmakers to consider for rural hospitals.