Public Health in the Rockies 2026

Background / Purpose: Colorado faces significant healthcare access disparities driven by economic, geographic, and systemic barriers. Federal workforce shortage models fall short in modeling these gaps because they exclude non-physician clinicians, fail to capture demographic variations in demand, and use a relatively coarse geographic resolution. In 2018 in response to these limitations, Board of Health Rule 6 CCR 1015-6 created authority for state health professional shortage area (sHPSA) designation to be administered in parallel with federal HPSAs. In this presentation, we debut our latest advancement to this work: Our newly developed Medicaid-specific sHPSAs.

Methods: Data capturing the supply of Medicaid health services were available via a custom Medicaid Claims data extract from the Colorado All-Payer Claims Database (CO APCD). The annual volume of Medicaid encounters is summed for each healthcare facility and health discipline (primary, dental, behavioral, and perinatal). Demand is based on Census Block Group Medicaid enrollment estimates, and is adjusted for varying rates of need by age, sex, and health discipline. The Variable Two-Step Floating Catchment Area method is used to calculate the ratio between supply and demand for each census block group.

Results: Medicaid sHPSAs yield a highly accurate, localized assessment of shortage by comparing actual Medicaid claims data to the demographic-specific needs of the enrolled population. Similar to all-payer models, shortages are most severe in rural and frontier communities; however, Medicaid sHPSAs reveal a distinct geographic pattern relative to all-payer models.

Implications: Medicaid-specific shortage models are increasingly important given the evolving federal policy landscape, constrained state budgets, and changing Medicaid eligibility requirements. Relying solely on all-payer models risks obscuring specific access barriers experienced by the Medicaid enrolled population. This strategic approach accurately maps where shifts in Medicaid coverage intersect with safety-net capacity, enabling state and local organizations to direct interventions efficiently and optimize limited public resources.