Welcome back to this weekly meeting of the Health and Safety Committee with Denver City Council.

Coverage of the Health and Safety Committee starts now.

Hi, focus.

We are on air.

There is a very odd.

All right, here we are.

Thank you.

Welcome everyone to the Wednesday, April 1st, 2026 meeting of the Health and Safety Committee of Denver City Council.

I'm the co-chair, uh Kevin Flynn.

I represent Southwest Denver's District 2.

I'm chairing for Councilman Watson, who I think will be online.

In fact, I believe he is online right now.

Before we start with our presentation, I want to remind folks there are two items on consent that'll go forward unless there's objection before the end of the meeting.

Um we have a presentation from Denver Health on the two Q sales tax uh spending a quarterly update.

And so I want to welcome them.

But first, uh let me have uh members introduce themselves.

And we now have uh two members online.

Let's introduce the members online first in in the order of your district, starting with district nine um thank you.

Uh Vice Chair Um Flynn Um Daryl Watson representing the fine district nine.

And Sarah Parody, uh, one of your two council members at large.

And for the folks at the uh table, uh, because of April Fool's Day, let me mix it up a little bit.

Let me start at the far end on my right and work our way around counterclockwise.

You're awake.

I'm not sure I'm gonna be able to do this.

I mean, sorry, your district five.

Wait, which way do we go?

Yeah, which way are we going?

Oh, yeah.

Hi, everybody said Anna Gonzalez Gutierrez, your other council member at large.

Last but hopefully not least, Paul Cashman, South Denver District 6.

Thank you.

And seeing how well that went, I'll probably never do that again.

Um, welcome to Donald Lynn and your crew, and we're looking forward to this presentation.

Uh folks have probably had an opportunity to see it before, but uh the public hasn't.

So uh please proceed and introduce your team.

Great.

Um thank you so much, Councilman Flynn and Councilman Watson, uh, who are remote.

Um I'm Donna Lynn, the CEO of Denver Health.

Happy to be here to talk both about 2025 2Q spending and our 2026 spending plan.

So I'm gonna turn it to you to introduce Stephanie Seiner Government Community Relations.

Happy to be here.

Hi, I'll Elise Mattal.

Uh I am the Denver Health Sales Tax Administrator within the Denver Department of Public Health and Environment supporting as a liaison between Denver Health and the City.

Hey, I'm Justin Halspir, interim CFO of Denver Health.

And there may be questions that I turn to some of the other staff.

We've got about four or five here, uh, and we'll introduce them if they are uh necessary to respond to questions.

Is that okay?

Great.

All right.

May I begin?

You're good.

All right, let's go to the first slide.

And um just as I said, we're gonna break this into two sections because 2025 uh we closed out and we have a report on how we've spent the money and some of the accomplishments, and then 2026.

We will um look forward and there will there may be modifications uh to the plan as we go forward.

All right, so sorry because the first slide is really full of a lot of information, but just to refresh everybody's memory, um we received from the city what we call an MI payment, medically indigent payment.

We have gotten that since the separation of Denver Health and the City.

Um it has been fairly flat uh for many years, and I'll show you a slide in a few minutes about that.

Um as we've seen more people coming to Denver, more people moving to Denver, more patients coming to Denver Health, and certainly the cost of health care.

We've seen our what we call our uncompensated care increase, and that uncompensated care falls into two buckets.

One is people who are completely uninsured who come to Denver Health, and we have no um way of collecting any money from the federal government from that.

And then we receive a pretty significant amount of Medicaid and Medicare, and I like to use the example of if you need to have a dollar of expenses.

And so as I evaluated that, I've been at Denver Health for three and a half years, and we engaged with the community.

We looked at other um cities and counties around the country, and many of them have special taxing districts, they have other property tax revenues that allow them to um provide this coverage.

Um without the support of the council and the mayor and the citizens to enact two Q back in November of 2024.

And I'm going to talk a little bit, not a lot, about what is ahead of us in terms of the federal government cuts, which will really start hitting us pretty hard in 2027.

We also are in the midst of working with the state of Colorado, state of Colorado, who has, as you know, a significant budget deficit.

And with a third of their spending being Medicaid, they are proposing a cut, which we believe will be enacted any minute now, which will be a reduction in the revenue that comes to Denver Health.

And that's a reduction that also doesn't take into account that we have inflation.

We have prescription drugs, other medical costs plus staff costs.

So we'll show you what we think some of that looks like.

So during 2Q, the build-up to 2Q for us was engaging with the community and getting an understanding of what were the services that were important to the community.

And so if you go to the next slide, we just wanted to refresh your memory about the ballot language.

It was a 3.4 cent tax on a $10 purchase.

So just to put it in perspective, and it resulted in about a $65 million increase in the revenue that comes to Denver Health.

We also said, and you'll hear in the presentation today, the areas where it is going to be spent.

It cannot be spent on capital, for example.

We can staff a new building, and we'll talk about that as we go forward.

So no capital expenses.

It was designed to cover the operating expenses that we incur because we don't get revenue to offset that up those operating expenses.

And then as we developed it, we talked to the community about, you know, what are the what are the high profile areas and the areas, quite frankly, that pay off.

If you invest, for example, in primary care and pediatric care, you're gonna have healthier people living in the city, going to the schools, and so those were two of our areas.

Emergency and trauma care, you know, can impact any of us at any point in time.

And then mental health and drug and alcohol use services.

We have an escalating problem, as you know, in not just Colorado Denver and Colorado, but the country around those services and trying to get people on a road to recovery or being able to function was very important.

Um you may remember from some of my earlier presentations, a third of our patients at Denver Health have some degree of behavioral health, mental health, or substance use problems.

So I like to say sometimes, although my orthopedists don't like this, anybody can fix a broken arm.

It's pretty easy, but fixing quote unquote somebody with mental health and substance use issues is not only a longer term scenario, but also creates some moral distress for our own employees who are engaged in that work.

So you're gonna see the we are gonna be very transparent and happy to answer questions both about the methodology but the kinds of services that we provide vis-a-vis V2Q.

Okay, just as a reminder, um, and Denver Health looks uh very different if you were to do this comparison with other health care systems in Colorado.

So almost half of our patients are on Medicaid, and as I said, Medicaid not only doesn't provide us today the amount of reimbursement that we need, but we are facing some real challenges going forward as uh the what's called HR1, the federal bill, one big beautiful bill, uh seeks to reduce the percentage of people that actually are on Medicaid.

We estimate that about 20,000 people in over the course of the implementation of some of the HR 1 requirements just in Denver, 20,000 people will lose their Medicaid coverage.

And as you can imagine, um they need health care, they get health care often at Denver Health, and so they are likely to continue to seek that care.

So we are very concerned about that.

So that's our biggest piece of the pie is our Medicaid population, about another 20 percent are on Medicare.

And commercial insurance is sort of typically the insurance that most of us at this table have.

Our employer provides that insurance often through, you know, Blue Cross, which is now called elevents, or through Kaiser or Cigna or other plans like that.

And that's unfortunate the unfortunate scheme that we have in health care is that you charge more money to the people who are commercially insured because it helps offset the lack of federal reimbursement.

Okay.

Next slide.

This is our uncompensated care in in Denver.

And you know, uh we saw some significant trends post-COVID, and we saw some significant trends also, partly due to the migrants, but not exclusively.

So we have seen this escalation of our uncompensated care costs.

And just to take you to the legend, we do, as you are well aware, see everybody regardless of their ability to pay, it doesn't matter where they live.

We see patients from 61 of 64 counties.

They sometimes come to us through the emergency room, but sometimes they're just seeking care for other reasons.

We've been very careful, actually, having talked to the mayor, but recognizing this trend even before he came into office, that we want to focus our care on Denver residents.

And we have done a number of things to refer patients back when necessary or appropriate to their counties of where they come from.

So we still have about over a hundred million dollars of uncompensated care that's attributable to Denver residents, and we have seen a little bit of a stabilization and even in a reduction in what we call out-of-county uninsured patients.

We're required by law to see Medicaid patients.

If a Medicaid patient lives in Durango and comes to Denver Health, we have to see that patient.

So we do have that discrepancy.

So you can see that when we started, when I came to Denver Health, there was 120 million of uncompensated care.

We saw that growing.

So we peaked in 2024, stabilized a little bit in 2025 in terms of the dollars that we don't get adequate reimbursement for.

And you've seen this one.

I used to call this my favorite slide.

Still pretty much my favorite slide, but it shows the flat line at the bottom, which is the my payment that we get from the city, and then the you know, I'll call it the hockey stick, the escalation of our costs at Denver Health.

So we are now one point 1.6 billion dollar enterprise as of for this year.

That's our estimate of what our costs will be.

You probably know this from your own health care expenses, and uh health care is going up at least two times general inflation, and certainly significantly above people's wages.

So when we left the city in 20, excuse me, in 1996, our budget was just a shade over 200 million.

The city was giving us 27 million in the MI payment, and today we get 30.7.

So 2Q was significant.

Um the city share is about 2% of our budget, the MI payment, and then the 2Q is about 4% of our budget.

So despite the size of Denver Health, there's about 6% of our revenue that comes from the city.

We get no revenue from the state as of this year, although Medicaid does pay a portion of that.

And Medicaid, as you know, is a split between the federal government and the state.

Okay.

So just that was background, and hopefully it's all a refresher to things that you know and that we've talked about in the past.

So I want to talk about 2025 and how we are reporting and attributing the money that we get for 2Q because transparency is very important for us.

And we've worked very closely, and I want to thank Elise for the work that she has done with us.

It's really been hand in hand to try to figure out how do we report this to you in a way that ensures that you feel that we're being accountable for the money that we get.

We have to submit reports to the federal government every year.

There is something called a Medicare cost report.

And so we decided to use that same methodology that we use when we send things to the federal government to calculate what our spending is.

So it's consistent where we are looked at by the feds who come in, the state that comes in, and so the city has helped in that ensuring that methodology works.

And so we look at the services that we provide, and we know exactly how the feds and the state have accepted our methodology in the past.

And then what I'm gonna share with you in a second is how do we show that money by category?

Okay.

And Justin's here to help me because I already had a conversation with Daryl, and he said, I don't understand what you're saying, and I said, I don't either.

But I do have somebody who does.

All right, so here's how we do this.

So we take a look at all the buckets.

We have services that we provide, as you know, in the hospital, and then we have services that we provide in our clinics.

That's our total cost, our total expenses.

We divide it by our volume, which is the number of visits that we have, and then we come up with a what does it cost for each encounter.

Now, on the inpatient side, it's way more expensive than it is on the outpatient side.

So an average can be a little a little challenging, but we can talk about, you know, depending on the services, how we split that out.

And then our expenses, what we do is we're going to share with you in the buckets in the five buckets that we have for 2Q, how we split that out from a dollar perspective.

And in some cases, we you know, there are direct services that we provide, so the cost of a nurse, the cost of a lab tech, et cetera.

And then we also do have some indirect costs that we include, so the cost of uh administrative staff, payrolls, security, et cetera, are built into what we call the indirect costs.

Okay, you can go to the next slide.

All right.

Here's what starts getting dicey.

That's what I'm gonna say, Justin.

Um so we wanted to show you what 2024 looked like from this exam in this example compared to 2025.

And then 2025 without 2Q, and then with 2Q, so that you understand that even with 2Q, we still have some expenses that are unreimbursed.

So Denver Health is not going to be able to say, like many hospitals and health care systems will say, and there are hospital systems that last year had an 18% profit.

There are some that had a 10% profit.

Um we generally are in, if we're not losing money, we're in the 1 to 2% range in terms of what we call a margin.

We don't call it a profit.

And that's partly because of the amount of uncompensated care that we have.

So just to take you through this legend on the far right uh bar, the light blue column represents the money that we get through Medicare, through Medicaid, commercial insurance, and everybody else.

The purple bar uh represents what we get through 2Q, so that's the 65 million, and then the striped uh the striped bar section of the bar is what we still have as uncompensated care.

So 2Q has been really important to us, but it hasn't solved the ongoing problem that we have at Denver Health.

Okay, I got you.

I got you.

All right.

Let's go to the how we spent the money by category.

If you can go to perfect.

Um we had estimated along with the city that the 2Q revenue, the point three four the point three four would generate about sixty-five million.

I think it's actually a little bit more, Elise, that we're we're seeing, which is a good thing.

When when there is more, uh we get more, and we'll show you that.

And remember, we also had a conversation around the administrative expenses that the city has, and I think we're Elise's gonna go through that uh shortly.

So by category, we um allocated this money through the five categories.

So emergency medicine and trauma was the single biggest category.

Where and and the reason is we didn't do that arbitrarily.

We looked at how much uncompensated care do we have in these buckets, and therefore we allocated the most amount of money to emergency and trauma care.

And then you can see the next biggest category was primary care, the third mental health at 13 million, and then pediatrics and alcohol and substance use at about two million each.

Okay, let's look at emergency care and emergency medicine.

So again, looking at how much money we get from Medicare, Medicaid, and from our commercial insurance.

That's the on the far right bar, that's the blue bar section of the bar.

Then the 34 million that we get from 2Q is how we attribute that.

And you can see in particular, there's still a significant funding gap when it comes to our emergency and trauma care.

I do want to emphasize to you that we do a lot of work in what we call revenue cycle.

That's a that's code word for we have to go collect the money.

And oftentimes we try to we we we do try, and sometimes we succeed, but sometimes we don't.

We do try to collect money from patients who are uninsured.

We also have some discount programs, and so um there's a lot of effort involved in trying to make sure that we just don't say, come on in, we'll give you free care, but we are we are um active, I don't want to say aggressive.

I know some hospitals are aggressive in trying to collect uh at least some portion of a patient's bill when they come in without insurance.

So that remaining gap, uh the stripe lines that you see is actually 91 million dollars that we don't have any other mechanism to collect from.

All right.

Now, what I wanted to do, and I've done in prior um hearings is also to say to you what were we able to do with the 2Q money because we want you to believe, and we are committed to doing this, that we are also investing in additional services for our patients at the same time that we're trying to cover all of our costs.

So on the emergency and trauma side, there are a number of things that we did.

One, uh, there's a nice little picture of um, if you haven't been in, hopefully you haven't, you don't know what this is.

So if you think about television, let's think about television.

And a patient all of a sudden is in the operating room, but then we need some kind of radiology.

We need some other intervention.

And the patient gets wheeled down a hall, oftentimes in an elevator.

And so, what this hybrid room allows us to do, and we only have one of them, um, it allows us to perform advanced surgical techniques that need radiology simultaneously, and nobody has to get wheeled any place else.

So you don't have that disruption in the care.

Um it's probably also somewhat unsafe wheeling people around and wheeling people back in that case.

So we built a hybrid, what we call a hybrid OR room.

They're somewhat common around the country, and um it was a it was an opportunity for Denver Health to sort of bring our services up to the rest of the company, country, excuse me.

Um we also um have a lot of trauma that, as you know, comes into Denver Health, and we are on a pathway to be a certified stroke center, and part of that is demonstrating to the people that give us those certifications that we have ICU capability, that we have all the staff that we need to be able to take people who have that kind of trauma.

Right now, what we do is we send them other places, and um that is not a good thing, both for the pay, neither neither for the patient nor from a revenue perspective.

Um we're also trying to, we have a pretty significant residency program for trauma, um, but we are also um bringing in fellowship, so post-residency, you often have a fellowship that provides enhanced skills.

And then finally, um we, as you know, with our paramedics have had some workforce retention problems based on pay.

Uh oftentimes paramedics at Denver Health go to other systems, they might go to the fire department where the salary schedule is quite different.

So we have uh what 2Q allowed us to do was not directly do this work, but it took a little pressure off of me and some of the demands that we have.

So we were able to do a lot of things that create for the city a better uh level one trauma center that serves all of our residents.

Okay, we can go to primary care.

Similar story, if you look at the far right bar, you can see that uh we spend about 158 million in this bucket that actually gets reimbursed by the feds, the state, or through a commercial insurance.

Uh we allocated 14 million.

This is our second biggest category to primary care.

We still have a funding gap in terms of um the lack of revenue that we get in primary care.

And then there's a few things that we're doing in the primary care space that are expansions in particular.

We have extended expanded some of our dental services, including making them more accessible to patients through longer hours.

Um we've also done that out at Lowry.

And thank you.

And we now have a Saturday clinic at Lowry.

Again, health care is kind of weird, other than emergency, we think everybody should get health care at the same time they're working, and that doesn't always work.

We luckily have other clinics that provide urgent care, so our Pena Clinic, we have a downtown urgent care, and we have a Denver Health Urgent Care location as well.

And then we also built a partnership with uh Warren Village, which you know they have a new campus on Alameda, and we are providing health care to those individuals two days a week.

We also do that at Roseandom, and we um longer term will be doing that.

I think as Councilman Watson knows, we will doing be doing that kind of work at Clayton Early Learning Center.

So we're trying to build a system that isn't just come to the 10 Denver Health community clinics or the school-based clinics, but we're also trying to embed ourselves in community-based services.

Again, let's look at the far right bar, which shows that we were able to collect a reimbursement of 32, almost 33 million in pediatrics, either Fed, state, or I'm sorry, Medicare, Medicaid, or commercial.

We are allocated two million from for 2Q to help us, still leaving us a gap.

And then a couple of other enhancements that we've been able to do in pediatrics is we will be adding our Sandoval campus for school-based centers.

We have added some additional practitioners in our school-based clinics.

And we do have a foster care kids program that actually tracks foster care kids' medical records.

We do that out of our Eastside Clinic, and we are adding a second clinic where we will be doing that program.

And then mental health, if you're slide again, go to the far right reimbursement that we got that covers our expenses of about 112 million dollars coming from Medicare, Medicaid, and Commercial, about 12, almost 13 million from 2Q, leaving a still pretty pretty big gap.

As Councilman Cashman knows, we have a lot of problems in the mental health area in terms of recruiting staff, keeping staff, and uh I know many of you were at our IMAP, which I'm gonna talk about in a minute.

All right, so um IMAP is the big accomplishment.

We had a number of, I think you're cutting the ribbon.

I think you were next to me, correct?

We were cutting the ribbon.

And uh Councilman Watson in the background, and I know a number of you have been able to tour it.

Our IMAP facility is a new concept, again, similar to the roll you out of the OR down to a radiology suite.

We were saying to people who had medical conditions, we're gonna take care of your medical condition, discharge you, readmit you for the psychiatric condition.

And so IMAP, uh we have 12 beds in our IMAP unit uh on the main campus.

And many of our patients are complex and it allows us to take care of them in one unit.

So you have behavioral health staff and um sort of traditional medical clinical staff.

We've served over 70 patients.

We opened in December, it took us a while to get all the license and other requirements done, and we've served over 70 patients in that program.

And then there's some other programs that we're working on on the behavioral health side that will enhance services.

And then our last category is alcohol and substance use.

We get about 18 million dollars in reimbursement and alcohol and substance use.

Um that's been a little bit of an increase from 2024.

We are allocating about 2 million from 2Q, which still leaves us with a pretty significant gap.

And our accomplishments in that space is that we added a number of FTEs to deal with our patients that have we have a lot of demand in this space.

And in fact, um unfortunately we do turn patients away who come through our emergency room, our separate freestanding emergency room because we just can't take care of all the needs that we have, particularly on the inpatient side.

So we see mental health patients and people with alcohol and substance use issues in a variety of settings, both in the main hospital.

We see them at Denver CARES, as you know, and we see them uh in our outpatient services as well.

Excuse me.

Okay.

Every year when I put a budget together, I look at how much do we have to spend, and most of it's on the expense side, but some of it's on the capital side.

And 2Q gave us a little relief on some of the things we have to spend on the expense side, and so we did add some additional uh I would I had a little bit more room in figuring out my capital budget, and I think the most significant thing, and you may not know what these two little pictures are.

The bottom one looks like it's COVID, but it isn't.

Um that's uh that is what we use to cover up uh what is called our robot.

We have now two robots at Denver Health.

They are used by our surgeons and highly complex surgery.

Uh I was meeting with somebody out on the eastern plains, a hospital on the eastern plains that has 25 beds, and the lead chief medical officer said, Oh, yeah, we have a robot.

And I went, What?

Do you have a robot?

You have 25 beds.

We have 550 at Denver Health, and we know that our physicians who come out of medical school expect to be able to use a robot to do surgery, and it's certainly safer for our patients.

So the top shows you what the physician is actually doing, which is watching, you know, the surgery, and then there's sort of little clause that they're using to perform the surgery on the patient.

So we're excited that we were able to add two of those for 2025.

And I'm gonna turn it over to Elise for this slide, and then happy to take questions, and then we'll talk about 2026.

Much less bright and shiny, but uh as part of our contract, uh, the city is uh able to receive up to one percent for administrative costs.

So part of our reporting is showing whether or not we actually spent the one percent.

And you can see uh it fluctuated a little bit last year, our original spending plan.

We had proposed using the full one percent when we came back to you in August, we said we're definitely not going to use the full one percent, and our actual was much less.

Uh so as part of our reconciliation process, when we realized that the tax revenue was also uh slightly higher, we included the unspent funds from administrative costs.

So I believe I processed the uh invoice yesterday for about 1.8 million additional to go to Denver Health.

Pretty simple.

But happy to answer any questions.

Great.

If it's okay, we'll take a pause and see if there are questions about 2025.

Um before we go to questions, I want to uh welcome council president.

Uh I'm out of sound of all district one is online.

And uh, we have our queue started.

So I'll go first to uh Councilmember Torres.

Uh thank you, Mr.

Chair.

Thanks, everyone.

Um I think one of my first questions is uh when you anticipate or when you said you anticipate major federal cuts hitting in 2027, is it because of the reduction anticipated in Medicaid spending because they're aiming to move folks off of those roles, or is it that and other things or just other things?

It's a couple of things.

As you've heard about the state budget, which is hitting us now.

So if you think about HR 1, they enacted the tax cuts before they had the revenue to offset the tax cuts.

So Medicaid was a big target.

The target um the federal government spends about $880 billion in Medicaid.

Um it's a big number, and there were perhaps other motivations for trying to cut Medicaid.

It had to fund uh tax cuts to individuals of multiples of that $880 million.

In the state, what happened was the tax cuts that people get off of their federal income tax are tied to state income taxes as well.

So the big driver, there's two drivers behind the current state budget.

They're spending more money for Medicaid than they thought, and they're getting less revenue from taxes.

So that's created that problem.

So when I say that we are taking a looks like a 2% cut for their fiscal year beginning in July of 25, 26, excuse me, um, that's due to their tax revenues coming down, and due to the costs.

The big hairy thing with HR one is that the federal government has decided that for Medicaid, there will be, excuse me, there will be work requirements.

So you have to work 80 hours or volunteer 80 hours, community service, or be in school 80 hours.

So you have to prove that.

And so we think people will fall off of Medicaid.

The second is that right now, if you're on Medicaid, you come in once a year to recertify that you're you're eligible for Medicaid.

So you have to show your income, and you're gonna have to show this work requirement.

You now have to do that twice a year.

Having met with Medicaid patients, and perhaps you know some of those.

In some cases, people are forgetful.

I don't know how they're all gonna know that they have to come in twice a year.

I mean, because people move and so forth.

I know we're gonna do, and the state's gonna do everything they can to tell people.

Oops, don't forget, you have to come in twice a year.

But we think, and all the think tanks think people are gonna fall off.

The third thing is that right now, if somebody comes in, I'm gonna use Denver Health as an example.

If I if somebody comes in January 1st and to the hospital, we try to qualify them for Medicaid, and we have 90 days to prove for them to, you know, if they're they've had a heart attack, we're not doing it while they're having a heart attack.

But maybe a couple days later we say, hey, you're eligible for Medicaid.

How can we help you enroll?

We have 90 days for that patient to fill out their paperwork, for HIPPUF, the state agency to say yes, they're eligible and for it come to come back for us.

We have 90 days, which means April 1st, I can claim that that person, that January 1st hospital stay was legitimate and covered by Medicaid.

The feds, as of January of 27, have shortened that to 30 days.

That's going to be really hard to meet, and we'll lose revenue because as much as we're going to try to do everything we can, we're dependent on the patient filling up their paperwork, and we're dependent on the state processing it.

Is there a lawsuit in that somewhere?

Um there isn't a lawsuit on that.

Um there's a lawsuit on everything else that is impacting our reimbursement, to tell you the truth.

So those three things are pretty significant.

The other thing that starts happening, and this gets complicated, I'm gonna I'm gonna make it like simple.

Um we get extra money, we get a little bit of extra money from the feds because Medicaid doesn't reimburse us, and it's called a provider tax.

The feds are going to cut that.

It's six percent.

They're gonna, over a number of years, they're gonna reduce it to three and a half percent.

What's interesting about all this is it affects every state.

So this isn't political.

I mean, some of the actions that we've seen have been Colorado, we don't like you, and we're gonna do this.

This is every every state, every hospital, every health care provider are gonna see this, and um it's gonna cause repercussions in Mississippi and Alabama as much as it does in Colorado.

It will disproportionately hurt Denver Health because of that slide that I showed you with us having 47% of our patients on Medicaid itself.

Okay.

Um as it relates to 2Q spend, um what might be helpful to understand is what becomes carrying cost of 2Q dollars versus what were one time 2025 expenditures that you don't expect to continue carrying in 2026.

And I think about that internally as um if you increased pay or right-sized pay, that's not a one-time cost.

You have to continue to keep that pay up.

If you um establish a school-based health center at Sandoval, uh, maybe some of that is one-time cost in equipment or something, but there are probably other things that are um routine or become a carrying cost of that investment.

Um that might be an interesting thing to see over time because you're gonna probably allocate a certain proportion of what you see in 2Q that are just gonna remain as constant expenditures because in the first couple years that's kind of what was identified to help support um undercompensated kind of areas.

So just to say I think that might be an important thing to share not just with us but also with um residents of Denver to say what's maintained through 2Q are um school-based clinic, ABC, right?

Certain things that we were able to either expand hours, Saturday hours, something like that, or if we're able to demonstrate we've been able to move that cost into kind of our general fund and opened up two Q investment elsewhere, just something like that for the future might be interesting.

The overwhelming percentage of this is gonna be salary wages and benefits, which means it's continuing.

I'm looking at Justin's computer because it looks like he's got this broken out by like every possible category, O B G Y N, you know, clinics, etc.

So um, but yeah, we can absolutely do.

This is in the base, it's never gonna change, uh, or this was perhaps a one-time expense.

But because we're not using this for capital, very little of it is gonna be one-time expense.

Okay.

That's helpful to know.

Um I'm gonna I'll make sure I'm telling the truth.

No, absolutely.

It's primarily routine costs and ongoing costs.

Okay, thank you.

And I think to that also, we're also gonna be trying to explain more of what the inflation is because I think even if volumes stay flat, we went up a three percent inflation, so we may have seen the same amount, but the cost was three percent higher, right?

So understanding that um volumes are not always going to determine that we spent more money.

It was the fact that without Medicaid reimbursement and with the higher inflation, we're that gap is growing.

Volumes may stay level, but that gap is gonna continue to grow based off those expenses.

Yeah.

Okay.

We attended a meeting with you, boy.

Oh, it's over a year ago in the mayor, because some of the things, a lot of the things that are happening in Washington are impacting us, which means then we say, okay, we've got to cut services to the city, not because the city's not funding us, but because the feds aren't funding us, and how do we use our Washington lobbyists, our elected officials at the federal level to tell them the story of what how this is going to impact the city?

Yeah.

Okay.

Um my last question is a little bit broader.

Um I pulled up an article the Colorado Sun did last November about how much money hospitals are making in Colorado.

And I one, I wonder if it's an accurate thing, because it does sound like he's the researcher is charging for his report out.

So I don't know if it's Alan Baumgarner.

Yeah, yeah.

But two, um the report um estates that um UC Health made the most revenue.

6.7 billion in a single year, and they're labeled a nonprofit.

Um, so they don't pay any taxes on that revenue.

So um just curious in like the landscape of Colorado uh uh public serving nonprofit or uh hospitals, like the imbalance that you're carrying debt year over year, like what do you do with that?

But then two, you've got another hospital system over here making that much revenue.

Um, like what happens 25 years from now, 50 years from now, to a system like that.

Yeah, it's a great question, and a couple things.

One, the hospitals do disclose their revenue and their earnings to the state, and the state produces a report, they just uh February released it, and you can literally see how much every single hospital, including small little 25-bed hospitals, are making.

And you can see the statement they made in this, they did a webinar was the profit, the range and profits for Colorado hospitals is from negative 40 percent to positive 35 percent.

Wow.

I don't know how the negative 40 percent people are staying.

We've never been at negative 40, we've been at negative numbers.

And why the heck are we allowing 40 percent profit?

Well, you know, somebody might cynically say, well, that's capitalism.

But at the end of the day, what is gonna happen is the that spread, then you lay on top of that all the Medicaid cuts.

A lot of the in particular the rural hospitals tend to be on the negative side.

Um, they're gonna close.

They've already shut down service lines, so um, I think the accurate I think the number is in half of our counties in Colorado, there is no OBGY in.

Wow.

That's not really a service you travel for, particularly when you're about to give birth.

I mean, maybe up to that point.

Um, so I spend a lot of time with the rural hospitals and some of the others, and they're really they're operating on very, very like low days of cash on hand, and some of them there's been some publicity in the past.

St.

Vincent's in Leadville, for example, needed a loan just to be able to make payroll a couple of years ago.

Um, the interesting thing is the other the hospitals that are making a lot of money, particularly in the Denver metro area, will say things like, we don't ever want to ever health to you know, have shut down services or curtail services, because guess what?

The people are gonna go to those places.

On the other hand, there isn't like a helping hand program where they say, you know, if we make more than 10%, we'll give this money out to other people.

Um it's a state inforcement might be too strong of a word because the state doesn't have any leverage.

I mean, they report this to your where is that report?

Just my um I'm happy to send it to you.

Okay.

I'm happy to send it to you, and I can send it to the chairs and the whole committee.

So uh the state HICPUF agency um produces this report.

All right.

Thank you so much.

Thank you.

Thank you.

Uh Councilmember Willows Gutierrez.

Thank you.

Uh Mr.

Chair.

Um thank you all for um all of the information and the work that's being done, and I know we're still gonna go into the 2026 part as well.

Okay, so I'll hold any questions on that front.

Um going to the pair mix slide.

Um a little maybe pie chart.

Too many windows.

Yes.

Slide five.

So it shows the the revenue 1.56 billion.

I'm curious where would we find the MI and the 2Q and any other like payments from the state that are oh I lost it that are accounted for in that pie charts.

So it has this broken down.

Like, you know, we don't have it up on the screen, but oh, there it is.

Okay.

Yeah.

So where would we find those other revenue sources?

Yeah, no, uh, great question.

So the 1.5, it's included in the 1.56 billion, um, but it is not a payer necessarily in in the traditional sense.

So it's not like a Medicaid or a Medicare or anything like that.

So that pie graph is representative of true payer sources that we get on an individual patient when they come in the hospital.

So then if this says payer mix, and this is the one point 1.56 billion, but the two Q 95 billion, 90 MI payments.

Excuse me, yeah, 95 million.

Uh-huh.

Would and and it's a good point.

We should uh have a way to incorporate it.

Yeah.

So it's as I said, it's equal to six percent of our revenue now.

And um, I think do we include it on the my favorite chart?

It's it's a lot, it's I mean it's it's because it's so small, it's the six percent, right?

Um it's on the that one, yep.

It's the green arrow.

But and so this is the operating expenses, not the revenue.

Right.

Yep, no, I think you bring up a good point that on this chart, even though it's not a traditional payer, that we can show that 95 million as of as a revenue source.

So the night that is incorporated that that amount on that chart is 1.56 billion.

The 95 million is is taken into account in that number.

Yes, is what you're saying.

Okay, I think that's helpful to know.

I just was like, wait a minute, we're missing something.

So yeah, so maybe we can figure out how to display it.

And both on that and the that would be line grip.

Um I think that's I think that was like the main one here.

I might have other stuff for the 2026, but let me just double check.

Keep switching between the wrong windows.

Um, yeah, the the on the fund unfunded gaps.

So as you walked through kind of each of the sections, um, and again, I appreciate you all like reaching out and us being able to have conversations around all of this.

Um just curious.

Um what beyond like payer reimbursement, what funding fills these gaps?

Are there other funding sources that you all have access to or that you're um generating any revenue from to fill those gaps?

There are some.

What we mostly do is we can bill, although we don't have to go back to the pie chart.

Um we try to bill the commercial insurer to offset some of these costs.

The problem is we don't have enough commercial patients that come to Denver Health to be able to do that.

So it either becomes uh we bill, like I use my example.

We need a dollar commercial payer, gets billed a dollar thirty um, or we simply suffer a loss in that particular bucket.

And maybe we need to build out this pair mix a little differently, because I think really the pair mix slide is to show how much we have gap, right?

So if you look at the 47% doesn't get full reimbursement, self-pay, you know, self-funded, so you're at already 60 almost 75 percent, 80 percent of services that we provide that are not reimbursable, right?

So I think to your point, maybe we need another graph to show where the that 90 million and showing the uncompensated care, right?

Because it's still a large pie that's still not covered, being that it's only six percent of the total budget, right?

Um but this really was to show like this actually shows huge gaps of where we're not getting reimbursed at all and and why that gap continues to grow.

Okay, we do also get grant programmatic grants from the federal government, sometimes from C the state from C D PHE that help us provide services.

Oh, they're not significant, and in fact, particularly the federal ones have been cut back under the current administration.

Um some of our public health services get um funded by grants.

Were you standing up to say that?

Um Dr.

Freddy go to Chief Government Committee Affairs members of the committee.

Thank you.

I I might say it a little differently.

I think probably have two graphs.

One that this is pair mix, standalone.

The second might be all sources of revenue that come to Denver Health, and that would be separate.

And I think that's what Donna's alluding to.

A contract that we get the operating agreement.

A lot of times it's cash in, cash out, because it's specific to certain things, but it is still a revenue source in the traditional sense.

So I think they're two different ones.

As you look at the pair mix itself, as Donna articulated earlier, in the Medicaid portion of the pie, 15 cents out of every one of those dollars are going to be represented in the uncompensated care.

A hundred percent of the self-pay or nearly a hundred percent of the self-pay would be represented in those uncompensated care.

So two Q is going to be spread out between Medicaid and self-pay in that chart.

But I appreciate the point.

That sounds great.

All right.

That's all I have.

Thank you, Mr.

Chair.

Thank you all.

Thank you, Councilmember.

That was exactly going to be my question because I was confused by that chart.

Or is it?

Maybe on subsequent reports, uh, we could have a lot more clarity and include that up front.

And maybe not a pie chart, but an actual table showing the showing the dollar amounts.

That'd be fabulous.

Uh next up, we have council uh council member parody online.

Yep.

Hi there.

Can you guys hear me okay?

Yes.

Yes.

Great.

Hopefully, my son will not join me, because then you may be hearing all kinds of noises that are not related to healthcare or Denver Health.

Um so far, so good though.

So I wanted to go back to the um slide that the really helpful slide that has the um boxes on how we're thinking about where two two Q money goes, and that we're basically you looking at a cost per visit uh kind of model for that.

And it would be helpful if we could put that back up, I think, if that's possible.

I'll give the producer a minute for that.

I don't remember the slide number, but the one with all the boxes.

It's nine.

Slide nine.

Yeah, yeah.

Just need to share on the screen.

Yeah, if it's possible to get it on the screen.

If not, that's okay.

But my question about it is really I would like to know more about what's in the blue and yellow boxes, I think, like like uh what contributes to the total cost of a visit.

And the reason that we have so many questions about this, yeah, this one.

So the inpatient total costs and the outpatient total costs or really, yeah.

So I'm trying to get my head around um what feeds into that in the same way that we're trying to get our head around um the other income streams that you have that are not linked to particular patient visits, you know what I mean?

Because in healthcare world, everybody thinks about this in terms of um how a visit is paid for, like that's very natural in the world of healthcare.

And then for the the what we usually are budgeting for and how we look at our city budget, it's completely foreign, you know.

Um, and so I just think for us, like uh that model makes less intuitive sense.

And it's it's a good way to look at the due Q money because it um it helps us think about making sure that people in Denver are getting cared for.

Like I like it as a as a way to view this, so don't get me wrong about that, but I think um it it gets to feel I get a little bit confused by like um how we think about, for example, things that are separately grant funded or things like that.

Um, and there's no probably perfect model of a way to do this, but I would love to understand a little bit more about those boxes.

Um, and then and I don't I I don't think that's probably a right now kind of answer.

Um so then the other thing is um I know there's been a little bit of conversation back and forth about kind of quality metrics, and I Demver Health from my experience and everything else is an exceptionally high quality place to get health care.

But I would love for us to talk a little bit about like um could we get improvements on like wait times for some of these really challenging services, or could we see what those are, you know, as time goes by, like how long is it taking someone to get seen for addiction health care, all those kinds of things um would be amazingly valuable to council just to know what kind of track we're on, and I'm sure you all have thought about that, so we'd love to hear more about how you're kind of measuring um what you're able to provide in these in these different buckets.

And I know you know the two Q dollars are um both really helpful, and they're not like uh earth-shatteringly large numbers within the budgets for these areas, so it's not as though they can uh completely transform what you're doing.

I think you're spending them very wisely, but I would love to know more about what your thoughts are about relevant kind of um quality metrics that could be shared with us in these categories as well.

Sure, sure.

Donna, we're happy to do that um in a subsequent report.

We so we measure access, meaning um time to first appointment, we measure average wait time, we measure, we have waiting lists for some services.

So all of that we collect.

Um we also do surveys for of our patients after they have a clinical clinical outpatient clinical visit, they get a survey that is called CAPS, CAHPS.

Um, and we are the federal government requires us to do that for Medicare, believe it or not, not for Medicaid.

Um we also collect clinical indicators that are on the ambulatory side might be the percentage of patients who have hemoglobin A1C of less than eight.

Um we have hospital indicators that are required by the feds uh as well, and um our state agency requires us to provide a lot of that information.

So and we have it in our health plan.

So we we got a lot of data.

We could show you, and we we can show you um, and maybe we'll just work on three or four indicators that we use to measure both effectiveness and um availability of care.

And uh councilman parody, uh Alisa and I have had this conversation as well because we've we took the feedback from the last meeting.

Um we have actually asked for an extension for the end of year report for this year so that we can um ensure that we're putting the right metrics in the final um end of year report to be consistent from now until forever.

Um and so we will be working through uh those this next month.

Um we also talked about overlaying uh report to the city because the operating agreement requires a report to the city at the end of at the beginning of May.

And so how can we make this a next chapter for that, right?

And so it's we're not duplicating any efforts, but we're adding a new two Q chapter to the report to the city with some of these quality metrics.

So thank you for the feedback.

We'll we'll add some of those that you put in that maybe we haven't thought about um into that end of your report.

Okay, that's amazing.

And I think like the again, I know you clearly you c you um co-ops and calculate so many of these different things, and so the question is kind of like anything.

I I think we um would be really grateful for just more of that uh information.

And even if that meant uh including it in the report for Joky, I think is um in a thoughtful way is really great because of that like repeated element of it over time.

But I also would say that if you have um reporting that you've done for other levels of government and you just want to share it with the members of the committee, I'd be thrilled by that.

You know what I mean?

So um some of it doesn't need to be reslicing and dicing things that you've already done.

I just um I personally am so curious about um, especially in the in the area of behavioral health and addiction treatment where we have such black logs and so much catching up to do.

I'm grateful to see information.

Absolutely.

Do you want to talk a little bit about the total cost?

I think she wants us to do it separate.

Okay, well.

Yeah, unless if you have something you want to say about that, feel absolutely free, but it seems like maybe more technical than it seems like maybe more written information than verbal information is my guess.

But feel free if you if you did have something you wanted to say about it verbally.

Yeah, that makes sense to me.

Okay, thank you so much.

Those were my questions.

Thanks, Mr.

Chair.

Thank you.

My GDPHG on Denver Health.

Tons of work has gone into this, and it's um it's really cool to be um have have this way to work a little more closely together.

So I'm so glad we passed the tax.

Thank you.

Your son has no questions for us.

Well, he does, but he's he's been banished.

Thank you.

Uh Councilmember Cashman.

Thank you, Mr.

Chair.

Um, if we can go back to Donna's favorite slide.

Um you know, it's really a basic question.

So the 30 million that was 30 million remaining 30 million.

There's still 30 million.

What is your understanding?

What is the purpose?

Why is the city paying any money at all that happens to be that 30 million dollar?

Well, I mean, 28 years ago, and or not 29 years ago, I guess now, back to 1996-97.

That was embedded, that's embedded in our basic operating agreement with the city.

Um, I believe the language, and I've got my lawyer here, but it is, you know, this amount shall be increased, you know, from but based on the two sides agreeing.

And so the two sides don't always agree.

But I mean, don't appro why or money at all.

Well, because the recognition that we have Denver Health had uncompensated care.

Back in 20, and sorry, in 1996, you know, that was equivalent to 12, the 30, the what was 27 million back then was pretty significant because it was more than 10% of our budget over time.

Over time, it's turned into an I appreciate the 30 million.

But it is such an inconsequential amount compared to the amount of uncompensated care that we provide, because it hasn't kept up with inflation.

It hasn't kept up with more people living in Denver since 1996, more people coming to Denver Health, and then the cost of health care escalating five, six, seven percent a year.

I mean, health care nationally this year increased eight percent over last year.

It is increasing at a rate of eight percent.

So this was intended to recognize that the city, I assume, and its budgeting process every year would say to the agencies, police department, parks department, Denver Health, you can have a little bit more because we know that you have to pay wage increases and you've got other issues.

And that really negotiation, and I've been involved in four years now of negotiations.

It's it's not even really a conversation.

I mean, the fact that we have to pay wage increases, and I know the cities had some constraints as well, um, is not factored into this payment.

So the expectation is we go get that money from our other payer sources, Medicaid, Medicare.

As I said, in the case of Medicaid this year, they're not even they're not giving us an increase, they're actually cutting.

So the net result of what will happen to us from a Medicaid perspective, that 47%, is we're basically going to take a five to six percent cut because wages went up by three percent.

The state's gonna cut us by two percent.

So inflation should have driven an automatic increase in the cost of living.

And Councilman Cashman, the the intent when they split was so that Denver Health could thrive and grow because the mission is to serve and to take any patient regardless of their ability to pay.

So that was the original intention from the city splitting was to allow Denver Health, but they knew that with the mission and it being a public institution, as it was when it was at the city, was that uncompensated care would still be an issue.

And so the city agreed to carry that to help offset that cost because we knew that we were taking care of the most vulnerable populations.

And so I don't ever think that the city realized that it would grow to as large of an institution as it has, and that the way that the formula was put in did not allow for that um inflation in the city budget.

So I think that's why the city has allowed it to be flat, even though the cost and the amount of people we're seeing is continuing to grow.

Um so the language in there was with good intent to make sure that we could continue to see those patients and the most vulnerable that were residing in Denver.

But if I were there in 1996, I would have said we need we need a cost of living adjustment, or I mean maybe even need a mediation.

We need something because the and this is not this administration.

I mean, this goes back as you can imagine to four different administrations.

The recognition that there's not a cost of living, it's always been, you know, we have reason we have resource constraints ourselves as the city.

But usually when you have a contract with somebody, you have a cost of living adjustment, and we don't have that.

Yeah, I think it's embarrassing.

I think the city's uh ignoring its obvious responsibilities to do a better job of supporting Denver Health.

And at a certain point, you know, this chart ten years from now, whoever's here, that line is gonna be two and a half billion, whatever it is.

And so thirty million dollars on two and a half billion becomes even more incon more inconsistent.

Yes, sir.

Sorry if I can interject.

We have two other folks in the queue and we have another section of the presentation to go, so we could uh speed it up the beef, uh be good.

Thank you.

Just asked one question.

Yes.

Thank you.

Are you done?

Yep, thank you.

And I just remember really quickly, I know Councilmember Watson's in the queue, but this actually attaches to Council Member Cashlands.

I was just gonna say I did a calculator on AI.

Um purchasing power of the dollar uh has had a cumulative price increase since 1996 to today of 108.28 percent.

The value of 30 million dollars today in 1996 would have been 62.48 million.

62.48.

Thank you.

Was that your only question?

Does it?

Okay.

Uh, Councilmember Watson, go ahead.

Uh thank you so much, John Bike Chair.

Thank you so much, CEO Um Um Uh Donald Lynn.

I'm gonna say I I'm gonna rely on Dr.

Federico and Stephanie to keep you off of that robotic arms on so you're not doing surgeries um within the um one question.

If 2Q didn't pass, can you kind of share a little bit as to opine a bit?

I know you shared kind of the benefit.

Share for um folks who are watching kind of what that impact from your perspective would have been if 2Q did not pass in an environment that we're currently in.

Running operating deficits, and you can only run an operating deficit for so long.

Um it's going out of business strategy, or it is a let's make decisions about what clinics to close, what services to curtail.

Um we're that's a scenario we're doing now as we think about HR1.

So it would be service reductions that would impact patients who you know, as I said, the other hospitals don't always want to see our patients.

And of course, we would see people getting sicker and then ending up in the emergency room because they didn't get you know an immunization or they didn't get you know some basic preventive care.

So it would it was a it was a potential going out of business strategy if we didn't have the 65 million, and I think some more difficult discussions with the city about whether or not that 30.7 could go up, and I know the city's budget isn't gonna allow for that.

Uh thank you, CEO and um thank you, Vice Chair, and uh Councilmember Cashman, I'm with you 100%.

No, no further questions.

Thank you.

Uh we could go on to the next section, but I did have just one quick question on the first on 2025.

So $65 million allocation from 2Q for 2025.

Did the end of year reconciliation show that that was uh that you should have had more than 65 million or less?

I can't tell because I looked ahead.

Yes, we're giving you a four percent, a little over four percent additional two Q money in 2026.

And we didn't project a four percent increase in our budget.

So you're clarifying.

Sure.

It showed and um Elise is our partner on this, it showed that we uh sh I want to say I don't want to say should have had more.

You know, the sales taxes, you know, fluctuates from month to month.

And when you look back, uh we decided to be conservative, and I think the number we used was 64.8 was that was that the number that we used.

So we budgeted 64.8 million.

It ended up being, as Elise said, both 67.

So combination of the sales tax revenue was higher and the administrative expenses were lower.

Yeah, it ended up being 65.8 uh for the revenue last year, 2025.

So we just uh paid them 1.8 more than because the difference it was about uh 1.3 million higher than the original estimate, which we used to set up the tax funds.

So is that makeup included in the 2026 allocation, or was that added on to 2025 books?

We did discuss this.

Yeah, so that's something that we we need to discuss a little bit more.

We discussed it yesterday because it actually shows in the city that it was closed out in the 2025 books, and so we need to discuss whether or not that can be applied to uh 2025 of our uncompensated care.

So it would just be an additional 1.8, and then we would just need to show where we put those funds because it it won't reconcile correctly with the city if we add it to the 2026 budget, right?

Because we've already been paid for that.

And if the if the sales tax decreases and we have to reduce, we don't want those to mix up, right?

Right.

Thank you, Stephanie.

I and I would suggest that that's the way that makes sense to me.

It's 2025 money to be accrued to 2025 expenses.

So we'll we'll make it a little better then.

Yeah, we'll get an update um with once we figure out that because it's the first time, right?

So we're like, whoa, what do we do?

But I think it's gonna be cleaner if it sits in the 2025.

So we'll we'll get that explanation out as soon as we we get it cleared up.

Yeah.

Let's move on to uh 2026.

And I think I can do this in a couple of minutes.

So our overall goals, as you know, in addition to being um accountable by those five uh clinical areas of pediatric care, primary care, emergency and trauma, and uh mental health and substance use is um uh particularly as councilman woman parity and councilman Watson were referring to, we have to be financially sustainable.

That's sort of that's the table stakes, because otherwise we then cutting cut services.

And to the questions around um councilwoman parity's questions around quality and access to care, um that clearly is also a priority.

We also look at where where's where are we feeling the demand from our patients?

Uh and clearly mental health and substance use is one of those, as I said, in our inpatient setting.

Unfortunately, we have so many people flowing into our psychiatric emergency room, and we don't have the beds for them.

They we often refer them to other facilities.

And we would prefer not to do that because other facilities don't always have the medical and psychiatric services.

So we know that's a high demand area.

It's also a low reimbursement area.

So if you look at the next slide, our estimate for the 2Q revenue is up a little bit.

It's 67.7 million.

And then there's just a marginal increase.

So we've taken the the 2Q money and spread it pretty consistently with what I went through.

So again, emergency medicine and trauma care getting about 35 million, primary care, the second highest area, and then mental health the third.

So on a percentage basis, about 51% of our two Q money goes to emergency medicine and trauma, 20% for primary care and mental health, and then it's 3% each for the other two areas.

And if you go to the next slide, these are the areas.

I mean, we're a quarter of the way into 2026, but part of our obligation is to tell you and tell the city how we're we plan to spend the money.

And you can see the various buckets.

But across the board, primary care, again, more service expansions.

We will be able to finally, Councilman Cashman, or I think you will see our new clinic on Evans and Monaco tonight.

We will begin seeing patients during 2026, both primary care and specialty care.

So yay.

That's vibrant Denver money, but in 2027, some of the expanded staffing in West Side will be covered by 2Q.

So a variety of things that we're going to be doing, and then I think my last slide that I can cover, and then I'll turn it to Elise in terms of the city expenditures.

That Medicaid flip is in 2026.

Well, we've seen some things in 2026 already.

We do know that there are patients who are staying away from health care, partly because of immigration issues, but I think a lot of confusion around Medicaid.

Cover all Coloradans is a state program that provides coverage for undocumented individuals, but who live in Denver.

You have to live in the state.

But cover all Coloradans will be cut, we believe by the state in you know the tail of their year, so that's the last six months of our calendar year.

And we are worried that we're seeing uh higher patient acuity because people are just not getting, you know, they're not voluntarily going to a clinic because of fear of being taken away.

So I'll turn it to Elise to go over how the city is going to spend its money and happy to take questions about 2026, but we'll be back in August in August to sort of give you a more complete picture of what we've spent in the first six months of this year.

Great.

Thank you, Donna.

Similar to the last slide that I presented, this is our proposed spending plan.

So uh similar to Denver Health, we have a proposed spending plan of how we plan to spend our 1%.

So you'll see uh we're breaking it up by administrative expenses uh related to personnel, so that would be my salary, half of a fiscal administrator who supports some of the contracting uh and invoicing, uh, some leadership time to account for that, um, and services and supplies, which are ambitious to make sure we have the ability, but likely will not spend all of them, and then a large function, a large chunk is related to a subcontractor that we've been working with, Third Horizon, that has been really helpful as we've been developing some of these conversations, thinking about what is reporting look like and how can we do meaningful reporting.

So that's been very helpful for us.

Similarly, uh we will not likely spend the full one percent.

We have the ability to spend about uh 670,000, but we are will not likely do that.

Um we will update in August and see if we're on track, but um, we will likely have a small amount that we'll get back to again next year.

Any questions?

Is that it?

That's it.

Thank you.

No one has joined the queue.

Uh I'd like to invite questions.

Um let me ask okay, go ahead, Councilmember Sawyer.

Oh, thank you.

I just I don't have a question.

I just wanted to say thank you.

Um I really appreciate all of the work that you guys are doing.

I also appreciate the stressful financial situation that you're in with all of the changes that are coming.

I'm very concerned about 2027, but really appreciate the transparency.

I think with you know, with residents tax dollars, city tax dollars, we need to be extra careful to make sure that we're sharing the information on how these dollars are being spent.

And this presentation was fantastic.

The um information that you provided was really helpful and I think really really really clear.

And I just wanted to give you that feedback because I think you guys did a fantastic job.

So thank you.

That's it.

Thank you.

Uh Councilman Rickonzala's good here.

Yes.

Thank you.

Um, Mr.

Chair, and uh yeah, thank you all again for the partnership um and the work that's being done, and I know you know we're still you know it's fairly new, and I know there's a lot of places that we're recognizing that we can see a little bit more information, um, a little more transparency, but I really appreciate the willingness to come to the table and figure that out and how to best present the information.

Um I couldn't agree more, you know, with with my colleagues as far as the funding goes, but it that also begs the question of um there's there's there's a there's a number of like out-of-county right um patients that are seen as well.

And you know, knowing that there is some money or was money coming from the state, right?

Um not sure how that's gonna look going forward, but um, you know, then the question is also, and I think this has been discussed before is how what are there are there other ways to also partner with other counties as well, knowing that you are the safety net hospital, and how do we make sure that you know that doesn't go away, right?

And that is on all of us, right?

And Denver carries a significant portion, but there could be some partnership, maybe additional partnerships happening there.

Um, and should it just all be reliant upon Denver as well.

But I do agree, like we need to really figure out you know where where else um are we missing some funding sources.

Um the the question that I have on just on 2026, um, and the I know councilwoman parody brought up the quality metrics.

Um I guess did and maybe I missed this and I apologize, but do we know when we will see kind of that a little more detailed out and in a possible like the spending plan addendum?

Um when will we see that for 2026?

For 26.

Um we'll we're working on closing out 25 metrics, and so I think once we have that um solidified, then we can show you the projection for 26.

So maybe we can um get that out just for you all to look at once we get the report.

Um and then in August when we come back to do the spending plan review, um, we we'll have those uh as part of our presentation.

Yeah.

So I think maybe by summer we'll be able to get you what the projection for the metric stuff is for 26, and then we'll have an end of the year report by May.

Okay, okay, great.

Thank you.

Thank you, Mr.

Chair.

Thank you.

Um on the new clinic in uh councilmember Torres' district uh 27.

What's the amount of the vibrant member funding?

And that doesn't, I'm sure that doesn't cover the entire capital cost.

What's the remainder of the capital?

So we anticipate a hundred excuse me, a hundred to a hundred and fifteen million is gonna be required to um build the clinic, and so we're building the clinic on a parking lot, knocking down the old clinic.

So somewhere between 100 and 115 million, depending on labor costs and you know, supply chain and all of that.

Vibrant Denver gave us 20 million.

Um I'm grateful, but I'm also disappointed, and I'll tell you why, because the outpatient medical center that we built in 2022 that was funded by a city bond covered half of the cost of the bond.

Excuse me, of the facility.

So 75 million of 150 million dollars was through a bond.

You would have to be in a very long line to be a in the club of people who are disappointed in their vibrant uh allocations because the peanut butter was spread extremely thin.

Uh I don't think any I can't think of anything that was fully funded.

Uh too many needs, too little dough.

Uh so does any of the two Q money, I know you can't spend that on capital, but does any of that uh is any of that money eligible to assist you with project oversight or does that have to come out of a capital fund?

So I think that all comes out of the capital.

The but the operating cost, so we will when we rebuild it, we're rebuilding it at a significantly larger footprint and adding services.

So some of those services can be part of two Q.

Okay, I want to clarify that there's a wall between this is all capital, so any expenditures that Denver Health might make in project oversight uh is strictly out of a capital side.

That's correct.

No assistance from two Q.

Okay, thank you.

Um I don't see any other questions.

Two items go forward on consent, and we're adjourned.