The found that nearly one in three of the state’s 5.3 million residents now get insurance through Medicaid or other public health insurance programs.

With nearly 1.3 million Coloradans now on Medicaid, the state has the fourth fastest-growing Medicaid program in the country behind Kentucky, Oregon and Nevada, according to an analysis earlier this year from the federal

The surge of Medicaid recipients in Colorado shattered Gov. John Hickenlooper’s 2013 projection that the state would add about 160,000 new Medicaid clients over 10 years without costing the state budget “a single dollar.”

According to the Colorado Health Access Survey, the state has 450,000 more Medicaid recipients in 2015 than in 2013. In states that expand their Medicaid programs under the health law, with incomes up to 138 percent of poverty ($16,242 per year for an individual in 2015) would qualify. Pregnant women and children in families with higher incomes — up to 260 percent of the federal poverty level or $60,700 for a family of four — can qualify for the Child Health Plan Plus in Colorado.

State officials are highlighting Colorado’s success, saying the state is close to covering everyone. In particular, they cited a major drop in the number of children who remain uninsured, from about 7 percent to 2.5 percent.

“Colorado is a state that has done what it set out to do. We got more people insured,” said Michele Lueck, president and CEO of the Institute, a research group. Analysts conducted the survey of 10,146 randomly selected households, including landlines and cell phones. The poll was conducted after open enrollment ended, between March 2 and June 26.

Sue Birch, executive director of Colorado’s Medicaid programs, downplayed the governor’s much lower projections for Medicaid expansion.

“The most important thing is that people got covered,” Birch said.

She said she and the governor stand by the promise that over 10 years, Medicaid programs will save enough money to cover the cost of additional patients.

“Health care transformation is an investment in time and the right strategies. Colorado has made the right choices and they are starting to pay dividends,” Birch said.

She said preventive care among patients is up, total cost of care per person is down 9 percent since Medicaid expansion started, more providers are stepping up to care for Medicaid patients and people with chronic conditions are getting better primary care.

“This was an invisible population,” Birch said. “Colorado’s story is about all this movement toward health.”

Most states that have expanded Medicaid have found that they guessed far too low, said Matt Salo, executive director of the National Association of Medicaid Directors.

“It’s hard to forecast what actually happens when you change a lot of pieces in an interconnected health care system,” Salo said. “A lot of states are finding that they’re enrolling more people (who qualify for Medicaid) than they assumed lived in the state.”

Those states include Colorado, Washington, Oregon, Kentucky and Ohio, Salo said.

“When you’ve got a state like Colorado that really puts its shoulder behind Medicaid expansion and expansion in coverage is something you go all in on, you’re going to see significant impacts,” he said.

Thus far, and even in a place like Ohio with a Republican governor running for president, there is no sign of backpedaling, Salo said.

“There have been very, very few examples where a big expansion has been followed by a big retraction,” he said. “Once you’ve actually given insurance to hundreds of thousands of people who didn’t have it before, taking it away is a very real thing.”

While many patients with new coverage welcome the chance to see doctors, skeptics say Colorado taxpayers will have to pay dearly for the ballooning Medicaid population starting in 2017 when the federal government no longer picks up the full tab for new clients. Federal assistance falls to 95 percent that year and gradually decreases until it reaches 90 percent in 2020.

“You didn’t have to be a brain surgeon to see this coming,” said Sen. Ellen Roberts, a Republican from Durango, Colo., who tried to persuade the governor in 2013 not to add so many people to the Medicaid rolls all at once. “We’re putting Medicaid expenditures on a collision course with every other state expenditure, from K-12 (education) to highways to higher education. Medicaid is just consuming our state budget.”

The survey, which the Institute conducts every other year, also found that Colorado’s health exchange for individuals buying private insurance failed to capture the majority of that market. Despite spending nearly $200 million in federal funds on start-up costs and IT systems that have thus far been full of glitches, Connect for Health Colorado accounts for just 42 percent of the individual market; the number of individuals signing up for private health insurance in the individual market has stayed roughly the same since before the Affordable Care Act launched — about 409,000.

Other trends emerging from the Colorado Health Access Survey parallel those around the country:

• California and Ohio data show dramatic drops in their uninsured rates. The Gallup survey found the sharpest declines in states that . Obama administration officials in August said the uninsured rate dropped nationally to 9.2 percent, from 14.4 percent in 2013.

• The percentage of people getting health insurance through their jobs has fallen from nearly 58 percent in Colorado in 2009 to 51 percent this year. More large employers in Colorado are providing health insurance, while small businesses are dropping coverage.

• Gaps in coverage include undocumented workers who don’t qualify and people living in ski resort regions and rural western Colorado, many of whom say health coverage costs too much.

• Nearly 12 percent of Hispanics in Colorado still don’t have insurance, compared to about 5 percent among others.

• In a surprise finding, Colorado hipsters in their 30s are skipping health insurance at even higher rates than those in their 20s. In both cases, about one-quarter of so-called young invincibles used to be uninsured. While many more now have coverage, 12.9 percent of twenty-somethings and 13.4 percent of thirty-somethings still are not buying health insurance.

• The high cost of health insurance is by far the biggest reason people cite for skipping coverage.

• While the ranks of the uninsured have dropped a lot in Colorado, those who are “underinsured”— meaning they don’t have enough coverage to pay for expensive health care problems — has continued to grow over the past four years. Low-income people have the highest rates of being underinsured as do those who buy their insurance on the individual market.

Sen. Roberts chairs a legislative oversight committee that will start considering legislation this month about whether to keep Colorado’s exchange or consider folding it into the federal exchange. The biggest complaint Roberts hears from residents in her area in southwestern Colorado is that people qualify for Medicaid, but don’t want it because they can’t find providers who will care for them.

On the other hand, in Jefferson County in the Denver metropolitan area, health professionals were ready for the surge of new Medicaid clients. In Wheat Ridge, patients are getting care in a polished new community health center where they receive integrated physical, mental health and dental services all in one place.

Jefferson County hugs the foothills west of Denver and is the state’s fourth most populous county. There, the uninsured rate dropped a stunning 75 percent in just two years from 11.6 percent to 2.8 percent. That was the largest decrease statewide, according to the survey; analysts found that about 50,000 fewer people are now uninsured in Jefferson County than in 2013.

Many are new Medicaid recipients, including Michael Goffinett, 53, of Lakewood.

He used to have insurance with his job as a fire restoration worker. Then he lost his job and need back surgery. First he got Medicaid and started going to the Wheat Ridge clinic. Now his wife and son also get coverage through Medicaid.

“It’s been a great help for me and my family. They’re always there for me,” Goffinett said as he braved his fears of dental care and had a cavity filled recently at the nonprofit Metro Community Provider Network’s Wheat Ridge clinic.

“They’re good,” Goffinett said of his doctors. “If you have a job or you don’t have a job, they take care of you. No hassles.”

Goffinett’s dentist, Dr. Fatima Kazi, had a waiting list of more than 200 patients when she started working at the Jefferson Family Health Services Center in December.

She had previously worked at other public health clinics in Colorado and welcomed the chance to practice at the big new clinic full of large windows, natural light and state-of-the art equipment.

“It’s beautiful,” Kazi said. “It’s comprehensive care in one place. That’s what makes a lot of public health successful. Patients only have to come to one location and they can get most of their treatment in one location.

“Part of the reason I do public health is that I believe everybody should have access to health care,” Kazi added. “Dentistry is not cheap. You can choose not to take care of your teeth and end up in the emergency room.”

She said having easily accessible dental care side-by-side with primary care makes it much easier for patients like Goffinett to come. He hadn’t seen a dentist in several years, but started having pain and his doctors sent him to the dentists.

As Kazi worked on his teeth, Goffinett fidgeted and kept asking if she was done.

“It’s the first time I’ve really dealt with my teeth. I love my dentist, but I don’t like going,” he said.

In the mental health section of the clinic, children with severe problems have group sessions with therapists while adults get help from peer counselors who have struggle with schizophrenia and other challenges themselves.

John Reid, vice president of fund development for the Metro Community Provider Network, credits the clinic’s CEO with having the foresight to brace for the surge in patients in Jefferson County and the other suburbs that surround Denver. The network got federal and local grants of more than $13 million to buy the land and open the Jefferson Family Health Services Center in Wheat Ridge in 2013. As the network finds and hires providers, it can treat more people and expects to serve about 10,000 patients at the center when it’s full.

Altogether, the network boasts 23 safety-net clinics, 10 of which are in Jefferson County. Last year, the network served nearly 43,000 patients. Some of the clinics are in schools while others are partnerships with the Jefferson Center for Mental Health.

The bump in Medicaid patients has been huge, Reid said. Previously about one-third of network patients qualified for Medicaid. Most of the rest were uninsured. Now nearly two-thirds of patients have Medicaid.

Reid said all the networks clinics are seeing thousands of new patients. They serve them regardless of their insurance status. Many are undocumented immigrants who can’t qualify for Medicaid.

“We want to be fiscally and financially sound. At the same time, we’re a community partner. We want to do what’s in the best interest of each and every patient, every touch every time. That’s our motto and we really live by that credo,” Reid said.

With the rush of patients in Jefferson County, some are arriving with severe problems.

Jamie Vader, a physician’s assistant at the Wheat Ridge Clinic, cared for a 61-year-old woman who arrived last week with severe abdominal pain. Vader and a student working with her did an extensive history and suspected more than the first-brush diagnosis of a bladder infection. They feared possible cervical cancer.

Tests showed they were right. The woman came back two days later. She was devastated, but the clinic set her up with a specialist to treat the cancer along with mental health care and a care coordinator to help her navigate the many appointments she’ll now need.

“It’s been over 10 years since she had any well care. Had she gotten care then, she wouldn’t have cancer,” Vader said.

The woman’s prognosis is not good since her cancer is so advanced.

While it’s good that people are getting coverage now, Vader said she’s seeing many sad cases.

“You have to clean it up first,” she said “We’ve always had a lot of really sick people. There are just more of them.”

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The rescue of the highly-touted program comes after Republican lawmakers earlier this year killed a bill that would have provided $5 million in public funding for IUDs and other long-acting reversible contraceptives for low-income teens and young women. Colorado health officials estimate that the IUDs and other devices have saved at least $79 million in Medicaid costs for unintended births, but some opponents claimed that IUDs are abortifacients and refused to approve funding in the Republican-controlled Senate.

From mid-2009 to mid-2015, the Susan Thompson Buffett Foundation funded a pilot effort in Colorado with a $25 million grant. provided teens and young women with more than 36,000 free or low-cost IUDs or other long-acting birth control devices.

The newest data from the Colorado Department of Public Health and Environment show a 48 percent drop statewide in unintended pregnancies and abortions. Births among teens ages 15 to 19 fell from 6,201 in 2009 to 3,361 in 2014, while abortions declined from 1,711 to 939 in the same period.

The 48 percent reduction is up from a 40 percent drop through 2013.

Teens and young women get the free and low-cost devices at 68 family planning clinics across Colorado. The Affordable Care Act requires health insurance companies to pay for birth control, but some plans don’t cover implants since they’re more expensive up front. State Medicaid programs increasingly are covering IUDs and implants, but patients who are uninsured or don’t qualify for Medicaid often need help paying for birth control. The Colorado Family Planning program has been essential to safety-net clinics. Managers used the grant funds to pay for the devices in advance, then worried about reimbursements later.

The lack of public funding for the IUD program in Colorado comes as health leaders across the country are racing to expand access to long-acting contraceptives. The most popular device in Colorado now is an arm insert called the Nexplanon. About 50 percent of Colorado patients request that device since it’s so easy for doctors to insert. Other patients opt for traditional vaginal IUDs known as the ParaGard and the Mirena.

At least 15 states are working on some kind of boost to the use of IUDs or implants, according to leaders at the Association of State and Territorial Health Officials. A study from the earlier this year found that more teens are waiting to have sex and that Colorado is far ahead of the rest of the country in teen use of long-acting contraceptives.

As funding withered for the Colorado program at the end of June, some county health agencies were creating waiting lists, while others were trying to stockpile IUDs for the neediest patients.

This week,  foundations rode in to the rescue with pledges to keep the program alive until the middle of next year. Their money will pay for an additional 6,000 devices.

“I feel fortunate that we have that community to turn to in what I considered an emergency situation,” said Dr. Larry Wolk, Colorado’s top health official.

While he celebrated the program’s survival through private funding, Wolk said that he and Democratic Gov. John Hickenlooper plan to keep fighting for taxpayer support. The governor will include funding for the birth control program in Colorado’s budget, Wolk said.

“We’ve made the case for a public benefit and we need public investment,” said Wolk, chief medical officer and executive director of the Colorado Department of Public Health and Environment. “That’s where ultimate sustainability lies.”

IUDs and other long-acting forms of contraception cost more initially than birth control pills, but they last from three to 10 years. The up-front cost for an implant or IUD is about $325 for clinics that get federal discounts or about $800 to $900 at full cost. By comparison, the discounted price for birth control pills is about $23 a month and the full price is about $70 a month. Without help affording birth control, some teens struggle to pay the initial cost of an implant. If they’re on the pill, they must get refills every couple of months and have to remember to take the pill every day. Imperfect use cuts effectiveness.

Since the Colorado legislature torpedoed funding, the evidence of success has only improved.

“We’re going to go back with our even more remarkable results,” said Wolk, a pediatrician with a specialty in treating teens.

County health officials celebrated the news that the program will survive for at least one more year.

In Jefferson County, Colorado’s fourth largest, health officials started creating waiting lists earlier this summer to be sure that they would have some IUDs on hand each month.

Kelly Conroy, nurse manager for clinic services for Jefferson County Public Health, said the program’s popularity is surging.

“The word is definitely getting out. We have a lot of patients who come in and specifically ask for the devices by name. A lot of it is word of mouth, friends and family. A friend will be on Mirena (an IUD). They will know which one they want — hormonal or non-hormonal. People are coming in way more educated,” Conroy said.

Since Conroy and her colleagues knew funding from the state was in jeopardy, they started hunting for funds elsewhere to be sure they could have IUDs and other devices on hand. They worked to bill insurance companies or Medicaid for devices they were implanting so they could recoup as much money as possible to pay for other devices. On average, she said, patients were having to wait about three weeks.

Now health officials should be able to stop creating a waiting list and provide devices for those who want them right away.

“We’re absolutely thrilled,” Conroy said. “We are a safety net for a lot of clients who are uninsured and underinsured. We don’t want to put any obstacles in their way. We certainly don’t want anyone to have an unintended pregnancy.

“Our ultimate goal is empowering not just women, but families with the ability to know that they can make the choice (to have a baby) when they’re ready,” Conroy said.

Evidence shows that cutting teen pregnancy rates also reduces high school dropout rates. Along with direct savings for Medicaid — births costs about $11,000 each — supporters of the IUD program liked the idea that better birth control can dramatically improve outcomes for girls. Those who get a good education go on to earn higher incomes, thus reducing poverty rates and cutting reliance on Medicaid and other programs for people living in poverty.

Health officials across the country have been meeting with Colorado leaders for about a year to learn about the IUD program.

“Other states are very excited about the results from Colorado,” said Lisa Waddell, chief of community health and prevention for the Association of State and Territorial Health Officials. “All states are results-oriented and want the best outcomes for adolescents, women and families.

“There’s a tremendous amount of energy around learning from Colorado and other states and looking at that return on it investment. What does it take (to start this program)? How do you leverage different partners?”

Waddell said many states are much more interested in IUDs for several reasons. They’ve seen the success in Colorado and are paying more attention to long-term benefits, not just up-front expenses. IUDs are much safer now after having had a tarnished reputation decades ago. The Affordable Care Act requires coverage for birth control, and research is showing that IUDs and other long-acting devices work much better than other birth control methods. At the same time, increased transparency in health costs is driving much greater attention to getting the best bang for the buck.

“In the last couple of years, there’s been this convergence of this best evidence coming out and this drive to make sure we’re purchasing the best health care,” Waddell said. “These are highly effective devices…You’re seeing a systems change.”

According to the CDC, the failure rate with IUDs and other long-acting devices is less than 1 percent, while birth control pills fail at a 9 percent rate and condoms don’t work 18 percent of the time.

Nationally, only 7 percent of women use IUDs or other long-acting devices.

Waddell’s group represents Dr. Wolk and his colleagues. Because of the extensive interest in the issue, they convened a “learning community” on long-acting contraception. The group met in person last year and holds regular virtual sessions.

Six states that have already changed their policies on long-acting birth control led the way. They are Colorado, Georgia, Iowa, New Mexico, Massachusetts and South Carolina. Six more states are slated to join the group shortly and leaders from the 12 states will meet in person again in October.

Waddell says 50 percent of pregnancies in the U.S. are unintended. One of the programs that has been most popular in other states is to offer women who have just given birth an IUD or other long-acting device while they’re still in the hospital after having had a baby. Medicaid will pay for those devices and health officials say it makes great sense to implant the device while the woman is in the hospital.

“They’re generally pretty motivated to get a contraceptive device that would allow their body to recover,” Waddell said.

Along with postpartum use of IUDs, South Carolina health officials have been focusing on using long-acting birth control as a method for driving down stubbornly high infant mortality rates. Premature births that can put babies in jeopardy are higher among teens and others who get pregnant unexpectedly.

Driving down the number of unwanted pregnancies should also result in fewer infant deaths, Waddell said.

Consumer demand is also central to the growth in popularity of IUDs and other long-acting devices, said Ellen Pliska, director of family and child health programs for the health officials’ group.

“Since the momentum has gotten started, more women are aware that it’s a viable option. We’ve been hearing that word of mouth has been incredible, particularly among teens. If one ‘influencer’ gets involved, they’re going to tell everybody about it,” Pliska said.

Among the groups that so far have pledged support for the Colorado effort are:

· The Ben and Lucy Ana Walton Fund of the Walton Family Foundation

· Buell Foundation

· Caring for Colorado Foundation

· Chambers Family Fund

· The Colorado Health Foundation

· The Colorado Trust

· Community First Foundation

· The Community Foundation Serving Boulder County

· Global Health Foundation

· Kaiser Permanente Colorado

· The Women’s Foundation of Colorado

Wolk said some of the money will be used to expand training so that many more providers will know how to insert IUDs and other devices.

While Wolk supports efforts to give IUDs to teens and women who have already had babies, he thinks it’s much better to reach out to them and provide the most reliable contraception before they get pregnant the first time. He’d like to set up a system comparable to the public funding for vaccines, which, like IUDs, cost a lot for providers to keep on hand. A steady stream of funding would provide two options. If a woman has private or public insurance, providers can give them IUDs and get reimbursed. If they don’t have coverage and still want long-acting contraception, they can still get help.

“We’d have (devices) for uninsured on one side and insured on the other,” said Wolk. “That’s my vision.”

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The found that nearly one in three of the state’s 5.3 million residents now get insurance through Medicaid or other public health insurance programs.

With nearly 1.3 million Coloradans now on Medicaid, the state has the fourth fastest-growing Medicaid program in the country behind Kentucky, Oregon and Nevada, according to an analysis earlier this year from the federal

The surge of Medicaid recipients in Colorado shattered Gov. John Hickenlooper’s 2013 projection that the state would add about 160,000 new Medicaid clients over 10 years without costing the state budget “a single dollar.”

According to the Colorado Health Access Survey, the state has 450,000 more Medicaid recipients in 2015 than in 2013. In states that expand their Medicaid programs under the health law, with incomes up to 138 percent of poverty ($16,242 per year for an individual in 2015) would qualify. Pregnant women and children in families with higher incomes — up to 260 percent of the federal poverty level or $60,700 for a family of four — can qualify for the Child Health Plan Plus in Colorado.

State officials are highlighting Colorado’s success, saying the state is close to covering everyone. In particular, they cited a major drop in the number of children who remain uninsured, from about 7 percent to 2.5 percent.

“Colorado is a state that has done what it set out to do. We got more people insured,” said Michele Lueck, president and CEO of the Institute, a research group. Analysts conducted the survey of 10,146 randomly selected households, including landlines and cell phones. The poll was conducted after open enrollment ended, between March 2 and June 26.

Sue Birch, executive director of Colorado’s Medicaid programs, downplayed the governor’s much lower projections for Medicaid expansion.

“The most important thing is that people got covered,” Birch said.

She said she and the governor stand by the promise that over 10 years, Medicaid programs will save enough money to cover the cost of additional patients.

“Health care transformation is an investment in time and the right strategies. Colorado has made the right choices and they are starting to pay dividends,” Birch said.

She said preventive care among patients is up, total cost of care per person is down 9 percent since Medicaid expansion started, more providers are stepping up to care for Medicaid patients and people with chronic conditions are getting better primary care.

“This was an invisible population,” Birch said. “Colorado’s story is about all this movement toward health.”

Most states that have expanded Medicaid have found that they guessed far too low, said Matt Salo, executive director of the National Association of Medicaid Directors.

“It’s hard to forecast what actually happens when you change a lot of pieces in an interconnected health care system,” Salo said. “A lot of states are finding that they’re enrolling more people (who qualify for Medicaid) than they assumed lived in the state.”

Those states include Colorado, Washington, Oregon, Kentucky and Ohio, Salo said.

“When you’ve got a state like Colorado that really puts its shoulder behind Medicaid expansion and expansion in coverage is something you go all in on, you’re going to see significant impacts,” he said.

Thus far, and even in a place like Ohio with a Republican governor running for president, there is no sign of backpedaling, Salo said.

“There have been very, very few examples where a big expansion has been followed by a big retraction,” he said. “Once you’ve actually given insurance to hundreds of thousands of people who didn’t have it before, taking it away is a very real thing.”

While many patients with new coverage welcome the chance to see doctors, skeptics say Colorado taxpayers will have to pay dearly for the ballooning Medicaid population starting in 2017 when the federal government no longer picks up the full tab for new clients. Federal assistance falls to 95 percent that year and gradually decreases until it reaches 90 percent in 2020.

“You didn’t have to be a brain surgeon to see this coming,” said Sen. Ellen Roberts, a Republican from Durango, Colo., who tried to persuade the governor in 2013 not to add so many people to the Medicaid rolls all at once. “We’re putting Medicaid expenditures on a collision course with every other state expenditure, from K-12 (education) to highways to higher education. Medicaid is just consuming our state budget.”

The survey, which the Institute conducts every other year, also found that Colorado’s health exchange for individuals buying private insurance failed to capture the majority of that market. Despite spending nearly $200 million in federal funds on start-up costs and IT systems that have thus far been full of glitches, Connect for Health Colorado accounts for just 42 percent of the individual market; the number of individuals signing up for private health insurance in the individual market has stayed roughly the same since before the Affordable Care Act launched — about 409,000.

Other trends emerging from the Colorado Health Access Survey parallel those around the country:

• California and Ohio data show dramatic drops in their uninsured rates. The Gallup survey found the sharpest declines in states that . Obama administration officials in August said the uninsured rate dropped nationally to 9.2 percent, from 14.4 percent in 2013.

• The percentage of people getting health insurance through their jobs has fallen from nearly 58 percent in Colorado in 2009 to 51 percent this year. More large employers in Colorado are providing health insurance, while small businesses are dropping coverage.

• Gaps in coverage include undocumented workers who don’t qualify and people living in ski resort regions and rural western Colorado, many of whom say health coverage costs too much.

• Nearly 12 percent of Hispanics in Colorado still don’t have insurance, compared to about 5 percent among others.

• In a surprise finding, Colorado hipsters in their 30s are skipping health insurance at even higher rates than those in their 20s. In both cases, about one-quarter of so-called young invincibles used to be uninsured. While many more now have coverage, 12.9 percent of twenty-somethings and 13.4 percent of thirty-somethings still are not buying health insurance.

• The high cost of health insurance is by far the biggest reason people cite for skipping coverage.

• While the ranks of the uninsured have dropped a lot in Colorado, those who are “underinsured”— meaning they don’t have enough coverage to pay for expensive health care problems — has continued to grow over the past four years. Low-income people have the highest rates of being underinsured as do those who buy their insurance on the individual market.

Sen. Roberts chairs a legislative oversight committee that will start considering legislation this month about whether to keep Colorado’s exchange or consider folding it into the federal exchange. The biggest complaint Roberts hears from residents in her area in southwestern Colorado is that people qualify for Medicaid, but don’t want it because they can’t find providers who will care for them.

On the other hand, in Jefferson County in the Denver metropolitan area, health professionals were ready for the surge of new Medicaid clients. In Wheat Ridge, patients are getting care in a polished new community health center where they receive integrated physical, mental health and dental services all in one place.

Jefferson County hugs the foothills west of Denver and is the state’s fourth most populous county. There, the uninsured rate dropped a stunning 75 percent in just two years from 11.6 percent to 2.8 percent. That was the largest decrease statewide, according to the survey; analysts found that about 50,000 fewer people are now uninsured in Jefferson County than in 2013.

Many are new Medicaid recipients, including Michael Goffinett, 53, of Lakewood.

He used to have insurance with his job as a fire restoration worker. Then he lost his job and need back surgery. First he got Medicaid and started going to the Wheat Ridge clinic. Now his wife and son also get coverage through Medicaid.

“It’s been a great help for me and my family. They’re always there for me,” Goffinett said as he braved his fears of dental care and had a cavity filled recently at the nonprofit Metro Community Provider Network’s Wheat Ridge clinic.

“They’re good,” Goffinett said of his doctors. “If you have a job or you don’t have a job, they take care of you. No hassles.”

Goffinett’s dentist, Dr. Fatima Kazi, had a waiting list of more than 200 patients when she started working at the Jefferson Family Health Services Center in December.

She had previously worked at other public health clinics in Colorado and welcomed the chance to practice at the big new clinic full of large windows, natural light and state-of-the art equipment.

“It’s beautiful,” Kazi said. “It’s comprehensive care in one place. That’s what makes a lot of public health successful. Patients only have to come to one location and they can get most of their treatment in one location.

“Part of the reason I do public health is that I believe everybody should have access to health care,” Kazi added. “Dentistry is not cheap. You can choose not to take care of your teeth and end up in the emergency room.”

She said having easily accessible dental care side-by-side with primary care makes it much easier for patients like Goffinett to come. He hadn’t seen a dentist in several years, but started having pain and his doctors sent him to the dentists.

As Kazi worked on his teeth, Goffinett fidgeted and kept asking if she was done.

“It’s the first time I’ve really dealt with my teeth. I love my dentist, but I don’t like going,” he said.

In the mental health section of the clinic, children with severe problems have group sessions with therapists while adults get help from peer counselors who have struggle with schizophrenia and other challenges themselves.

John Reid, vice president of fund development for the Metro Community Provider Network, credits the clinic’s CEO with having the foresight to brace for the surge in patients in Jefferson County and the other suburbs that surround Denver. The network got federal and local grants of more than $13 million to buy the land and open the Jefferson Family Health Services Center in Wheat Ridge in 2013. As the network finds and hires providers, it can treat more people and expects to serve about 10,000 patients at the center when it’s full.

Altogether, the network boasts 23 safety-net clinics, 10 of which are in Jefferson County. Last year, the network served nearly 43,000 patients. Some of the clinics are in schools while others are partnerships with the Jefferson Center for Mental Health.

The bump in Medicaid patients has been huge, Reid said. Previously about one-third of network patients qualified for Medicaid. Most of the rest were uninsured. Now nearly two-thirds of patients have Medicaid.

Reid said all the networks clinics are seeing thousands of new patients. They serve them regardless of their insurance status. Many are undocumented immigrants who can’t qualify for Medicaid.

“We want to be fiscally and financially sound. At the same time, we’re a community partner. We want to do what’s in the best interest of each and every patient, every touch every time. That’s our motto and we really live by that credo,” Reid said.

With the rush of patients in Jefferson County, some are arriving with severe problems.

Jamie Vader, a physician’s assistant at the Wheat Ridge Clinic, cared for a 61-year-old woman who arrived last week with severe abdominal pain. Vader and a student working with her did an extensive history and suspected more than the first-brush diagnosis of a bladder infection. They feared possible cervical cancer.

Tests showed they were right. The woman came back two days later. She was devastated, but the clinic set her up with a specialist to treat the cancer along with mental health care and a care coordinator to help her navigate the many appointments she’ll now need.

“It’s been over 10 years since she had any well care. Had she gotten care then, she wouldn’t have cancer,” Vader said.

The woman’s prognosis is not good since her cancer is so advanced.

While it’s good that people are getting coverage now, Vader said she’s seeing many sad cases.

“You have to clean it up first,” she said “We’ve always had a lot of really sick people. There are just more of them.”

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The rescue of the highly-touted program comes after Republican lawmakers earlier this year killed a bill that would have provided $5 million in public funding for IUDs and other long-acting reversible contraceptives for low-income teens and young women. Colorado health officials estimate that the IUDs and other devices have saved at least $79 million in Medicaid costs for unintended births, but some opponents claimed that IUDs are abortifacients and refused to approve funding in the Republican-controlled Senate.

From mid-2009 to mid-2015, the Susan Thompson Buffett Foundation funded a pilot effort in Colorado with a $25 million grant. provided teens and young women with more than 36,000 free or low-cost IUDs or other long-acting birth control devices.

The newest data from the Colorado Department of Public Health and Environment show a 48 percent drop statewide in unintended pregnancies and abortions. Births among teens ages 15 to 19 fell from 6,201 in 2009 to 3,361 in 2014, while abortions declined from 1,711 to 939 in the same period.

The 48 percent reduction is up from a 40 percent drop through 2013.

Teens and young women get the free and low-cost devices at 68 family planning clinics across Colorado. The Affordable Care Act requires health insurance companies to pay for birth control, but some plans don’t cover implants since they’re more expensive up front. State Medicaid programs increasingly are covering IUDs and implants, but patients who are uninsured or don’t qualify for Medicaid often need help paying for birth control. The Colorado Family Planning program has been essential to safety-net clinics. Managers used the grant funds to pay for the devices in advance, then worried about reimbursements later.

The lack of public funding for the IUD program in Colorado comes as health leaders across the country are racing to expand access to long-acting contraceptives. The most popular device in Colorado now is an arm insert called the Nexplanon. About 50 percent of Colorado patients request that device since it’s so easy for doctors to insert. Other patients opt for traditional vaginal IUDs known as the ParaGard and the Mirena.

At least 15 states are working on some kind of boost to the use of IUDs or implants, according to leaders at the Association of State and Territorial Health Officials. A study from the earlier this year found that more teens are waiting to have sex and that Colorado is far ahead of the rest of the country in teen use of long-acting contraceptives.

As funding withered for the Colorado program at the end of June, some county health agencies were creating waiting lists, while others were trying to stockpile IUDs for the neediest patients.

This week,  foundations rode in to the rescue with pledges to keep the program alive until the middle of next year. Their money will pay for an additional 6,000 devices.

“I feel fortunate that we have that community to turn to in what I considered an emergency situation,” said Dr. Larry Wolk, Colorado’s top health official.

While he celebrated the program’s survival through private funding, Wolk said that he and Democratic Gov. John Hickenlooper plan to keep fighting for taxpayer support. The governor will include funding for the birth control program in Colorado’s budget, Wolk said.

“We’ve made the case for a public benefit and we need public investment,” said Wolk, chief medical officer and executive director of the Colorado Department of Public Health and Environment. “That’s where ultimate sustainability lies.”

IUDs and other long-acting forms of contraception cost more initially than birth control pills, but they last from three to 10 years. The up-front cost for an implant or IUD is about $325 for clinics that get federal discounts or about $800 to $900 at full cost. By comparison, the discounted price for birth control pills is about $23 a month and the full price is about $70 a month. Without help affording birth control, some teens struggle to pay the initial cost of an implant. If they’re on the pill, they must get refills every couple of months and have to remember to take the pill every day. Imperfect use cuts effectiveness.

Since the Colorado legislature torpedoed funding, the evidence of success has only improved.

“We’re going to go back with our even more remarkable results,” said Wolk, a pediatrician with a specialty in treating teens.

County health officials celebrated the news that the program will survive for at least one more year.

In Jefferson County, Colorado’s fourth largest, health officials started creating waiting lists earlier this summer to be sure that they would have some IUDs on hand each month.

Kelly Conroy, nurse manager for clinic services for Jefferson County Public Health, said the program’s popularity is surging.

“The word is definitely getting out. We have a lot of patients who come in and specifically ask for the devices by name. A lot of it is word of mouth, friends and family. A friend will be on Mirena (an IUD). They will know which one they want — hormonal or non-hormonal. People are coming in way more educated,” Conroy said.

Since Conroy and her colleagues knew funding from the state was in jeopardy, they started hunting for funds elsewhere to be sure they could have IUDs and other devices on hand. They worked to bill insurance companies or Medicaid for devices they were implanting so they could recoup as much money as possible to pay for other devices. On average, she said, patients were having to wait about three weeks.

Now health officials should be able to stop creating a waiting list and provide devices for those who want them right away.

“We’re absolutely thrilled,” Conroy said. “We are a safety net for a lot of clients who are uninsured and underinsured. We don’t want to put any obstacles in their way. We certainly don’t want anyone to have an unintended pregnancy.

“Our ultimate goal is empowering not just women, but families with the ability to know that they can make the choice (to have a baby) when they’re ready,” Conroy said.

Evidence shows that cutting teen pregnancy rates also reduces high school dropout rates. Along with direct savings for Medicaid — births costs about $11,000 each — supporters of the IUD program liked the idea that better birth control can dramatically improve outcomes for girls. Those who get a good education go on to earn higher incomes, thus reducing poverty rates and cutting reliance on Medicaid and other programs for people living in poverty.

Health officials across the country have been meeting with Colorado leaders for about a year to learn about the IUD program.

“Other states are very excited about the results from Colorado,” said Lisa Waddell, chief of community health and prevention for the Association of State and Territorial Health Officials. “All states are results-oriented and want the best outcomes for adolescents, women and families.

“There’s a tremendous amount of energy around learning from Colorado and other states and looking at that return on it investment. What does it take (to start this program)? How do you leverage different partners?”

Waddell said many states are much more interested in IUDs for several reasons. They’ve seen the success in Colorado and are paying more attention to long-term benefits, not just up-front expenses. IUDs are much safer now after having had a tarnished reputation decades ago. The Affordable Care Act requires coverage for birth control, and research is showing that IUDs and other long-acting devices work much better than other birth control methods. At the same time, increased transparency in health costs is driving much greater attention to getting the best bang for the buck.

“In the last couple of years, there’s been this convergence of this best evidence coming out and this drive to make sure we’re purchasing the best health care,” Waddell said. “These are highly effective devices…You’re seeing a systems change.”

According to the CDC, the failure rate with IUDs and other long-acting devices is less than 1 percent, while birth control pills fail at a 9 percent rate and condoms don’t work 18 percent of the time.

Nationally, only 7 percent of women use IUDs or other long-acting devices.

Waddell’s group represents Dr. Wolk and his colleagues. Because of the extensive interest in the issue, they convened a “learning community” on long-acting contraception. The group met in person last year and holds regular virtual sessions.

Six states that have already changed their policies on long-acting birth control led the way. They are Colorado, Georgia, Iowa, New Mexico, Massachusetts and South Carolina. Six more states are slated to join the group shortly and leaders from the 12 states will meet in person again in October.

Waddell says 50 percent of pregnancies in the U.S. are unintended. One of the programs that has been most popular in other states is to offer women who have just given birth an IUD or other long-acting device while they’re still in the hospital after having had a baby. Medicaid will pay for those devices and health officials say it makes great sense to implant the device while the woman is in the hospital.

“They’re generally pretty motivated to get a contraceptive device that would allow their body to recover,” Waddell said.

Along with postpartum use of IUDs, South Carolina health officials have been focusing on using long-acting birth control as a method for driving down stubbornly high infant mortality rates. Premature births that can put babies in jeopardy are higher among teens and others who get pregnant unexpectedly.

Driving down the number of unwanted pregnancies should also result in fewer infant deaths, Waddell said.

Consumer demand is also central to the growth in popularity of IUDs and other long-acting devices, said Ellen Pliska, director of family and child health programs for the health officials’ group.

“Since the momentum has gotten started, more women are aware that it’s a viable option. We’ve been hearing that word of mouth has been incredible, particularly among teens. If one ‘influencer’ gets involved, they’re going to tell everybody about it,” Pliska said.

Among the groups that so far have pledged support for the Colorado effort are:

· The Ben and Lucy Ana Walton Fund of the Walton Family Foundation

· Buell Foundation

· Caring for Colorado Foundation

· Chambers Family Fund

· The Colorado Health Foundation

· The Colorado Trust

· Community First Foundation

· The Community Foundation Serving Boulder County

· Global Health Foundation

· Kaiser Permanente Colorado

· The Women’s Foundation of Colorado

Wolk said some of the money will be used to expand training so that many more providers will know how to insert IUDs and other devices.

While Wolk supports efforts to give IUDs to teens and women who have already had babies, he thinks it’s much better to reach out to them and provide the most reliable contraception before they get pregnant the first time. He’d like to set up a system comparable to the public funding for vaccines, which, like IUDs, cost a lot for providers to keep on hand. A steady stream of funding would provide two options. If a woman has private or public insurance, providers can give them IUDs and get reimbursed. If they don’t have coverage and still want long-acting contraception, they can still get help.

“We’d have (devices) for uninsured on one side and insured on the other,” said Wolk. “That’s my vision.”

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