Memorandum: Improving Healthcare Access for Non-Citizens in Colorado: A Policy and SWOT Analysis

From Katia Diamond-Sagias

Memorandum

To: Colorado State Policymakers
From: Katia Diamond-Sagias, MPP student at the University of Denver
Date: June 2025
Subject: Improving Healthcare Access for Non-Citizens in Colorado: A Policy and SWOT Analysis

Executive Summary

Non-citizens in Colorado face multiple intersecting barriers to healthcare access, including lack of insurance options, prohibitive costs, fear of immigration enforcement, language and system complexity, and medical discrimination. These challenges lead to worse health outcomes, increased reliance on emergency care, and financial strain on safety-net institutions like Denver Health (Misra et al., 2021). While programs such as OmniSalud and Cover All Coloradans have improved access for some, they remain insufficient to meet the needs of all vulnerable noncitizen populations in the state. This memo identifies barriers to healthcare access and offers targeted policy solutions, concluding with a SWOT analysis of the healthcare landscape for non-citizens in Colorado.

Problem Overview

Roughly 300,000 non-citizens live in Colorado, contributing to the state's economy and labor force while facing profound challenges in accessing healthcare (“State Immigration Data Profiles, Colorado,” n.d). Undocumented individuals, TPS holders, H-2A workers, humanitarian parolees, and asylum seekers are among the most vulnerable, with limited or no access to insurance, elevated fear of deportation, and systemic discrimination in medical settings (Albright et al., 2022).

Key Barriers to Healthcare Access

  • Insurance access and cost: Over half of undocumented immigrants are uninsured (Colorado Health Institute,” n.d.). Most are excluded from Medicaid and ACA coverage, and private insurance is often unaffordable.
  • Fear and distrust: Concerns about immigration enforcement, public charge rules, and job security deter care-seeking behavior, even when services are technically accessible (Pillai et al., 2025).
  • Language and system complexity: Approximately 51% of non-citizens in Colorado are Limited English Proficient (LEP) (“State Immigration Data Profiles, Colorado,” n.d.). Lack of translation services and opaque processes limit navigation and health literacy.
  • Discrimination and racism: Discrimination based on legal status, ethnicity, or language results in lower quality care, reduced trust, and lower rates of service utilization (D’Anna et al., 2018).

Policy Recommendations

  • Expand OmniSalud: Increase available slots and widen eligibility requirements.
  • Broaden Cover All Coloradans: Extend eligibility beyond children and pregnant people by age group.
  • Invest in language accessibility: Mandate standardized translation service, including in-person interpretation for languages spoken by at least 2% of the population by Colorado county.
  • Enhance culturally responsive care: Require training on cultural sensitivity and expand funding for diverse healthcare workforce development.
  • Scale telehealth services: Bolster remote care options and increase outreach to encourage users of CAC and Omnisalud to access preventative care that reduces geographic, financial, and psychological barriers.
  • Strengthen communication on available care options and privacy: Proliferate clear information about rights, program eligibility, and data sharing.

Conclusion

Healthcare access for non-citizens in Colorado is limited by deeply entrenched and interrelated barriers. Addressing these through targeted policy interventions is essential to reduce disparities, improve public health outcomes, and ensure a sustainable healthcare system for all.

 

Works Cited

Albright, Karen, Maria De Jesus Diaz Perez, Theresa Trujillo, Yesenia Beascochea, and Joe Sammen. 2022. “Addressing Health Care Needs of Colorado Immigrants Using a Community Power Building Approach.” Health Services Research 57 (S1): 111–21. https://doi.org/10.1111/1475-6773.13933.

“Behind the Numbers: Insurance and Immigration | Colorado Health Institute.” n.d. Colorado Health Institute. https://www.coloradohealthinstitute.org/research/behind-numbers-insurance-and-immigration.

D’Anna, Laura Hoyt, Marissa Hansen, Brittney Mull, Carol Canjura, Esther Lee, and Stephanie Sumstine. 2018. “Social Discrimination and Health Care: A Multidimensional Framework of Experiences Among a Low-Income Multiethnic Sample.” Social Work in Public Health 33 (3): 187–201. https://doi.org/10.1080/19371918.2018.1434584.

Misra, Supriya, Simona C. Kwon, Ana F. Abraído-Lanza, Perla Chebli, Chau Trinh-Shevrin, and Stella S. Yi. 2021. “Structural Racism and Immigrant Health in the United States.” Health Education & Behavior 48 (3): 332–41. https://doi.org/10.1177/10901981211010676.

Pillai, Drishti, and Samantha Artiga. 2023. “Employment Among Immigrants and Implications for Health and Health Care | KFF.” KFF. November 6, 2023. https://www.kff.org/racial-equity-and-health-policy/issue-brief/employment-among-immigrants-and-implications-for-health-and-health-care/.

“State Immigration Profiles, Colorado.” n.d. Migration Policy Institute. https://www.migrationpolicy.org/data/state-profiles/state/demographics/CO.

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Policy brief condensed from Masters in Public Policy Capstone, supervised by CIPR Director, Professor Rebecca Galemba, Josef Korbel School of International Studies.