Colorado launched the Behavioral Health Administration in 2022 with the idea that the agency would guide future investments in mental health and addiction care until everyone in the state had relatively easy access.

Three years later, most of the groundwork is in place for those investments, but threatened federal cuts and a state budget crunch mean even maintaining existing services could be a challenge. The BHA had a difficult start, with conflicts over leadership as well as stakeholders saying the state moved too fast and risked making mistakes.

At a mental health summit in late May, BHA Commissioner Dannette Smith said the agency and the rest of the state’s behavioral health system will have to try to get the most benefit for people out of limited resources. Expanding services isn’t an option in the immediate future, she said.

“We’re trying to hold on to what the BHA is doing and funding right now,” she said.

Colorado could lose $7 billion to $12 billion in Medicaid funding over the next decade if the “Big Beautiful Bill,” which includes work requirements and limits states’ ability to draw down federal funding, passes Congress in its current form, according to an analysis by the health-focused nonprofit KFF.

The state faces a budget crunch in the coming year, and Gov. Jared Polis has said it won’t have the resources to make up for lost federal dollars.

The BHA doesn’t provide services but develops rules for mental health and addiction providers in Colorado, while overseeing contractors that develop a network of providers willing to see patients who can’t pay.

The agency also runs campaigns to reduce stigma and encourage people who are suffering to seek help.

Part of its intended role was to find out where the safety net has gaps and to advise lawmakers on how to deploy funds to close them — a task that almost everyone acknowledges would be futile in the short term, given the state’s budget crunch.

Medicaid is separate from funding for the BHA’s programs to pay for care for uninsured people, but if people lose Medicaid coverage, they’ll have to rely on the BHA programs, straining their budgets, said Kim Bimestefer, executive director the Colorado Department of Health Care Policy and Financing.

Signs suggest Colorado’s Medicaid program already may be in retreat. Providers who expanded their behavioral health services, with the promise of higher Medicaid rates, recently found out they won’t get that money, according to the Colorado Sun.