Colorado's Medicaid-DPC Bill Passed the House. Then the Senate Shelved It.

A bipartisan bill that would have given Colorado Medicaid recipients the option to pay out of pocket for direct primary care just hit a wall.

House Bill 26-1096 passed the Colorado House in February with a 40-22 vote. On Thursday, the Senate Health and Human Services Committee voted 4-3 to postpone it indefinitely.

The bill isn’t dead in the traditional sense. But it’s off the table for now, and the reasons it stalled tell you a lot about where DPC-Medicaid policy stands in 2026.

What the Bill Would Have Done

HB 26-1096 didn’t ask Medicaid to cover DPC. That’s an important distinction.

Instead, it would have removed barriers that currently prevent Medicaid members from paying out of pocket for DPC services. Under the bill, Medicaid recipients could choose to see a DPC doctor on their own dime, paying a monthly membership fee for direct access to a primary care provider.

The target audience was specific: Medicaid members in rural Colorado who can’t reliably find a primary care provider through their existing coverage. If your Medicaid card says you have primary care access, but no one within 50 miles is taking Medicaid patients, the coverage is theoretical.

Co-sponsor Sen. Janice Rich (R-7th District) framed it in practical terms: “This bill could reduce both human suffering and long-term costs to taxpayers.”

Why the Senate Committee Shelved It

The committee hearing included extensive public testimony. And here’s the thing: most of the speakers actually liked the bill. They just thought it needed work.

Kevin McFatridge, executive director of the Colorado Association of Health Plans, laid out the core concern: “Without clear guardrails, there is a risk that members may not fully understand that direct primary care services are not covered by Medicaid and cannot be billed to the program.”

That’s a real issue. DPC is already confusing to people with commercial insurance. For Medicaid members, the distinction between “you have Medicaid” and “this doctor doesn’t take Medicaid but you can pay them separately” is even harder to communicate clearly.

McFatridge also raised the possibility of “individuals paying out of pocket for services they already have access to and that are already covered.” In other words, a Medicaid member might pay $70-$100 a month for DPC when their insurance already covers primary care visits at no cost.

Twelve amendments were proposed during the hearing. All speakers in opposition said they could support the bill if those amendments were adopted. The committee chose to hit pause rather than push through a bill that everyone agreed needed refinement.

The Bigger Picture: DPC and Medicaid

Colorado isn’t the first state to wrestle with this question. The intersection of DPC and Medicaid is one of the trickiest policy areas in the movement.

The argument for access is straightforward. If you’re on Medicaid and you can’t find a primary care doctor, having the option to pay a DPC physician directly is strictly better than having no option at all. DPC practices typically charge between $70 and $100 per month for individual memberships, and many offer sliding-scale pricing.

The argument against is also reasonable. Medicaid exists to ensure low-income individuals don’t have to pay out of pocket for basic health care. A policy that encourages Medicaid members to spend their own money on services they’re theoretically entitled to for free raises equity questions.

The 40-22 House vote shows this isn’t a fringe idea. Bipartisan support carried it across one chamber. The 4-3 Senate committee vote shows it’s not a slam dunk either.

What This Means

Colorado’s bill is shelved, not buried. The fact that opponents expressed willingness to support an amended version suggests HB 26-1096 could come back in a future session with stronger consumer protections.

If you’re a DPC physician in Colorado, this doesn’t change your practice today. You can still see patients who pay out of pocket, regardless of their insurance status. What the bill would have done is formalize that pathway and potentially open the door for Medicaid programs to acknowledge DPC as a legitimate access option.

For the broader DPC movement, Colorado is a test case worth watching. As more states grapple with Medicaid access gaps in rural areas, the question of whether DPC can serve as a safety valve will keep coming up. The answer will likely depend on getting the guardrails right, exactly the issue that paused this bill.

The 12 proposed amendments are the real story here. They represent the gap between “DPC could help Medicaid members” and “here’s how we make sure it actually does.” Closing that gap is the work ahead.