Children’s Behavioral Health – Financial Mapping

In today’s health care landscape, it’s not enough to know that services exist—we need to know who they’re reaching, how they’re paid for, and whether we’re using our dollars to make the biggest impact possible. That’s exactly the mission the Colorado Department of Human Services (CDHS) and Colorado Health Institute (CHI) took on in 2019, when they joined forces to examine funding in Colorado’s behavioral health care delivery system for children and youth.

With behavioral health services spread across multiple agencies and funding streams, the opportunity to streamline investments and increase their effectiveness was too important to pass up. This multi-agency effort set out to answer three critical questions:

• How are state and federal funds currently allocated in Colorado’s behavioral health delivery system?
• What services are those dollars purchasing?
• Are there opportunities to reallocate funding to better leverage federal matching dollars and improve outcomes?

To help find answers, CHI tapped into the Colorado All Payer Claims Database (CO APCD)—a one-of-a-kind resource that captures detailed health insurance claims across commercial payers, Medicaid, and Medicare Advantage. By incorporating CO APCD data alongside other sources, CHI gained a clearer view of how behavioral health services are delivered and funded across the state.

A Data-Driven Discovery

Working with data from six state agencies, CHI’s analysis found that in fiscal year 2018-2019 alone, Colorado invested up to $810 million in behavioral health services for children and youth. That figure, powerful on its own, became even more revealing when layered with CO APCD insights. The claims data painted a better picture of the health system, showing:

• Nearly 7.2 million behavioral health services were provided to children and youth in 2018 through public and private insurance.
• Of the 2 million children and youth in the state, nearly 600,000 received behavioral health care that year.
• However, 14% of youth reported unmet mental health needs due to cost concerns, insurance limitations, or trouble securing appointments.

This analysis was about more than understanding spending—it was about reshaping it. CHI used these findings to spotlight five major strategies to strengthen Colorado’s behavioral health infrastructure:

• Consolidate services and funding streams
• Maximize federal dollars through better alignment
• Advance equity in access and outcomes
• Improve substance use disorder treatment availability
• Invest in better data collection and integration

The Role of the CO APCD

Why was the CO APCD so critical to this work? Claims data—though inherently complex—reveals the “when, where, what, and how much” behind the services people receive. As the state’s most comprehensive source of health insurance claims, the CO APCD enabled CHI to explore site of service, payer type, and service type with a level of specificity unmatched by other datasets. When paired with other information—like demographic insights or community-level data—these claims tell a powerful story about access to care, equity, and investment effectiveness.

Behavioral health care represents one of Colorado’s largest and most urgent investments. When dollars are well-placed, children and families get the right support at the right time. But when funding is fragmented or misaligned, those same families fall through the cracks. Thanks to this collaborative effort, and the insights made possible by the CO APCD, state leaders now have actionable recommendations to ensure behavioral health resources are used more efficiently, equitably, and impactfully.

Learn More

• The CO APCD
• Non-Public Data
• Public Data