By: Dr. Ethan Kerns

During my junior year at the University of Iowa College of Dentistry, I vividly recall an assignment in which we were asked to rank our preferences for clinical rotations outside the dental school. One listing quickly caught my attention: a Community Health Center in Colorado that provided comprehensive oral health services to low-income and vulnerable populations. At the time, I had never heard of a Community Health Center, but the description mentioned an integrated model of care, oral health quality metrics, a strong focus on disease prevention and compliance with accreditation standards. It also noted that the center, Salud Family Health, had hosted University of Iowa dental students since the early 1970s.

I was intrigued. The opportunity to work in a setting that prioritized underserved populations and emphasized prevention and quality resonated deeply with me. Nineteen years later, I’m still at Salud Family Health, now serving as Chief Dental Officer. I consider it a privilege to continue delivering oral health care to some of our most vulnerable populations.

WHAT ARE COMMUNITY HEALTH CENTERS?
Community Health Centers (CHCs) are community-based nonprofits or public agencies and are patient-governed organizations dedicated to delivering high-quality, comprehensive primary health care to underserved communities across the United States. CHCs are a cornerstone of the health care safety net. “Community Health Centers” is a term that includes both Federally Qualified Health Center (FQHC) grantees and Look-Alikes.

To qualify as a CHC, organizations must meet rigorous federal standards and undergo regular on-site audits to confirm compliance. These include providing integrated services (such as medical, dental and behavioral health) alongside essential patient support services such as transportation, outreach, translation, enrollment assistance and care coordination. Their volunteer governing board composition must be comprised of at least 51% consumers of services, and they are required to have quality metrics that are reported to the federal government every year. CHCs are mandated to serve all patients regardless of insurance status or ability to pay, offering a sliding fee for those at or below 200% of the Federal Poverty Level. For those at or below 100% of the Federal Poverty Level, services must be offered for a nominal fee (such as $50 for a quadrant of direct restorative treatment). In Colorado, approximately 88% of CHC patients have family incomes at or below 200% of the Federal Poverty Level.

THE ROLE OF COMMUNITY HEALTH CENTERS IN COLORADO’S ORAL HEALTH LANDSCAPE
Colorado is home to 21 CHCs operating 268 clinic sites across 48 counties (out of Colorado’s 64 counties). Collectively, they serve more than 850,000 individuals and family members (about one in seven Coloradans) through 2.8 million visits annually for all primary care services. In terms of oral health, CHCs provide dental care to approximately 174,000 Coloradans through a variety of delivery models, including in-clinic services, mobile units, school-based programs and teledentistry.

All CHC clinic locations must be federally approved based on demonstrated community need. As a result, many are in rural and underserved areas where access to oral healthcare is limited or nonexistent. In these communities, CHCs are sometimes the only dental providers available, making their presence essential to public health.

EDUCATING THE NEXT GENERATION OF DENTAL PROFESSIONALS
CHCs play a vital role in shaping the future dental workforce. Many CHCs host dental residents, dental students, hygiene students and dental assisting students for multi-week clinical externships. They not only refine their clinical skills, but they also immerse themselves in the realities and rewards of serving vulnerable populations. In 2024, nine CHCs provided clinical education experience to an estimated 375 students preparing to be dental assistants, hygienists or dentists. This exposure is critical to developing a workforce that is both clinically competent and socially conscious, and it helps build a pipeline of providers and staff who are committed to addressing Colorado’s persistent oral health access challenges.

A SHIFTING POLICY LANDSCAPE
While the mission of CHCs remains steadfast, the policy and funding environment is rapidly evolving. Recent developments at both the state and federal levels are reshaping how CHCs operate and how care is delivered.

In Colorado, advocacy efforts led by the Colorado Dental Association (CDA) successfully preserved adult dental Medicaid benefits, despite a $1.2 billion state budget shortfall. However, another projected shortfall in 2026 raises renewed concerns about potential cuts to the adult dental Medicaid program.

At the federal level, legislation signed by the President on July 4, 2025, presents even greater challenges. Medicaid is the primary source of revenue for CHCs, enabling them to provide care for millions of low-income and underserved patients. The newly enacted budget bill, known as the One Big Beautiful Bill Act, includes sweeping changes that are projected to increase the number of uninsured people nationwide by 10 million. These changes include reduced Medicaid eligibility and cuts to federal funding for state Medicaid programs.

CHCs across the country and in Colorado were already facing financial challenges due to the Medicaid unwind. In Colorado, about two-thirds of CHCs were operating with negative margins in 2024. Unfortunately, the changes from recent legislation will push them into an even deeper financial crisis. With millions of patients projected to lose Medicaid coverage nationwide, CHCs will encounter a significant increase in uncompensated care that poses a serious threat to the sustainability of services in rural and high-need communities. According to the National Association of Community Health Centers (NACHC), the recent legislation could lead to the loss of at least 34,000 CHC jobs and the closure of 1,800 CHC clinic locations nationwide.

WHY THIS MATTERS TO THE ENTIRE DENTAL WORKFORCE
CHCs are not isolated entities; they are integral to the broader oral health ecosystem. When CHCs face funding cuts or policy setbacks, the ripple effects extend far beyond their walls. Emergency departments see more dental-related visits, and school attendance suffers due to untreated oral pain. These impacts touch every corner of our communities, especially in areas where CHCs are the only accessible providers.

Many dental professionals serve Medicaid patients or those without insurance. Changes to Medicaid coverage, reimbursement rates or eligibility criteria affect all providers. A reduction in Medicaid enrollment means more patients will seek care without coverage, straining resources across the entire dental system.

LOOKING AHEAD
As we navigate this uncertain and evolving landscape, it’s more important than ever to understand the vital role CHCs play in Colorado’s health care system and the growing challenges they face. With Medicaid serving as the primary revenue source for CHCs and the passage of federal legislation that will remove Medicaid coverage for millions, there is a serious threat to the financial stability of these centers.

In Colorado, anticipated state budget shortfalls could further jeopardize funding for safety-net providers. This is not just a concern for CHCs. Policymakers, private practice dentists, health care advocates, and community leaders all have a stake in ensuring that access to care remains strong. Whether through advocacy, collaboration, or education, we must work together to protect and strengthen the systems that serve our most vulnerable Coloradans. There are many meaningful ways to support your local CHC during these challenging times; from donating funds or equipment, to volunteering your time, accepting patient referrals, and advocating for their mission by sharing the value of CHCs with policymakers at the local, state and federal levels. The health of our communities and the sustainability of Colorado’s oral health access depend on it.

Dr. Ethan Kerns is the Chief Dental Officer for Salud Family Health Centers. Dr. Kerns is active in organized dentistry and advocates at the state and national levels. He is a Past President of the National Network for Oral Health Access (NNOHA) and is active in the Colorado Dental Association (CDA).