Source: CPR
Four boys burst from their moms’ vehicles and ran across the gravel parking lot of the farm to greet each other and start playing. Toys lay on the grass near riding rings and horse stables. Chickens and cats meandered along the property, inspecting the visitors and basking in the sun.
Taneal Behm, owner and occupational therapist at Iron Horse Therapeutic Farm—located just outside of Timnath, southeast of Fort Collins—welcomed the kids and their families warmly.
“They’re really fun,” Behm said of the children. “It feels really chaotic, but the growth and the skills they’re working on—it’s pretty amazing.”
Through occupational therapy at the farm, Behm helps kids with various diagnoses, including autism, Down syndrome, cerebral palsy, attention-deficit/hyperactivity disorder and trauma. Parents and providers say these therapies influence children’s educational and social outcomes. They are especially helpful when kids are not meeting developmental milestones.
The number of children in Colorado who use Medicaid and received physical, occupational and speech therapy services— working to improve their skills to communicate, learn in a classroom and make friends—in the last five years has increased by 36%. State Medicaid spending, however, has nearly doubled, according to an analysis of Medicaid data from the Colorado Department of Health Care Policy and Financing.
The reason spending for these specific services has gone up this much is unclear, but experts say the result is that more kids are accessing the services they need. The increased state spending follows a trend of growing costs for Medicaid in the state budget due to a variety of reasons, including higher prices for medical care and more utilization of services.
But now, lawmakers have slashed reimbursement rates for providers, effective April 1, putting the growing access to physical, occupational and speech therapy services in jeopardy.
Between July 2019 and June 2025, the state spent $1.2 billion on physical, occupational and speech therapies. Spending increased 90% during that same period. The number of Medicaid claims rose by about 49%.
Research shows that these types of therapies can help children close developmental gaps. Occupational therapy can improve cognitive development in young children. Speech therapy can help kids communicate their thoughts and needs more effectively. Physical therapy can improve the fine motor skills of kids with disabilities.
The January therapy session was one of many weekly sessions that Behm hosts at Iron Horse Therapeutic Farm. Four elementary-aged kids gather with occupational therapists on Tuesday mornings to spend an hour learning motor skills, such as handwriting, and social skills, such as interacting with each other. This includes learning to advocate for their own needs, managing big emotions when things don’t go their way and limiting what they share to make space for others in conversations.
“One little boy’s needs are to be able to accept other people’s ideas and to be flexible,” Behm said. “He sees the world very black-and-white. And another is to just sit and attend in a group setting, and another is to find his voice within this group.”
On the docket that morning was a game of Mouse Trap, feeding the goats cabbage and building an obstacle course. The children and members of the therapy team filed into a barn-like building with lights crisscrossing across the ceiling. Shelves brimmed with stacks of games and art supplies, gymnastics mats were tucked away in a corner of the room, and hand-painted artwork decorated the walls.
The boys sat in low chairs as they listened to the plan.
Asa Scheer, 7, has been working on giving space to the other boys’ ideas. That day, the therapists rewarded him with Mouse Trap after he’d patiently waited for two weeks.
Throughout the course of the game, the kids played rock-paper-scissors to choose who went first, brought each other into the fold by assigning someone to distribute cheese and took turns triggering a complex trap designed to capture “mice.”
Behm said the therapists help the kids learn to play because that is one of their daily occupations.
“You play throughout your whole life, and knowing how to get along in a group and how to advocate for your needs within a group, or how to accept someone else’s ideas within a group, those are lifelong skills that probably some adults should have OT and work on them,” Behm said.
The number of kids accessing PT and OT went up by a third
An analysis of HCPF data found that 32% more kids enrolled in Colorado’s Medicaid program accessed physical and occupational therapy in 2025 than in 2019—up to 41,569 children, from 31,375 in 2019. During that same timeframe, expenditures grew 89% to $145 million by 2025.
That is only about 1% of the estimated $13 billion in total Medicaid spending in Colorado, according to KFF, a health policy research nonprofit. The documented rise in Medicaid spending is notable at a time when lawmakers have voted to cut Medicaid funding for caregivers and disability programs.
Medicaid spending has drawn the attention of state legislators as they dig their way out of a budget hole. Parents and advocates have warned that cuts to these programs will affect the children who benefit from them. The Joint Budget Committee, the powerful legislative body that helps the state balance the budget, recommended that providers be paid at 85% of the Medicare benchmark, effective April 1, to save tens of millions of dollars a year.
Lawmakers and the governor approved the cuts in February in House Bill 26-1155. Marc Williams, a HCPF spokesperson, wrote in an email that the cuts were necessary.
“No one is happy making budget reductions, but we are focused on responsibly limiting Medicaid growth to ensure that Medicaid is sustainable and Coloradans have access to the care we need in the future,” Williams said.
Eric Maruyama, a spokesperson for Gov. Jared Polis, wrote that Medicaid spending overall has increased in Colorado in the proposed budget and that the budget balances “protecting important investments in education and public safety” while “setting Medicaid up for future sustainability.”
A HCPF bulletin from October 2025 projected these rate reductions.
Behm wrote in a text message that these cuts will cause problems for her, other small providers and the people they help. “I think most small practices will go under, leaving only the hospital affiliates still in business,” she wrote before the cuts went into effect. “Thousands will lose their therapy team!”
Jill Hawks, a licensed speech-language pathologist and president of the Colorado Speech-Language-Hearing Association, wrote in an email that these cuts would likely reduce the number of people who can get care. Providers could choose to stop taking Medicaid patients, and rural hospitals would be forced to operate on thinner margins.
The result, according to Hawks, would be “limited access to care to Medicaid beneficiaries, limited access to skilled and qualified Medicaid providers and longer wait times to get in with skilled Medicaid providers.”
Chris Edmundson, the co-chair of the government affairs committee for the Colorado chapter of the American Physical Therapy Association and a physical therapist with a private practice in Firestone, wrote in an email that these cuts would destabilize the insurance network.
“Everyone’s bracing for catastrophe right now with the Medicaid cuts coming,” Edmundson said.
Some practices with caseloads primarily composed of Medicaid patients will be forced to close, and others will be required to drop insurance carriers with even lower reimbursement rates than Medicaid.
“Colorado will become a desert for children’s rehabilitation services,” Edmundson wrote. “Evidence strongly suggests that neglecting these children will lead to significantly greater expenses for our health care system later (not to mention the lower function and quality of life they will experience as a result).”
Edmundson said he’s not sure why the state data show so much money being spent on these therapies and at a rate that is growing “too rapidly,” especially since Medicaid claims are growing much more slowly than spending.
Even with the spending increase, Edmundson said the physical therapy industry is struggling to retain therapists and make much of a profit. He said he barely broke even last year.
A review of Colorado Department of Regulatory Agencies data showed the state licensed 728 physical therapists in 2025, 16% more than in 2019, when 630 were licensed.
