The sheet goes back 11 years, a third of Erin’s life. There are holes in the narrative: Her daughter is schizophrenic bipolar, Vassis said, and she’s moved around different parts of the country. Still, even incomplete, Vassis’ growing tracker provides a glimpse at the revolving doors that Erin and hundreds of other Coloradans are stuck in every year.

From April 2021 to April 2022, for instance, Erin spent 106 days bouncing between emergency rooms, detox facilities, hospital beds, homeless shelters and crisis centers. During that time, she never spent more than two weeks at a time in one hospital, Vassis said. Instead, she repeatedly was discharged within a fortnight, still unstable, thanks to a decades-old Medicaid rule that often forces the early discharge of low-income, mentally ill patients.

Vassis looks at the spreadsheet again. After one hospital stay in 2021, Erin was dropped at a bus stop. It was January, and other than a dog blanket that a passing stranger had given her, she was wearing only hospital scrubs.

“They just spit you out like you’re a throwaway human being,” Vassis said. “And that’s really tragic.”

Erin is one of 300 to 400 low-income Coloradans with severe mental illnesses who need longer hospital stays but don’t get them because Medicaid caps inpatient treatment at many psychiatric hospitals to 15 days per month, a requirement that advocates say is harming vulnerable patients and straining the broader public safety net. The patients, many of whom are homeless and are discharged before they’re fully stabilized, are left to tumble through jails and psychiatric evaluations, shelters and city streets, emergency rooms and nonprofit groups.

The details are maddening, providers and advocates said: If a patient stays at one facility for 10 days and another for six, neither hospital gets paid. Because the 15-day limit is based on a monthly clock, a patient’s length of stay is partially determined by when they are admitted. A patient admitted on Dec. 8 is likely to be out before Christmas, for instance. But a patient hospitalized on Dec. 18 can stay the rest of the month and then remain in the hospital when the countdown restarts on Jan. 1.

As the state broadly re-assesses its mental health system, a group of legislators, mental health advocates and parents are working to change the Medicaid mental health rule and provide 30 days of inpatient treatment to patients who need it. That requires a waiver from the federal government, plus $7.2 million in annual funding, according to projections provided to the Colorado Department of Health Care Policy and Financing earlier this year. Nineteen other states have secured or are awaiting a final answer on similar waiver applications, according to KFF, a health policy think-tank.

With state Medicaid officials on board, Gov. Jared Polis allocated $2.5 million in his recent budget proposal to ensure hospitals are paid for 15 days, even if a patient stays a bit longer. Now, legislators and advocates are calling on the legislature to find the remaining $5 million to extend the program to a full month.

“That just seems like money well-spent,” said Rep. Judy Amabile, a Boulder Democrat involved in the discussions. “That seems very inexpensive to me.”

The rule, advocates and lawmakers say, was well-intentioned: When Medicaid was established nearly 60 years ago, its architects didn’t want large mental hospitals to permanently warehouse vulnerable patients.

But as the decades have worn on, patients are increasingly bouncing between a series of institutions, like jails and emergency rooms, that were never intended to serve as regular pieces of the mental health puzzle. Psychiatric hospitals end up absorbing costs for longer patient stays, and some are cutting back on the number of beds they have available for the service because it isn’t economically viable, said Dr. Roderick O’Brien, the director of intensive treatment at Centennial Peaks Hospital in Louisville.

For patients who need more care, shorter stays exacerbate their illness. If they’re not fully stabilized, they may not understand the full breadth of their condition or the need to take medications, said Dr. Chelsea Wolf, the medical director for Denver Health’s inpatient psychiatric unit. Mental illnesses are “chronic, debilitating illnesses,” she said, and they will worsen over time if they’re not treated correctly and consistently.

Most patients don’t need lengthy inpatient treatment stays. But providers said it’s a vital option for those who do, especially if they’re unhoused or aren’t being treated elsewhere. O’Brien estimated that two-thirds of his patients with mental illnesses who decompensate — meaning their condition has worsened — need inpatient care for longer than two weeks.

“So the concern is that people’s health is not getting better,” said Vincent Atchity, the CEO and president of Mental Health Colorado. “They get discharged before they’re better and then, in short order, decompensate yet again and become vulnerable to other unfortunate outcomes, like prolonged periods of homelessness or harmful substance use or engagement in the criminal justice system.”

Those are the revolving doors that patients like Erin have been caught up in. The short stays then strain whichever institution next encounters the patient. Wolf, the Denver Health provider, said her hospital’s emergency room is “very, very, very frequently” filled with patients “who need ongoing psychiatric care and aren’t getting it.”

Others end up in jail. In one 12-month period several years ago, Vassis said, Erin was hospitalized nine times. In six of those cases, she was arrested within three days of being discharged. Erin was arrested again last year for breaking into her mother’s house. She is now waiting for a judge to determine if she’s competent to stand trial.

The state has a broader problem with delays within its competency system, through which people awaiting trial are psychiatrically evaluated. But that crisis overlaps with the Medicaid rule: Patients who were discharged early have ended up arrested and waiting in essentially the same hospital bed they’d been released from before, Amabile said. The difference is they were now caught up in the criminal justice system.

There are positive signs that legislators will set aside the needed money to give patients longer stays. Rep. Shannon Bird, a Westminster Democrat and the chair of the powerful Joint Budget Committee, said there was “great interest” in the idea. At a legislative meeting Thursday, she questioned the basic morality of discharging patients who need more care.

“Keeping people in the hospital for the time they need to get the care they need, instead of sending them out before they’re ready to go, only to recycle them and bring them right back when they relapse or something else happened… it seems like a good thing for us to do,” she said in an interview.

State Medicaid officials are on board with a change, too. They had discussed the problem before but didn’t pursue it because of the relatively small number of patients impacted by the rule — several hundred per year, though Amabile suspects it’s much higher.

But mounting frustration from advocates and hospitals, including from facilities with overwhelmed emergency rooms, prompted state regulators to throw their support behind expanding the rule. The health care policy and financing department can apply for a waiver from the federal Centers for Medicare and Medicaid Services this spring, depending on how much money is available. The approval process will take months.

“The reason we’re changing this policy is that we are concerned that the payment policy is driving clinical decisions,” Cristen Bates, the deputy Medicaid director here, said.

For Vassis, 30 days would be a good start. She doesn’t think it’s enough for people like her daughter, but it’s better than the status quo. Erin is creative, a painter. She’s curious about the world around her. When her illness is under control, she’s held jobs, lived on her own, gone to school. She just needs help staying stable.

“She’s someone who’s so at risk for recidivism and homelessness, it’s not even funny,” Vassis said. “If they can’t get her in the real world, she doesn’t have a chance.”

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The “Roadmap to Colorado’s Future: 2026” lays out six broad objectives, largely targeted at increasing housing supply and affordability while seeking to dovetail those efforts with improved access to transit and the state’s climate goals. Polis unveiled the plan at an affordable apartment complex near a transit stop in Lakewood, highlighting the connection he’s made in developing more transit and more housing.

Though the governor repeatedly stressed the roadmap as a vision for the state to pursue, the 34-page document further cemented Polis’ broader desire to reform land use and zoning across Colorado, along with calls for more strategic growth to maximize resources, prepare for wildfires and protect the state’s outdoor areas.

Zoning reform and coordinated strategic planning are policy solutions that the governor and other Democrats see as a panacea to several of the state’s current and future ills, from climate change to housing and transit development to water limitations. The roadmap comes seven months after Polis’ marquee zoning proposal collapsed in the Capitol and four weeks before legislators return to Denver to debate the issue at length once again.

“We have too many obstructions that get in the way of building more homes, especially starter homes — homes in the 200 (thousand), 300 (thousand) range, multifamily and apartments,” Polis said in an interview. His office previously released similar roadmaps to address climate change. “What we’re really seeking to do is create a vision, a compelling vision, for Colorado’s future that’s more livable, more affordable, protects our water and our open space.”

The plan, which is pegged to the state’s 150th birthday as well as the end of Polis’ second term in 2026, details a list of worrying data points about Colorado’s present and future: The state, Polis’ office wrote, is the 12th most expensive for renters and sixth most expensive for homebuyers. Nearly three-quarters of renters making less than $75,000 spend more than 30% of their income on rent. Crop land is decreasing. Homelessness has increased.

What’s more, the report notes, the state is going to continue growing. Thirty-five thousand new households are expected to move here each year through the end of this decade.

“Unless we direct this growth in thoughtful ways, and build enough housing in existing communities and near job centers, this reality will drive up the cost of housing and put additional pressure on open space, our quality of life, affordability, and our environment,” Polis’ office wrote.

Collaboration with local governments

To hit the broader vision, the roadmap calls for eliminating exclusionary zoning practices and promoting a mix of housing types, a nod to the need for condos and multi-unit buildings, as opposed to single-family homes. Polis specifically called out making it easier for Coloradans to build accessory-dwelling units, also known as carriages houses or granny flats. ADUs are regulated differently across the state. Polis set aside money in his budget proposal to subsidize ADU construction, and a bill to allow for the building of more ADUs is expected to be introduced in the coming legislative session.

Other strategies include updating housing regulations and modernizing “regulatory and zoning policy”; supporting expedited local government permitting and housing construction; and focusing on more walkable neighborhoods and development near existing and future transit corridors.

While acknowledging that more renewable and electric energy will be a “major” part of the state’s climate change strategy, the roadmap argues that “the design of both buildings and transit systems over the coming years will have pollution, traffic and cost-of-living implications for decades, further emphasizing the importance of expanded transit and smart building design.”

In a way, the Lakewood development where Polis unveiled the plan Thursday is a perfect synthesis of land-use reformers’ ideals. The building charges $950 a month to rent a one-bedroom unit, and it’s available to people making 30% to 60% of the area’s median income. It’s near public transit and neighborhood schools. It also has baked-in requirements to keep it available for lower-income renters. Affordable housing advocates have repeatedly said they support land-use reforms, so long as they include affordability requirements.

Local governments, meanwhile, were strident critics earlier this year of the governor’s proposed land-use reforms, which would’ve legalized ADUs across the state and eased zoning restrictions in transit areas. They promise to be similarly opposed in 2024, arguing that zoning decisions are best made by local officials.

Polis said his plan doesn’t focus solely on zoning reform and noted that he was seeking to collaborate with local governments, including with millions of dollars in incentives to make reforms more palatable. His roadmap includes several examples of local governments’ own efforts to improve housing, and he and other speakers pitched the roadmap as a collaborative vision.

“Your skepticism is not just valid — it’s essential,” Peter LiFari, who runs Adams County’s housing authority, said of reform skeptics. “…How do we navigate growth without forsaking the essence of our Coloradan identity?”

Polis and other proponents of reform have argued that the housing crisis — and the broader climate and water challenges facing Colorado — don’t care about city or county boundaries and that coordination, including on a statewide level, is required to provide more housing and improve transit.

“Move as fast as possible”

Polis pitched his vision as a roadmap not just for the coming decades but for the rest of his term, though he said Thursday that there weren’t specific benchmarks to judge if his roadmap is coming to fruition.

Proponents acknowledge that land-use reforms take time to bear fruit. But there’s an urgent need in Colorado for renter relief now: Evictions are surging across the state and have already hit record levels in Denver. Polis’ roadmap encourages interventions to prevent and reduce homelessness, but it otherwise focuses on his preferred, supply-side solution to the housing crisis of development and strategic growth.

“We are going to partner with the legislature and with local government to implement this roadmap,” the governor said. “We believe that Colorado needs to move as fast as possible and, in a perfect world, we would have moved a couple of years ago on this route, but it’s not too late.”

Echoing what land-use reformers have long advocated, the roadmap argues that improved transit availability can cut down on car pollution and ease congestion. Polis’ office argues that the state “should be on the forefront of rail infrastructure in the United States,” and Polis touted the $500,000 in seed money that the state will receive from the federal government to bolster a Front Range passenger rail system.

The roadmap calls for increasing transit options; improving new and existing networks while planning for new ones; and promoting a complete and connected system.

“Zoning is a part of any discussion, but it’s a lot broader than zoning,” Polis said. “It’s about tax credits for placemaking, including art spaces. It’s about reforming and investing in transit. It’s about Front Range rail. It’s about the kind of Colorado that we want to live in. That saves people time and money, reduces traffic improves air quality, and it’s fundamentally more affordable.”

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It’s the latest milestone in a lawsuit that alleges Trump engaged in insurrection surrounding the Jan. 6, 2021, siege of the U.S. Capitol — and in doing so, disqualified himself from regaining the nation’s highest office under a Civil War-era amendment to the U.S. Constitution. The provision of the 14th Amendment bars anyone who swore an oath to the Constitution and then “engaged in insurrection” from holding office again.

In November, a district court judge in Denver found Trump did engage in insurrection while also finding that the 14th Amendment restriction did not apply to the presidency the way it would to other federal offices.

Since then, lawyers for both sides as well as outside organizations and state officials across the country have weighed in on how Colorado’s justices should decide the matter. The Supreme Court is set to hear arguments in the early afternoon.

Here’s a guide to the case and what’s at stake.

Why is the Colorado Supreme Court involved?

Denver District Court Judge Sarah B. Wallace ruled, after a weeklong trial this fall, that Trump can appear on Colorado’s 2024 Republican presidential primary ballot, despite her finding that he participated in an insurrection. This prompted both the petitioners and Trump’s legal team to appeal, though from opposite directions.

The state Supreme Court agreed to hear the case last month.

Who is challenging Trump’s eligibility?

The lawsuit was brought by a group of unaffiliated and Republican Colorado voters who are working with the liberal watchdog group Citizens for Responsibility and Ethics in Washington. The Republican petitioners include Claudine Cmarda, a former Rhode Island congresswoman who now lives in Colorado; Norma Anderson, a former majority leader in both Colorado’s state House and state Senate; and Denver Post columnist Krista Kafer.

Republican-turned-unaffiliated voter Chris Castilian, who served as deputy chief of staff for Colorado’s last GOP governor, Bill Owens, is also involved in the suit. None of the voters involved are current Democrats.

What are the plaintiffs seeking from the higher court?

Wallace’s underlying ruling that Trump engaged in insurrection through his words and actions was seen by critics of the former president as a victory in its own right. But the plaintiffs are now asking the state’s justices to go where Wallace didn’t.

Her overall ruling that the president does not qualify as an officer of the United States — a key phrase in Section 3 of the 14th Amendment — would “yield absurd results,” the petitioners argued.

“It would defy logic to prohibit insurrectionists from holding every federal or state office except for the highest and most powerful in the land,” their attorneys wrote in the appeal. The legal team includes former Colorado Solicitor General Eric Olson.

Why did Trump appeal a ruling he won?

Trump’s legal team, which includes former Colorado Secretary of State Scott Gessler, agrees with Wallace’s ruling that the 14th Amendment shouldn’t apply to Trump. But his appeal argues she committed “multiple grave jurisdictional and legal errors” — including by finding he engaged in insurrection.

Trump’s speech near the White House on Jan. 6 didn’t call for violence, his attorneys argued, and still “the district court found that President Trump’s supposed intent, and the effect of his words upon certain listeners, sufficed to render his speech unprotected under the First Amendment.”

The appeal also questions whether the five-day trial that began in late October was a proper venue for constitutional litigation and the establishment of “new, unprecedented, and unsupported legal standards.”

How have challenges of Trump’s eligibility fared elsewhere?

Similar lawsuits challenging Trump’s eligibility have been filed in several states, with none succeeding so far. Among other cases with significant backing, the Minnesota Supreme Court ruled in November that Trump could remain on the ballot there because political parties have discretion over their primary ballots. And a Michigan judge has ruled that Congress should decide if Section 3 applies to Trump.

How will Colorado’s high court consider the case?

The Colorado Supreme Court doesn’t generally overturn a lower court’s findings of facts unless the judge made a clear error, meaning the justices likely will give some deference to Wallace’s finding that Trump did engage in insurrection. Instead, their eyes will focus more closely on how she applied the law and whether the 14th Amendment applies to Trump.

The court has no specific timeline for a ruling, but Secretary of State Jena Griswold must certify the primary ballot in January. That election is set for March 5.

What’s at stake?

In her ruling, Wallace wrote that she took the gravity of the case seriously: “To be clear, part of the Court’s decision is its reluctance to embrace an interpretation which would disqualify a presidential candidate without a clear, unmistakable indication that such is the intent” of 14th Amendment’s Section 3.

Michael J. Gerhardt, a constitutional law professor at the University of North Carolina, called it “significant” that Wallace declared that Trump engaged in insurrection. He is the author of the upcoming book “The Law of Presidential Impeachment” and was the only expert called by both Republicans and Democrats in President Bill Clinton’s impeachment.

He said recent scholarship is supportive of the petitioners’ arguments that the 14th Amendment should apply to former presidents. But he didn’t have any predictions for the case — except that a ruling in the lawsuit plaintiffs’ favor would make it more likely that the U.S. Supreme Court would get involved, having the final say.

“It’s just speculation when and whether the U.S. Supreme Court will ever hear this case,” Gerhardt said. “But if somebody is being declared ineligible to run for the presidency, that could possibly make this a more pressing matter.”

What outside voices have weighed in?

The case has drawn interest from more than a dozen parties that have filed formal advisory briefs with the Colorado Supreme Court, expressing a range of opinions. Some briefs are outwardly partisan, including joint briefs submitted by more than a dozen state Republican parties; by 19 states with Republican leaders, spearheaded by the attorneys general of Indiana and West Virginia; by the Republican secretaries of state in Wyoming, Missouri and Ohio; and by the Republican National Committee.

“The Reconstruction Congress (after the Civil War) did not grant state officials sweeping authority to undermine the federal government,” attorneys for the national GOP wrote in a brief that argued the 14th Amendment provision shouldn’t be applied until after an election.

Trump’s team also has received backing from Treniss Jewell Evans III — a Texan who pleaded guilty last year to misdemeanor charges related to storming the Capitol on Jan. 6; he admitted to drinking a shot of Fireball whiskey in a conference room that other rioters told him belonged to then-Speaker Nancy Pelosi. In his brief, Evans, who said he’d been defamed by the petitioners, disputed characterizations of that day, arguing that “there was no competent evidence … to support that Donald Trump engaged in an insurrection or that there was any insurrection.”

What about on the other side?

Several law professors as well as Colorado Common Cause and the Constitutional Accountability Center, which advocates for a progressive reading of the founding document, urged the state’s justices to bar Trump from the state’s ballot.

Nine law professors countered Trump’s First Amendment defense in a joint brief, arguing it doesn’t protect speech that incites lawless action or constitutes a threat — and that disqualification wouldn’t infringe on protected speech, anyway. The filing from Common Cause, a left-leaning government watchdog group, called it “a great credit to prior generations of American political leaders” that the disqualification clause of the Constitution had so rarely been invoked — but argued this case rose to that standard.

“The fact that the Disqualification Clause is so clearly implicated at this hour, then, is a proportionally great discredit to Mr. Trump himself, who allowed a lust for power to supersede his own Oath of Office and over two centuries of American political precedent,” the filing reads.

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It’s unclear how many people were on the bus. Sen. Julie Gonzales, a Denver Democrat who was at the Capitol as the bus was unloading about 8:30 a.m., estimated the number of people onboard at 40 to 50. She directed them into the building to get warm while officials coordinated the next steps.

Gonzales said some of the migrants told her they’d come from Eagle Pass, a Texas town near the border with Mexico. Evan Dreyer, a deputy chief of staff to Denver Mayor Mike Johnston, said he hadn’t received confirmation about the circumstances of the bus trip but that it matched a recent pattern of buses arriving from the border state.

“The state of Texas, the governor’s office, has contracted with two or three different bus companies to transport migrants out of Texas to various locations around the country, Denver being one of those locations,” Dreyer said. “That’s our understanding, and that’s how this has operated for several months. Denver has received more than 200 charter buses direct from Texas over the last six months.”

Spokespersons for Texas Gov. Greg Abbott did not return requests for comment Monday.

Gonzales said the migrants she spoke to told her they were from Venezuela. More than 29,000 migrants, primarily from Venezuela, have arrived in Denver since December 2022, after groups of people crossing the U.S.-Mexico border began overwhelming Texas cities. Many of the migrants have fled widespread violence and economic instability in the South American country, often traveling through Central America on foot.

Dreyer said city officials repeatedly have requested that arriving buses take migrants to Union Station or a city intake center, but those requests have been ignored. Migrants have been dropped off near city and county buildings, though Dreyer said he believed Monday was the first time people have been left at the state Capitol.

The migrants were later directed to the Wellington E. Webb Municipal Office a few blocks away, Dreyer said.

Gonzales praised city officials for their work in helping migrants in recent months.

But Dreyer criticized the decision to drop the migrants in Denver without coordination or cold-weather clothing. Temperatures in Denver were in the low to mid-40s Monday morning.

“These are folks who have come from the Texas border after long journeys, and they are not prepared for cold weather,” he said. “And to drop them off like that, just randomly, in the cold — in the freezing cold — is inhumane, dangerous and it puts their lives at risk. It’s shameful.”

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State Rep. Ruby Dickson, a Greenwood Village Democrat and rising star in the majority party, announced her resignation, effective Dec. 11.

“While I’m proud of our legislative accomplishments, it has recently become clear that the sensationalistic and vitriolic nature of the current political environment is not healthy for me or my family,” Dickson wrote in a letter to the House’s chief clerk.

She also thanked her constituents and called her time in office “the honor of my life.”

Dickson did not immediately return a request for an interview.

House Speaker Julie McCluskie, a Dillon Democrat, praised Dickson in a statement soon after her announcement, calling her “a brilliant champion for working families.” McCluskie did not return a request for comment about Dickson’s cited reason for resigning.

Dickson won her seat in November 2022 with 56% of the vote. In the days before the special session last month, she told housing advocates that she was working on legislation for early 2024 to address parking regulations amid the broader push by Democratic legislators to reform land use codes.

She would have faced reelection next November. Her seat will be filled by a vacancy committee in the coming weeks.

Staff writer Seth Klamann contributed to this story.

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And all were from Pueblo or other parts of southern Colorado, driven up Interstate 25 by independent transportation contractors who suddenly had flooded the state’s Medicaid system.

As clinics scrambled to process the patients, they thought it was odd so many were coming from outside of metro Denver — especially while clinics were open and waiting in southern Colorado, some recalled later to The Denver Post. Providers at the methadone facilities, which are tightly regulated and highly stigmatized, made note of the vehicles dropping off these new patients: new SUVs with temporary tags, driven by men who often spoke accented English and who all had enrolled in a lucrative program that paid them to drive patients to the doctor.

The drivers billed Medicaid for every mile they drove, on a per-patient basis. The more-than-200-mile round trip between Pueblo and Denver, with a packed car, could net well over $10,000 a day.

State officials now believe the drivers were part of a coordinated Medicaid scheme that exploited the most vulnerable Coloradans and the medical system designed to keep them healthy. In a matter of months, officials say, scores of drivers are believed to have flouted Medicaid rules and the law, bilking a program that providers say is vital — and which auditors previously flagged as needing tighter scrutiny.

The Post’s reporting found that drivers appeared to share the opportunity by word of mouth and often registered new businesses using the same address. And recent changes to Medicaid, intended to bolster the program here and improve access to drug treatment, increased the money-making potential.

“The organized fraud scheme and the number of individuals that have come into this state in a coordinated fashion is unprecedented,” said Kim Bimestefer, the executive director of the state Department of Health Care Policy and Financing, which oversees Colorado’s Medicaid program.

The total cost remains unclear as state officials review thousands of Medicaid claims, a process that’s expected to take weeks. The scheme was caught in a matter of months, but in that short time, Bimestefer said, it likely cost the state millions of dollars.

The alleged fraud went beyond taking advantage of permissive rules, officials said, potentially violating both state and federal law.

Bimestefer said she contacted the FBI and the Colorado Attorney General’s Office after learning about the scheme. Both agencies declined to confirm to The Post if they were investigating.

The federal Centers for Medicare and Medicaid Services also was alerted, Bimestefer said. On Oct. 1, the agency accepted Colorado officials’ request to block any more drivers from enrolling in the transportation program. The state is now working to tighten its enrollment requirements.

Long-distance patients — many of whom, providers said, were being manipulated and weren’t yet ready to start treatment of their own volition — have since stopped coming to metro Denver clinics.

The Post interviewed more than 20 treatment providers, Medicaid officials, drivers and harm-reduction advocates who described the scheme. Though methadone clinics were an attractive target because patients initially needed to visit daily, state officials said the alleged fraud covered a broad array of the health care system — including routine doctor’s visits and hospital discharges.

One man who uses fentanyl and is unhoused said he was picked up from an encampment in Pueblo every morning before the sun rose. The Post was connected to him by a harm-reduction advocate in the city who also was familiar with the transportation scheme. The man asked not to be identified because of his substance use.

The man said he was paid $100 a day to ride in a vehicle to a methadone clinic in Aurora, packed in with as many as nine other people. This went on six days a week for five months. Pueblo patients could be paid between $50 for riding to Colorado Springs and $200 for riding to metro Denver or beyond, he and others with knowledge of the incentives said.

Sometimes, he said, one of the other patients in the car would sell fentanyl pills to the riders.

“I started it because I wanted to get off the blues and get a job,” the man said, using the slang term for fentanyl pills. “I mean, $100 a day was nice, but that’s not going to pay the bills, you know? It was barely buying lunch and dinner.”

The man has since been dropped by his driver and is no longer receiving treatment.

Floodgates opened in the spring

Several drivers and health care officials described similar incentives paid to the passengers.

Providers who noticed the unusual carpools soon began asking questions, with some saying they found the drivers argumentative. Denise Vincioni, the regional director for Denver Recovery Group, which operates methadone clinics across the Front Range, said patients often had a rotating set of explanations about why they’d come so far for treatment. New patients began arriving in groups in July at the company’s Colfax and Littleton locations.

“So it was plausible — kind of, sort of believable,” she said. “It didn’t dawn on us that this was something else,” at least initially. But Vincioni said her clinic quickly stopped accepting the new patients and reported her concerns to Medicaid.

State authorities had been alerted to the scheme as early as May by a Denver homeless services nonprofit.

Cathy Alderman, the spokeswoman and chief public policy officer for the Colorado Coalition for the Homeless, said the organization told the state about its concerns after vanloads of patients with similar stories arrived at the coalition’s Stout Street Health Center, which offers drug treatment.

The clinic was among the first in the state to be targeted, Alderman said, citing discussions with other health clinics. But soon, carloads arrived at methadone clinics elsewhere in Denver, in Littleton and in Aurora, providers at those facilities said.

Some methadone clinics in Denver became overwhelmed or stopped accepting patients from Pueblo because they suspected fraud. Drivers would then switch to another clinic, the providers said.

It’s unclear how many patients were transported as part of the scheme.

Angela Bonaguidi, who works for the University of Colorado’s Addiction Research and Treatment Services program and leads the state’s opioid treatment trade group, said she estimated 500 to 600 patients were involved. At Denver Health’s methadone clinic, program supervisor Shannon Unger said the facility saw dozens of new patients in August.

Bonaguidi said drivers directly solicited patients, often recruiting one patient who then would recruit others.

“You’re talking about individuals that are unhoused, that are in the throes of their addiction, and I think waving a couple hundred dollars in front of a person who is actively using is a large incentive,” she said.

Adam Weldemeskel, who had driven for a larger established transportation provider in Denver, said he launched his own business after hearing how much money drivers could make working in southern Colorado. Rumors had spread about drivers making $100,000 a week, he said.

But Medicaid rejected his and other drivers’ recent applications, those drivers told the Post, because of fraud concerns within the program.

“What (drivers) say is like, one guy figured out he could do things like this … and they told their friends — and it essentially got out of control,” said Weldemeskel. He said he never engaged in fraudulent activity.

In nine central Colorado counties, Medicaid transport is overseen by one company, IntelliRide. In all other counties, independent companies — sometimes staffed by just one driver — enroll with Medicaid and then strike out on their own.

They advertise to potential clients and to hospitals and medical clinics.

Among the requirements they must satisfy is passing an on-site inspection handled by a third-party contractor. Weldemeskel said his inspection consisted of a video call in which he pointed the camera into his car, at his name on the building directory for the limited space he was renting, and at a lockable filing cabinet that he said he was required to have.

Dozens of drivers registered their businesses to the same address in Colorado Springs, a shared office space that charged $150 a month for a desk, according to Weldemeskel and Dejene Mekonnen, another prospective driver who spoke to The Post.

Leslie Stevens, the landlord for the Colorado Springs building, also described the video call inspection process. She said she’d tried to work with Medicaid to ensure that the drivers, who were proving to be consistent tenants, complied with the rules and could stay in business.

“These people all live in the same community. Most are family. They all know each other. They communicate,” Stevens said. “Word (of the opportunity) spreads like wildfire, so we provided the office space.”

Many of the drivers believed to be involved in the scheme spoke a language common in Ethiopia, Bimestefer said, and they used similar bank information.

But the state Department of Health Care Policy and Financing declined to provide names or information about drivers suspected of fraud, citing the ongoing investigations.

Alleged fraud exploited Medicaid changes

The scheme took advantage of multiple recent changes to the transportation program.

Colorado lawmakers repeatedly have increased Medicaid reimbursement rates since the pandemic began, in a bid to boost the health care system that treats vulnerable Coloradans. Medicaid officials had expected that bump to draw in more providers, but they took notice when scores signed up in a matter of months this year.

And in early 2023, the state agreed to ease a geographic limitation, allowing patients to travel farther to seek drug treatment, Bonaguidi and Vincioni said.

After the fraud was discovered, the providers said, the state reinstituted a 25-mile cap on travel.

State and federal auditors previously have raised concerns about the program’s vulnerabilities. Federal regulators examined programs in several states last year and determined that varying proportions of transportation claims failed to comply with federal requirements — ranging from a low of 14% in one state to a high of 86% in another one.

A Colorado audit, released in 2021, found the state had paid out more than $5 million for claims that may not have been compliant — roughly 15% of the $33 million paid during a seven-month period.

Bimestefer, the head of the health policy and finance department, said the scheme in Colorado was related in some way to fraud detected earlier this year in Arizona and New Mexico. In those cases, low-income patients were targeted and driven to fake drug treatment facilities in Phoenix.

But she suspected Colorado detected its scam early. Medicaid officials say roughly 130 drivers are believed to have participated.

The state’s investigation and pause on enrollment of drivers “allowed us to stop 632 more providers who had the same demographics from coming into our network,” Bimestefer said.

“That’s why we’re saying this is unprecedented,” she added.

Providers said the scheme put patients’ health at risk, including the drug users. Even if they benefited from treatment, receiving it 100 miles from home wasn’t a recipe for long-term recovery.

“This was the most vulnerable population, and so it makes them an easy target,” said Bonaguidi, the University of Colorado provider. “This situation increases stigma for opioid treatment programs specifically, and patients receiving medications for opioid-use disorder and treatment for opioid-use disorder.”

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The gathering opened as pro-Palestinian protesters geared up to oppose — and potentially disrupt — the event in downtown Denver this weekend. A group of about 60 protesters gathered Thursday evening at the Colorado Convention Center’s blue bear and chanted, shouted and banged on the windows.

“We want to be loud, visible and hostile to our enemies,” an unidentified speaker said through a megaphone.

The disruption could be heard inside the convention center, host to the annual conference, which is put on by the Jewish National Fund-USA. The conference has become a local flashpoint in the weeks since Hamas carried out a deadly surprise attack on southern Israel, killing more than 1,200 and capturing nearly 250 people to be held as hostages.

The Israeli military’s response to the Oct. 7 raid has left more than 13,000 Palestinians dead in the Gaza Strip, according to the Hamas-controlled Health Ministry, inflaming tensions around the world.

On Thursday, Denver police closed a section of 14th Street, between Stout and Welton streets, to vehicle traffic as a security measure, and it put up concrete barriers. The closure will be in effect until 8 p.m. Sunday.

About 10 police vehicles blocked access to the front doors of the convention center Thursday night, as protesters marched past the windows of the facility with signs and Palestinian flags. Security was tight at the event, with heavily armed law enforcement officers stationed throughout the convention center.

Polis delivered welcoming remarks at the conference, which is scheduled to last through Sunday.

“There’s a lot of pain, and it’s made worse by the rise of anti-Semitism and hate,” the governor said. “Our greatest strength is our ability to stand together. Together we must fight all forms of hate.”

The governor’s appearance at the conference was denounced by the Colorado Palestine Coalition. The group labeled Polis “hypocrite-in-chief” on its Instagram page and accused him of welcoming “some of Israel’s most noted Islamaphobes and racist genocidaires” to Denver.

The organization is calling for a shutdown of the conference. And on Monday, Pro-Palestinian demonstrators speaking out against the Global Conference for Israel took over the chamber of City Council, causing the meeting to be postponed.

Yaron Marcus, an Israeli-American who serves as the vice president of the Mountain States region of the Jewish National Fund-USA, said his parents were called “Zionist, racist pigs” as they entered the conference Thursday.

“It’s disheartening,” he said inside the convention center.

NOW: Pro-Palestine activists getting loud and banging on convention center windows, while also blowing whistles and banging pots and pans in downtown Denver. They are opposed to the Global Conference for Israel happening inside. Governor Polis is scheduled to address the event pic.twitter.com/tfRThCofsz

— John Aguilar (@abuvthefold) December 1, 2023

The protesters this year are “angry, hostile and threatening,” said Marcus, who grew up in a Tel Aviv suburb and now lives in Denver. And they erroneously conflate the American arm of the organization to the Israel-based Jewish National Fund organization, he said.

“We own no land (in Israel),” Marcus said. “We are a nonprofit whose mission is to carry out humanitarian and other philanthropic endeavors in Israel.”

Polis, who is Jewish, told The Denver Post through a spokesman last week that “Israel has a right to defend its citizens against Hamas and to respond to the brutal murder of hundreds of Israeli citizens, and to work to facilitate the return of hundreds of hostages.”

Hamas has been designated as a terrorist organization by the United States, Canada and the European Union.

Polis’ spokesman, Conor Cahill, added that hate against any faith in Colorado “will not be tolerated, and that includes ensuring that any effort to intimidate or prevent people from speaking to a group of Jewish Americans convening in Denver does not succeed.”

Many pro-Palestinian activists accuse the Jewish National Fund of supporting policies that have displaced Palestinians from their land and have resulted in the severe curtailment of their rights as they seek to create a nation-state of their own.

Sarah Kaplan Gould, a member leader of the Denver/Boulder chapter of Jewish Voice for Peace, said the Jewish National Fund-USA “supports a vision in Israel that does not support equality for Palestinians and for all people.”

Jewish Voice for Peace calls for an end to U.S. support “for Israel’s oppression of Palestinians” on its website. It also calls for a permanent cease-fire in the current war. A tenuous cease-fire that began a week ago was extended Thursday to release hostages, but it’s not clear how long it will last.

“The JNF doesn’t represent Jews everywhere,” said Kaplan Gould, who is Jewish. “I’m here to say: ‘Not in my name.’ ”

Jewish Voice for Peace plans to hold an “interfaith solidarity picket” near the convention center on Friday and another downtown protest Sunday. The actions are among a number of events being promoted by the Colorado Palestine Coalition this weekend, including a planned Friday walkout of Denver Public Schools students and a rally and march at the state Capitol on Saturday.

“I hope that people in Denver who are not sure they should speak out for Palestinian rights know they have a place and a community here and in Israel who recognize the intertwined fates of Jews and Palestinians,” Kaplan Gould said.

Marcus countered that Israel’s fight isn’t with Palestinian civilians.

“We’re not at war with Palestinians; we’re not at war with Gaza,” he said. “We’re at war with Hamas, the terrorist organization that governs Gaza.”

The New York Times on Thursday published the results of several recent polls that show that the level of support for Israel among Americans is decidedly stronger than U.S. support for Palestinians. In a Marist poll, 61% of respondents said they sympathized more with Israelis, and 30% sympathized more with Palestinians.

An NBC poll conducted in November showed that 47% of Americans say they feel positively toward Israel while 24% feel negatively toward the country. Only 1% of Americans feel positively about Hamas, while 81% feel negatively about the militant group, the poll found.

A mid-November Quinnipiac poll asked Americans who was “more responsible for the outbreak of violence” in Israel and Gaza. Sixty-nine percent pointed to Hamas, and 15% chose Israel.

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“We’re investing in America (and) investing in Americans. And it’s working,” Biden said Wednesday during a 24-minute speech from a temporary stage on the factory floor of CS Wind, the largest wind turbine tower manufacturer in the world.

The stop was part of the Democratic president’s “Investing in America” tour to tout the benefits of the Inflation Reduction Act and other laws passed early in his term. The South Korea-based CS Wind cited the law as a factor in its $200 million investment in expanded capacity at the Pueblo plant, and with it, the creation of more than 800 new jobs.

Tony Salerno, a production manager for CS Wind, said during introductory remarks that “this factory found new life” when Biden signed the act into law.

The setting gave Biden a jumping-off point to cast the economy as strong — even as he acknowledged that there’s “more work to do” to slow down inflation.

Unemployment has sat below 4% for a stretch not seen since the 1950s, he said, and America’s share of manufacturing for high-tech components such as microchips is rebounding. More than 250,000 new jobs have started in Colorado alone during his administration, Biden said.

Despite that messaging and the positive data points, voters have a sour view of the economy — and they largely blame Biden for it, according to recent polls.

A Gallup poll released Tuesday showed a 37% overall approval rating for Biden as he ramps up his reelection campaign. The survey found that just 32% of adults approve of his handling of the economy.

Beyond his economic message, the Pueblo setting also gave Biden a stage to slam Congresswoman Lauren Boebert, a Republican whose sprawling district includes the blue-collar city, as “one of the leaders of this extreme MAGA movement” standing against his efforts.

Displaying a sly grin, he made the sign of the cross at his first mention of Boebert.

She voted against the Inflation Reduction Act and several other laws Biden credited with spurring more than $1 billion in private investment in Colorado. Boebert narrowly won reelection in 2022.

After rattling off investments in microchip manufacturing, solar energy and wind turbine manufacturing, Biden quoted Boebert’s past criticism of the IRA, chiding: “Folks, none of that sounds like a ‘massive failure’ to me.”

“You all know you’re part of a massive failure?” Biden said. “Tell that to the 850 Coloradans who get new jobs in Pueblo at CS Wind thanks to this law. Tell that to the local economy that’s going to benefit from these investments.”

Ahead of Biden’s speech, a statement from Boebert criticized the president and “Bidenomics” — a term emblazoned on a banner in the rafters during Biden’s event.

“On Joe Biden’s watch, credit card debt, inflation, groceries and gas prices have all reached record highs,” Boebert said. “These high prices are squeezing working-class Coloradans and rural America. Rather than cutting wasteful federal spending and unleashing American energy production, Joe Biden continues to pander to radical extremists, lock up more land, and spend his time focused on campaign stunts and vacations rather than doing the job he was elected to do.”

(View the White House’s recorded video on YouTube.)

Besides Boebert, Biden took aim at former President Donald Trump, now his potential 2024 election opponent.

Trump also was Biden’s focus during a fundraiser Tuesday night in Cherry Hills Village at the home of Tamara Totah Picache, a managing partner of the Flatiron Group. He drew contrasts with Trump and highlighted public response to the U.S. Supreme Court’s decision last year to overturn abortion rights established by Roe v. Wade.

“Donald Trump’s about to find out the power of women in America in 2024,” Biden told attendees, according to a press pool report.

The president had planned to visit Pueblo last month but postponed the trip because of the escalating conflict between Israel and Hamas. U.S. support for Israel during its war in the Gaza Strip, which was launched in response to a terrorist attack by Hamas on Oct. 7, has posed political challenges for Biden among his Democratic base.

On Tuesday night, a few dozen pro-Palestinian protesters demonstrated on the street in front of the hotel where Biden stayed in downtown Denver.

Biden last visited Colorado in June, when he delivered a commencement address at the U.S. Air Force Academy.

During his Pueblo visit Wednesday, the CS Wind factory looked as though work had stopped mid-production, with metal tubes — a dozen feet or more in diameter and weighing tons — lying on the floor. On a typical day, it would be a hive of work and a cacophony of warning bells, whirring motors, welding hisses and hammering steel.

Biden went on a tour of the factory before his speech. He asked workers questions about the process for building the giant wind turbines and other work conducted on-site, according to a press pool report.

At one point, he shouted to a worker: “Corey, watch out that entire sucker starts coming back towards you.”

U.S. Sen. John Hickenlooper, a Colorado Democrat, predicted the $740 million Inflation Reduction Act’s impact on the country eventually would be likened to President Franklin Roosevelt’s New Deal. Hickenlooper proved a key negotiator last year as senators recruited enough votes to pass the bill, which included record climate spending.

“Energy independence begins in places like Pueblo,” Hickenlooper said.

Biden and his allies also extolled the effects of the $1.2 trillion Bipartisan Infrastructure Law, passed in 2021, and other legislation that has invested in high-tech manufacturing.

State Sen. Nick Hinrichsen, a Pueblo Democrat, said the setting Wednesday reflected the historic steel town’s “resiliency and its expertise,” while the investment in the wind tower factory represents “long-term growth and sustainability” for the community.

He sees the area as sitting at a crossroads, since it’s also home to the state’s largest coal-fired power plant, which is preparing to shut down in the next decade. CS Wind’s expansion, he said, moves the community and the state forward.

“We’ve got concerns about (the coal plant) and what replaces that,” Hinrichsen said. “But we’re also providing the energy that will power our state into the future cleanly and renewably.”

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The money, passed by lawmakers during a special session last week, will nearly double the $35 million already available in the current fiscal year for state rental aid. It bolsters the state’s ability to keep people in rental housing after the hundreds of millions of dollars received by the state in federal pandemic-era aid funds has run dry.

“The state’s investment in emergency rental aid will help nearly 6,000 households avoid eviction,” estimated Zach Neumann, the co-founder of the Community Economic Defense Project, which distributes rental aid for at-risk tenants. “It’s a meaningful commitment to keeping our neighbors housed.”

Under the legislation, the state must spend the money by June 30, when the fiscal year ends.

The $30 million approved by lawmakers and Polis will provide $10 million more than the state would have spent under Proposition HH, the property tax relief ballot measure rejected by Colorado voters in the Nov. 7 election. The state’s new investment comes as Denver, facing a record-breaking eviction wave, has budgeted nearly $30 million next year to help local tenants through a city rental assistance program.

The new state money will be sent to the state’s Department of Local Affairs. It will contract with nonprofit groups across the state to distribute money to landlords who have low-income tenants facing eviction.

“While we continue to work on long term solutions to lower housing costs and reduce evictions, this is a critical way we can get immediate relief directly to the families that need it most,” Sen. Janet Buckner, an Aurora Democrat, said in a statement. She co-sponsored the bill with fellow Democratic Sen. Julie Gonzales and Reps. Leslie Herod and Mandy Lindsay.

After Proposition HH failed and Polis announced a mid-November special session, progressive lawmakers and their allies had prioritized a boost in rental aid as part of a broader effort to deliver relief to lower-income earners. Rep. Emily Sirota, a Denver Democrat, told fellow Democrats before the special session that an “overarching theme” from Proposition HH’s failure, in her view, was a “need to address support for renters.”

Other legislators and housing advocates pointed out that policymakers had rushed to insulate property owners from the same cost increases that renters have weathered for years.

In Denver, city officials expect eviction filings to surpass 12,000 this year, the most since at least 2008, which is as far back as the city keeps records. Statewide, evictions are higher than before the pandemic.

The rental aid bill was one of seven approved during the special session. As the four-day session ended Nov. 20, Polis signed four bills, including the marquee measure aimed at blunting the impact of expected property tax increases coming early next year by changing residential deductions and assessment rates. Others will provide uniform refunds under the Taxpayer’s Bill of Rights, which will increase the returns for most taxpayers; will expand the Earned Income Tax Credit; and will increase staffing to support a tax deferral program.

On Tuesday, Polis signed the rental measure and two other bills: one signing the state up for a federal program that will provide summer meals for children and another that will create a task force to study long-term property tax solutions.

“This special session was about delivering relief for hardworking Coloradans,” Polis said in a news release.

Polis and legislative leaders say the task force, which is set to include several county commissioners, will begin meeting in December and will report its recommendations to lawmakers by March 15.

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The annual conference has become the latest focal point of reaction locally to Israel’s war in the Gaza Strip, which it launched in response to Hamas’ deadly Oct. 7 terrorist attack on Israeli soil. The conference, organized by the Jewish National Fund-USA, is set to begin Nov. 30 at the Colorado Convention Center.

Colorado Gov. Jared Polis, who is Jewish, is scheduled to speak at the event on its opening night. The Denver Police Department said Wednesday that it was “working with the organizers to ensure a safe event.”

“As a precaution, the department will be providing additional resources to enhance security surrounding the conference,” DPD’s statement read. “We will not share specific numbers or planning strategies for safety reasons.”

The Global Conference for Israel is expected to attract around 2,500 people to downtown Denver. It is the 22nd annual gathering, according to Sam Goldberg, president of the Jewish National Fund-USA Mountain States board. Last year’s conference was in Boston.

Pro-Palestinian activists have organized recurring events in Denver, maintaining a presence that included interrupting the Colorado legislature’s special session on property taxes over the weekend.

On the Colorado Palestine Coalition’s Instagram account, the organization declares that “Zionists,” “racists” and “genocide apologists” are “not welcome” in Denver, referencing next week’s conference. In a Nov. 13 post, it called for the shutdown. But exactly what an attempted shutdown would look like is unclear.

Abdullah Elagha, an organizer with the Colorado Palestine Coalition, told The Denver Post in an interview Wednesday that he was “not sure exactly what we will be doing” during the conference.

He’s critical of the Jewish National Fund-USA, saying the organization, which describes itself on its website as “Your Voice in Israel,” has had “a direct hand in the brutalization of Palestinians” for decades. He pointed to both the war in Gaza as well as the ongoing building of Israeli settlements in the occupied West Bank, which the United Nations has found violates the Fourth Geneva Convention, as concerns.

“The state of Israel, or any of its affiliated organizations, should not be fundraising in our state in the middle of a genocide,” Elagha said, referring to the more than 12,700 Palestinians who have been killed since the war in Gaza began in early October. That figure has been released by the Palestinian health authorities.

Israel began launching air strikes, and later ground incursions, in Gaza after Hamas terrorists brutally slaughtered more than 1,200 Israelis and took more than 200 people hostage in the Oct. 7 raid. Israel declared war on Hamas, which has been designated as a terrorist organization by the United States, Canada and the European Union.

Israel and Hamas agreed to a temporary cease-fire agreement, announced Wednesday, that’s intended to allow for the release of dozens of hostages taken during Hamas’ raid.

The conference in Denver was planned well before the latest hostilities, but the escalations will have an unavoidable impact. Goldberg, from the Jewish National Fund-USA Mountain States board, discussed his outlook.

“Hamas will not be forgiven for its intentional murder of babies and the brutal rape and mutilation of women,” he said. “All of the hostages that remain in Gaza must be freed immediately — especially the little kids.”

At the same time, there are “certainly reasonable and thoughtful critiques of Israel” to be had, Goldberg said, and many of them will be voiced at the conference.

But those who support Israel’s destruction, he said, “are unwelcome.”

Elagha’s interest in the war is personal. He was among Palestinian-Americans who recently recounted to The Post how their families in Gaza have been affected by the war. Elagha’s family has lost more than 30 members to Israeli airstrikes since the war began last month, he said.

A spokesman for the governor, Conor Cahill, told The Post this week that he intends to deliver remarks at the conference as planned.

Polis, Cahill said, “strongly believes that Israel has a right to defend its citizens against Hamas and to respond to the brutal murder of hundreds of Israeli citizens, and to work to facilitate the return of hundreds of hostages.”

Cahill added: “Here in Colorado, he has made it clear that hate against Jews, Muslims or Christians will not be tolerated, and that includes ensuring that any effort to intimidate or prevent people from speaking to a group of Jewish Americans convening in Denver does not succeed.”

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