The State of Colorado may have to return up to $19 million in federal funding that was awarded to provide medical insurance for needy children, because not enough income-eligible families signed up.

The bad news is not that the money will have to go back to the federal government, but that Colorado children who were eligible for Children’s Health Insurance Program coverage still don’t have insurance. That creates complicated problems.

First, it means that some children are not receiving the health care they need. Because they are part of low-income families, they’re likely to be at greater risk for some health problems, and without either insurance or money, their access to treatment is limited. Their family members experience the same health-care limitations, and so communicable diseases can more easily gain a foothold in those populations and then spread. That’s a concern for all of us.

It’s also a drain on public resources. An ounce of prevention is worth a pound of cure, and when that prevention isn’t provided, the costs mount rapidly. That’s the theory behind subsidizing childhood immunizations, for example; a $10 injection is much less expensive than even one emergency room visit, and a comprehensive immunization program is cheap compared to the cost of an epidemic.

Hospitals are charged with providing a certain amount of indigent care, a challenge for small rural facilities already squeezed by reduced reimbursement through other government programs such as Medicare. Patients without insurance tend not to have regular patient-provider relationships. For that reason, they sometimes let problems continue until they’re far more difficult to treat than they initially might have been. When they are forced to seek care, they must visit hospital emergency rooms — the most expensive source of medical assistance — because that’s the only avenue open to them. That’s not an effective use of resources.

The money was available to change that system, and for various reasons, too many Colorado families failed to take advantage of it. Enrollment totaled 24,000; as many as 69,000 additional children are estimated to be eligible. The enrollment forms were complicated, and parents who lacked sufficient language skills or functional literacy in English were intimidated by them. When the program was designed, assumptions were made that because these families had income above the qualifying level for Medicaid, they would have the communication skills and political savvy access the new program. That proved not to be the case, and state officials didn’t do an adequate job of promoting the program.