A public health grant provides a lifeline for pregnant and postpartum women in Colorado. Federal cuts threaten its stability.
Racquel Garcia, the founder of HardBeauty, an organization in Colorado that provides peer support to people facing substance use and behavioral health challenges, was headed to a funeral in late March when the email came through.
Due to an assessment by the Department of Government Efficiency, it read, the federal government was terminating grants funded by COVID-19 appropriations early. Over $11 billion in national public health funding was being canceled.
The timing of the email was morbidly prescient: Garcia was attending the funeral of a mother who had died of an overdose, the exact thing she was working to prevent.
For Garcia, it looked like the early end of one of HardBeauty’s grants providing behavioral health and substance abuse support to women through pregnancy, birth and postpartum in Colorado’s Western Slope, a region with primarily rural and frontier counties.
Instead, it was the beginning of weeks of funding limbo complicated by a federal lawsuit filed by 23 states, including Colorado, as well as Washington, D.C., challenging the DOGE cuts. As it works its way through the courts, providers are notified periodically, sometimes week-to-week, about the status of the lawsuit, which will decide the fate of their funding for the rest of the grant period.
There has been some reprieve. A little over a week after the cuts were announced, a federal judge ordered the Trump administration to temporarily restore the grants.
But many providers are still grappling with significant questions about their funding, which provide crucial public health services like vaccine clinics and substance use recovery programs.
“This is a really challenging period for grantees,” said Kylie Hibshman, director of integrated behavioral health and continuum of care at the Colorado Perinatal Care Quality Collaborative, which administers the grant to HardBeauty. “Every week or so, we hear that the funds are still being litigated. This creates a lot of uncertainty for us as an organization and our grantees, like HardBeauty, who are working hard to support families across the Western Slope.”
Providers face down grant cuts
Garcia says HardBeauty is currently the largest employer of people recovering from substance abuse in Colorado, but the concept started much smaller, with two hands.
It was a few weeks after the start of 2018 when Garcia walked into a tattoo parlor. Although she had been in long-term recovery for eight years, new challenges were intensifying. Her husband, who she loved deeply, was still actively using, and Garcia worried it would erode their life together.
At the start of the year, Garcia decided to set a mantra. “Strong” didn’t fit, neither did “faith” or “believe.” Frustrated, she tried to sleep one night and dreamed fitfully. In her dream, she heard two words over and over again.
“I could not sleep,” Garcia said. “I just kept getting the words ‘hard beauty,’ ‘hard beauty.’”
The dream was a catalyst for Garcia. The next morning, she resolved two things: She would file for divorce from her husband (they have since saved their marriage) and get a new tattoo. “Hard” on each knuckle of her right hand, “Beauty” on the left.
Racquel Garcia’s hands. “I could not sleep,” she said. “I just kept getting the words ‘hard beauty,’ ‘hard beauty.’”
Permission granted by Racquel Garcia, HardBeauty
“Hard beauty means doing what’s best for yourself over anything or anyone,” Garcia said.
In late 2019, Garcia’s mantra “hard beauty” turned into the title of her organization providing peer recovery and coaching for those struggling with substance use in Colorado.
Originally, Garcia began by hosting support meetings for young people in a church basement after two teen suicides tore through her town. Then, during the COVID-19 pandemic, Garcia and a co-founder began coaching and helping people who were struggling with substance abuse and behavioral health challenges. Social media boosted Garcia’s organization, and it grew. HardBeauty now employs 34 peer coaches and two counselors across the state.
The backbone of the organization’s programs relies on peer coaches: trained workers with personal experience of substance abuse who guide clients through help and recovery. In time, HardBeauty saw an opportunity to expand their services to clinics, acute care hospitals, and labor and delivery wards, including programs supporting pregnant women.
If a pregnant woman enters a hospital and is unhoused, actively using substances or has a baby who is exposed to substance use, HardBeauty workers can come and offer support. The organization’s workers can communicate with Child Protective Services and healthcare professionals, and many can help deliver babies — nine of its employees are certified doulas. HardBeauty also works with different hospitals around the state to offer peer support.
“Oftentimes, all focus is on the baby in that space, and mom’s forgotten,” Garcia said. “She’s not getting medication. She’s not getting asked what her needs are.”
In 2024, HardBeauty received a one-year grant, through the Impact BH program from CPCQC, to expand its community support services to pregnant and postpartum women during the perinatal period. The grant, which supported both HardBeauty and other organizations in the state, was funded through Colorado’s Behavioral Health Administration and federal funds.
The skyline of Grand Juncture, Colorado, in Mesa County. HardBeauty expanded their perinatal services to Mesa County through the IMPACT BH grant.
For CPCQC, the extension of services to the area was critical. The grant allowed HardBeauty to expand its services in the Western Slope, in counties like Mesa and Eagle. It also allowed HardBeauty to offer perinatal peer support services in the region, especially important in a state where suicide and unintentional overdose are the leading causes of maternal mortality, and 70% of those deaths occur between six weeks and one year postpartum.
“During pregnancy, you see your healthcare providers a ton, you are there all the time, and then you give birth,” Hibshman said. “Typically, for most people, you go home, you maybe go back for a six-week postpartum visit, and then you’re on your own.”
“At some point we go home to our communities, and it’s ultimately our communities that hold or don’t hold us when we go home postpartum,” Hibshman said.
In late March, however, the Trump administration’s abrupt cancellation of funding appropriated through various federal funds and pandemic-related laws seemed to jeopardize that work. The pandemic “is over,” the email said. The funding’s “limited purpose has run out.”
The funding halt threatened to disband public health initiatives like infectious disease tracking, substance abuse prevention and childhood vaccination programs across the country, according to the lawsuit filed against the HHS. It also came amid a substantial reorganization at the HHS, in which approximately 10,000 staff were laid off and half its regional offices shuttered.
In Colorado, the cuts risked more than $229 million in funding for the remainder of the grant term, state Attorney General Phil Weiser said in his lawsuit against the Trump administration.
“These cuts will also have a negative impact on Colorado’s most vulnerable residents seeking behavioral health and substance abuse treatment, including high-risk children and individuals with serious mental illness,” Weiser said in a press release.
For CPCQC and HardBeauty, about 25% of its original grant term, of which HardBeauty was slated to receive $75,000, was being canceled months before its scheduled end on June 30.
On a larger scale, the federal cuts threatened the work for all those who received CPCQC’s grants for community-based services on the Western Slope. That would be the potential loss of hundreds of opportunities to screen perinatal patients for depression and substance use. It also risked funding for mental health and substance use workforce training for 30 participants who had already registered, and seven community group meetings to discuss perinatal behavioral health gaps, according to a letter sent by CPCQC to the Colorado attorney general’s office.
Although CPCQC has secured additional funds for a new grant term starting in July, organizations still await the federal lawsuit’s ruling to see what happens to the funds they were scheduled to receive.
As of April 3, after a federal judge issued the temporary emergency order to stop the cuts, grantees can again bill for services — for now.
Despite the reprieve, it feels like whiplash for grantees.
“I just haven’t been able to come to terms with how to tell my clients,” said Susann Plenus, a HardBeauty recovery coach and doula providing services through the Impact grant. “I don’t know from one day or the next whether I’m going to wake up in the morning and be told, ‘Well, now it’s gone.’”
The grant provided enough hours for Plenus to work full time, in addition to other services she was providing for HardBeauty. The cuts meant she could lose half her income immediately.
There still is, however, one 10-day period that can’t be billed at all. The grant funds were canceled in the interim period between when the funding cuts were announced and the lawsuit was filed. Two women supported by HardBeauty gave birth during that time — HardBeauty responded, and Garcia paid for it out of her own pocket.
For the time being, Garcia is trying to operate like business as usual even under significant uncertainty about the funding, although she acknowledged it’s “pretty much day-to-day, depending on what happens in these lawsuits.”
“Every day I know I can until I can’t,” Garcia said. “Which is a sh— way to operate business…But it is what it is.”
Editor’s note: This story has been updated to clarify the number of community group meetings referenced.
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