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Human Services Gap Map

Methodology & Sources

Program Access Estimates

The program access graphs (Gap 1) display the “gap” between the estimated number of people eligible for Medicaid, SNAP, WIC, CCCAP, TANF, and HUD rental assistance programs and current caseloads for each of these programs by county.

Caseload numbers were estimated from administrative data obtained from the state agencies that oversee these programs: Colorado Department of Human Services and Colorado Department of Public Health and Environment; as well as the US Department of Housing and Urban Development. Caseload numbers for Medicaid came from the Colorado Health Institute’s Eligible but Not Enrolled reports (their data came from Colorado Department of Health Care Policy and Financing). Annual county caseload numbers for 2015, 2016, 2017, 2018, and 2019 were averaged to align with eligible population estimates from the American Community Survey. Since we were only able to collect comparable estimates on eligible populations for WIC for 2015-2017, caseload numbers for that program reflect the average of those three years, not the full five-year period analyzed for the remaining programs. CDHS suppresses caseload data for counties with TANF caseloads of less than 30 to protect client privacy. Caseload data was averaged for counties for years data was available—if no year had data available then we did not include an estimate for that county.

Eligibility estimates were derived mostly from the US Census Bureau’s American Community Survey. This does create some limitations to our analysis—mainly that we are comparing administrative data with estimates derived from a small, yet representative sample of the population of Colorado. Eligible population estimates from the American Community Survey are at the 90% confidence level—in other words the true number of eligible people or households in a county could vary, within a range, from the estimates we include in the Gap Map. While these ranges are insignificant for Colorado’s larger counties, a different value within the margin of error for smaller counties could have a significant change on the estimated outcome. That said, we feel confident that the US Census Bureau’s estimates are the best estimates available but do encourage caution when interpreting the estimates for smaller counties.

Due to complex eligibility requirements, it would be exceedingly difficult if not impossible to accurately estimate the true eligible population for these programs. As such, we only take into account income eligibility when determining if an individual or household is likely eligible for a program. However, programs have different rules around what counts as income for eligibility purposes which also differ from the US Census Bureau’s definition of income.

Data from the US Census Bureau came from the 2019 5-year American Community Survey. The American Community Survey is available in two versions: a 1-year and a 5-year survey. While the 1-year survey is more timely, estimates are not available for less populous geographies—most of Colorado’s counties. The 5-year estimates pool the 1-year estimates in 2019 with 1-year estimates from the previous four years allowing the Census Bureau to create more reliable estimates for counties with smaller populations. We average the caseload numbers from the corresponding five years (2015 through 2019) in our analysis to account for the fact our eligibility estimates will be influenced by population trends over a five-year period. It is important to note that for some programs, caseload data is based on the number of families or households served while others collect caseload data based on individuals served. We used either population or household estimates, depending on the program in our analysis.

Estimates for eligible Medicaid populations were provided by the Colorado Health Institute through their annual Eligible But Not Enrolled (EBNE) reports. We thank them for their assistance with this data. Estimates for renter households with incomes of 50% of the area median income (AMI) or below came from the US Department of Housing and Urban Development’s Comprehensive Housing Affordability Strategy (CHAS) data. This data is created by HUD using 5-year ACS data.

Fiscal Data

The primary source of fiscal data for the four programs we looked at were the state agencies who administer these programs.

  • Gap 2: For TANF and CCCAP, we averaged the allocation and expenditure data for SFY 2015, 2016, 2017, 2018, and 2019. Although Colorado’s state fiscal year (July-June) does not line up with the calendar year (January-December), there is enough overlap between the years 2015 and 2019 to provide us with reasonably comparable values.
  • Gap 3: For CCCAP, SNAP, and TANF, we used data from state agencies to estimate how much money in program benefits are distributed per administrative dollar spent. This measure can be influenced by many factors, including efficiency of enrollment procedures, staffing costs driven by cost of living, the types of services a county chooses to provide, or other unique factors. For example, a high benefit to administrative cost ratio in a program like CCCAP could reflect the high cost of childcare in the area rather than an indicator that a county is more generous in the amount of childcare subsidy it provides to families.
  • Gap 4: For CCCAP, SNAP, TANF, and Medicaid we used data from state agencies to estimate the cost per case—the administrative dollars spent per cost to enroll and manage a case. It is important to note that cost per case is a measure of administrative costs and not the amount of benefits provided to individuals or households. A lower cost per case could be an indicator of more efficient systems for enrolling, processing, and managing caseloads. At the same time, a low cost per case might be indicative of county understaffing and that the low value was achieved by staff having more cases than they can effectively manage.

We do not include WIC or HUD rental assistance programs in our fiscal gap analysis. These programs are administered in a slightly different manner than the other four programs (SNAP, TANF, Medicaid, and CCCAP). WIC and HUD rental assistance programs are administered by local agencies partners (WIC Clinics and public housing agencies) that may operate outside of county government. For example, private non-profit organizations can serve as WIC Clinics. There is also a difference in terms of the geographic areas served by these local agencies. In some cases, there might be multiple local agencies in a county, such as in Boulder County where the Boulder County Housing Authority, Boulder Housing Partners, and Longmont Housing Authority all serve as public housing agencies. On the other hand, multiple counties may be served by a single local agency partner, such as in northwest Colorado where WIC Clinics in multiple counties are managed by Northwest Colorado Health, a non-profit organization.

While we did not include WIC and rental assistance programs in the analysis, we believe the program access data is a valuable starting point for advocates who would like to understand if there could be improvements in the way these programs are run in their communities. A list of WIC Clinics in Colorado can be found at: https://www.coloradowic.gov/find-wic-clinic; and public housing agencies: https://www.hud.gov/program_offices/public_indian_housing/pha/contacts.

Additional Considerations When Reviewing the Data

Because there are so many program- or county-specific variables that might explain a high or low outcome in any of these gaps, we encourage advocates, policy makers, elected officials, and others interested in improving these programs to interpret the results presented in the Gap Map with caution. In addition, these programs are not static and many have changed since 2019. We offer this data as a snapshot of how these programs were being administered prior to the COVID-19 pandemic, while acknowledging that the administration of these programs, and the challenges facing participants and administrators alike, have changed drastically since 2020.

For these, and many other reasons, we stress that this data should be used to as a starting point for conversations among all stakeholders about the best ways to improve these programs and make them work better for the low-income Coloradans they are intended to serve.

 

Data sources

SNAP

  • Caseload data: Colorado Department of Human Services
    • Average county caseload CY 2015, 2016, 2017, 2018, and 2019
  • Fiscal data: Colorado Department of Human Services:
    • County administrative expenses in CY 2015, 2016, 2017, 2018, and 2019
    • Total annual benefits issued by county CY 2015, 2016, 2017, 2018, and 2019
  • Eligible population estimates:
    • We followed the approach of USDA’s Program Access Index (PAI), which means we used estimates from the 2019 5-year American Community Survey for the population at or below 125% FPL in each county to estimate the eligible population in each county.

Medicaid (Health First Colorado)

  • Caseload data: Colorado Health Institute
    • Annual Medicaid enrollment as captured in CHI’s Eligible but Not Enrolled reports for 2015, 2016, 2017, 2018, and 2019 using data from Colorado Department of Health Care Policy and Financing.
  • Fiscal data: Colorado Department of Health Care Policy and Financing
    • Total county administrative expenditures (regular and enhanced) for CY 2015, 2016, 2017, 2018, and 2019.
  • Eligible population estimates: Colorado Health Institute
    • Eligible Medicaid population as captured in CHI’s Eligible but Not Enrolled reports for 2015, 2016, 2017, 2018, and 2019 using data from the American Community Survey.

WIC

  • Caseload data: Colorado Department of Public Health and Environment
    • Annual number of pregnant women, infants, and children served by county for CY 2015, 2016, and 2017 as captured in CDPHE’s “Colorado WIC Percent Eligible Enrolled” reports.
  • Fiscal data: N/A
  • Eligible population estimates: Colorado Department of Public Health and Environment
    • Annual number of pregnant women, infants, and children eligible for WIC by county for CY 2015, 2016, and 2017 as captured in CDPHE’s “Colorado WIC Percent Eligible Enrolled” reports.

CCCAP

  • Caseload data: Colorado Department of Human Services (We requested data prior to the creation of the Department of Early Childhood Education)
    • Unduplicated count of children who used CCCAP care by county (defined as any CCCAP subsidy dollars spent on care for al child and/or any positive amount of CCCAP care units used (i.e., any instance of care covered by parent fee) for CY 2015, 2016, 2017, 2018, and 2019
  • Fiscal data: Colorado Department of Human Services
    • Total administrative and direct service expenditures by county, SFY 2015, 2016, 2017, 2018, and 2019.
  • Eligible population estimates:S. Census Bureau, 2019 5-Year American Community Survey Public Use Microdata Sample (accessed through IPUMS USA)
    • Population by county of the population ages 13 and below living in a household within income at or below 165% FPL.
    • We used the Missouri Census Data Center’s Geocorr (geographic correspondence engine) to derive county-level estimates using PUMA-level estimates from the ACS.

TANF

  • Caseload data: Colorado Department of Human Services
    • Annual Colorado Works unduplicated basic cash assistance, state diversion and county diversion cases by county SFY 2015, 2016, 2017, 2018, and 2019.
  • Fiscal data: Colorado Department of Human Services
    • Annual Colorado Works allocation, expenditures, beginning balance of reserve fund, administrative expenditures and basic cash assistance and state diversion payment amounts for SFY 2015, 2016, 2017, 2018, and 2019.
  • Eligible population estimates: US Census Bureau, 2019 5-Year American Community Survey
    • County population at or below 100% FPL with children under 18

HUD rental assistance programs

  • Caseload data: US Department of Housing and Urban Development, Picture of Subsidized Households
    • The number of households served through the Housing Choice Voucher, Project-Based Section 8, and Public Housing Programs by county in CY 2015, 2016, 2017, 2018, and 2019
  • Fiscal data: N/A
  • Eligible population estimates: US Department of Housing and Urban Development, 2015-2019 Comprehensive Housing Affordability Strategy (CHAS) data
    • Number of renter households with incomes of 50% AMI and below by county

HEALTH:
HEALTH FIRST COLORADO (MEDICAID)

Health First Colorado is the name given to Colorado’s Medicaid program. Medicaid provides public, low-cost health insurance to qualifying adults and children. It is an entitlement program funded by the federal, state, and county governments and is administered by counties in Colorado. Those who are required to pay must pay a small co-pay when receiving certain health care services.

State Department: Department of Health Care Policy and Financing

Eligibility: Most adults 18 to 64 are eligible for Medicaid in Colorado if their household income is at or below 133% of the federal poverty limit (FPL). Pregnant women are eligible with incomes of up to 195% FPL, while children under 18 may be eligible if the live in a household with income at or below 142% FPL. Some adults over 65 may also be eligible for Medicaid.

Program Benefits: Through Medicaid, low-income Coloradans are eligible for a range of health care services at little to not cost. Services provided include doctors visits, prescription drugs, mental health services, and dental care. Co-pays for certain individuals may be needed for certain services.

Program Funding and Access: Colorado funds our Medicaid program through state and federal dollars. Medicaid is an entitlement program, which means that all who are eligible for Medicaid can access the program, regardless of the funding level in a given year. This does not mean that it is always easy to access Medicaid, even when eligible. And since the program is administered by counties, funding levels for county staff and other administrative roles can make it easier or harder for Coloradans to access the program. On top of this, not all medical providers accept Medicaid which limits the ability of Coloradans to seek health services even if enrolled, such as if the nearest provider is a 2+ hour drive away.

Note: This data is from before the pandemic and does not reflect changes in enrollment rules during the COVID-19 pandemic and public health emergency.

Statewide Program Access 2015-19: Over the study period of this report, an average of 89.0% of the population at or below 133% of FPL (i.e., the population who is likely to be eligible for Medicaid) were enrolled in Medicaid in Colorado.

FOOD SECURITY:
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)

The Supplemental Nutrition Assistance Program or SNAP helps low-income Coloradans purchase food by providing individuals and families with a monthly cash benefit that can be used to buy certain foods. SNAP is an entitlement program that is funded by the federal and state governments and administered by counties in Colorado.

State Department: Department of Human Services

Eligibility: Currently, Coloradans qualify for SNAP if they have incomes below 200% FPL, are unemployed or work part-time or receive other forms of assistance such as TANF, among other eligibility criteria. Income eligibility for SNAP was different during the study period of this report than today—it was 130% FPL back in 2019 for example. The US Department of Agriculture uses the population at or below 125% FPL when calculating the Program Access Index (or PAI) for SNAP. We follow this practice in our analysis despite Colorado currently having a higher income eligibility threshold.

Program Benefits: SNAP participants receive a monthly SNAP benefit that is determined by the number of people in their household and their income. Benefit amounts decrease as income increases, helping households avoid a sudden loss of SNAP when their incomes increase, even by a minor amount. Benefits are provided to an Electronic Benefit Transfer (EBT) card that can be used to purchase eligible food items, such as fruits and vegetables; meat, poultry, and fish; dairy products; and breads and cereals. Other items, such as foods that are hot at their point of sale, are not allowable purchases under current SNAP rules.

Program Funding and Access: SNAP, like Medicaid, is a federal entitlement program. This means that Colorado must serve any Coloradan who is eligible for the program. As such, funding should not be a limit to how many Coloradans can be served by the program. However, funding for administration of SNAP at the state and county level can limit the ability of county human service departments to enroll those who are eligible. Other program rules and administrative barriers can make it difficult for Coloradans to receive the benefits they are legally entitled to receive.

Statewide Program Access 2015-19: Over the study period of this report, an average of 61.1% of the population at or below 125% of FPL (i.e., the population who is likely to be eligible for SNAP) were enrolled.

FOOD SECURITY:
SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC)

The Special Supplemental Nutrition Program for Women, Infants, and Children, also know as WIC, provides healthcare and nutritional support to low-income Coloradans who are pregnant, recently pregnant, breastfeeding, and to children under 5 who are nutritionally at risk based on a nutrition assessment.

State Department: Department of Public Health and Environment

Eligibility: To participate in WIC you must be pregnant, pregnant in the last six months, breastfeeding a baby under 1 year of age, or a child under the age of 5. Coloradans do not need to be U.S. citizens to be eligible for WIC. In terms of income, households cannot have incomes that exceed 185% FPL. Families who are enrolled in SNAP, TANF, Food Distribution Program on Indian Reservations (FDPIR), or Medicaid are automatically eligible for WIC. Regardless of gender, any parents, foster parents, or caregivers are able to apply for and use WIC services for eligible children.

Program Benefits: WIC provides a range of services to young children and their parents. These include funds to purchase healthy, fresh foods; breastfeeding support; personalized nutrition education and shopping tips; and referrals to health care and other services participants may be eligible for.

Program Funding and Access: WIC is funded by the US Department of Agriculture. The state uses these federal funds to contract with local providers, known as WIC Clinics. In most cases, these are county public health agencies, but that is not the case in all Colorado counties. Some WIC Clinics cover multiple counties, while others are served by multiple clinics. Private non-profit providers are also eligible to be selected as a WIC Clinic.

Statewide Program Access 2015-17: Between 2015 and 2017, an average of 52.2% of the population eligible for WIC were enrolled in the program in Colorado.

Financial Security:
Colorado Works

Colorado Works is the name given to Colorado’s program for Temporary Assistance to Needy Families or TANF. It is an employment program that supports families with dependent children on their path to self-sufficiency. Participants can receive cash assistance, schooling, workforce development and skills training depending on the services available in their county.

State Department: Department of Human Services

Eligibility: In general, Coloradans are eligible to enroll in TANF if they are a resident of Colorado, have one or more children under the age of 18 or pregnant, and have very low or no income. For example, to be eligible to receive a basic cash assistance grant through TANF, a single-parent of one child could not earn more than $331 per month, with some exclusions—and would only receive $440 per month (as of 2022). That said, there are other services provided by counties through TANF that those with incomes as high as $75,000 may be eligible for. In addition to these, participants in TANF are required to work or be pursuing an eligible “work activity” or work-related activity. Any eligible individual can only receive assistance if they have not previously been enrolled in TANF for a cumulative amount of time of more than 60 months—this is a lifetime limit that does not reset. Counties may have additional requirements and offer benefits that are not available in other counties in Colorado.

Program Benefits:  While the exact benefits that one is eligible for under TANF can vary, all qualified participants are eligible to receive a monthly cash payment, call basic cash assistance. Other than cash assistance, counties are have a lot of choice in how to use their TANF funding; generally a use of TANF funds is appropriate so long as it advances one or more of the four purposes of the program: (1) provide assistance to needy families so that children can be cared for in their own homes or in the homes of their relatives; (2) end the dependence of needy families on government benefits by promoting job preparation, work, and marriage; (3) prevent and reduce the incidence of out-of-wedlock pregnancies; and (4) encourage the formation and maintenance of two-parent families.

It is important to note that those eligible for TANF are also eligible for many of the other programs we’ve included in this report, such as SNAP, Medicaid, and CCCAP.

Program Funding and Access: Colorado funds its TANF program through funds received from the federal government through the Temporary Assistance for Needy Families block grant. Most of the federal funds are allocated by the state to counties, which are required to provide a 20% match of state funding. Federal and state rules allow the state and counties to retain a portion of unspent funds in a TANF reserve.

Statewide Program Access 2015-19: Over the study period of this report, an average of 50.7% of the population at or below 100% of FPL (i.e., the population who is likely to be eligible for TANF) were enrolled in TANF in Colorado.

EARLY LEARNING:
COLORADO CHILD CARE ASSISTANCE PROGRAM (CCCAP)

The Colorado Child Care Assistance Program provides child care assistance to low-income families and caregivers living in Colorado in the form of reduced payments for child care. It is a program funded by the federal, state, and county governments and is administered by counties in Colorado. The share owed by parents/caregivers is determined on a sliding scale based on the family’s income.

State Department: Department of Early Childhood Education

Eligibility: Counties set eligibility for families separately, but must serve families with incomes at or below 185% of the Federal Poverty Limit. Families accepted to the program are no longer eligible once their income exceeds 85% of the state median income. Parents or caregivers must be employed, searching for work, or engaged in another approved activity to be eligible for CCCAP. Parents and caregivers enrolled in Colorado Works (Temporary Assistance to Needy Families or TANF) or in the child welfare system are also eligible to participate in CCCAP. Generally, CCCAP serves families with children under 13, although children as old as 19 may be eligible under certain circumstances.

Program Benefits: If a family is eligible for CCCAP and has income, they may likely have to pay a portion of their child’s or children’s child care costs each month. The amount that families owe is based on their gross income, number of household members, and the number of children in child care in the household. As such, households tend not to experience a benefit cliff with CCCAP when they see their incomes increase

Program Funding and Access: Colorado funds the CCCAP program using federal dollars it receives from the Child Care and Development Block Grant program. The state allocates federal and state funds to counties using a formula that takes into account factors like current caseloads and the number of eligible residents. Assistance is available until the county’s funds are spent, so the number of families that can be served is often a function of how much funding is available and the income and composition of the household that applies. It is not uncommon for counties to overspend or underspend their allocations of funds. The state reallocates unspent funds from counties who underspent to those who overspent. While underspending could indicate a problem with the way a county administers its CCCAP program, it could just as likely be a sign that there are few providers in the county who participate in CCCAP—or a lack of providers generally.

Statewide Program Access 2015-19: Over the study period of this report, an average of 10.8% of the population at or below 165% of FPL and younger than age 13 (i.e., the population who is likely to be eligible for CCCAP) were enrolled in CCCAP.

Housing:
HUD rental assistance programs

The US Department of Housing and Urban Development (HUD) has three housing assistance programs that we look at together: Housing Choice Vouchers (Section 8), Project-based Section 8, and Public Housing. In Colorado, these programs provided assistance to over 90% of the households who received federal housing assistance from all HUD programs. Through federally funded, local or regional public housing agencies (PHAs) are the agencies that administer these programs, through not all are available in all counties. These are not the only programs available in Colorado that assist households afford the cost of housing, such as units funded through federal and state tax credit programs.

State Department: Department of Local Affairs

Eligibility: Generally, households with incomes under 50% of the area median income (AMI) of the county they live in are eligible for these rental assistance programs, although PHAs have discretion to select households with incomes at higher percentages of AMI. That said, HUD requires that 75% of new vouchers issued through the Housing Choice Voucher/Section 8 program in a given year are targeted to households with incomes at or below 30% of AMI. PHAs are also able to create criteria that give priority to certain types of households who are on waiting lists for these programs.

Program Benefits: These rental assistance programs help households afford the cost of housing by reducing their housing costs to around 30% of their household income. In the case of the Housing Choice Voucher program, the PHA pays the voucher holder’s landlord the remaining portion of the rent.

Program Funding and Access: Funding and access are both challenges for these rental assistance programs. In addition to limitations on the number of public housing units or housing vouchers a PHA can manage or issue, lack of funding compared to the need constrains the ability of PHAs to assist low-income households. In 2020, Coloradans were on waitlists for Housing Choice Vouchers for an average of 17 months. Waitlists also exist for the other rental assistance programs.

Statewide Program Access 2015-19: Over the study period of this report, an average of 21.1% of renter households with incomes at or below 50% AMI (i.e., the population who is likely to be eligible for HUD rental assistance programs) were living in subsidized housing.