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Jun 22, 2018

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Elisabeth Arenales’ speech for GIH’s Andy Hyman Award

by | Jun 22, 2018

CCLP Statement, Health

Here is the acceptance speech from Elisabeth Arenales, Director of CCLP’s Health Care Program, upon receiving Grantmakers In Health’s Andy Hyman Award during the organization’s annual conference in Chicago on June 22:

Thank you to the Robert Wood Johnson Foundation and Grantmakers In Health. It is a privilege to be here with the GIH community. I especially want to thank the staff and the awards’ committee for all of their efforts, for the gift of this award and for the logistical work that I know goes into making all of this happen.

I want to talk about the award itself and its purpose in celebrating and recognizing the life and contributions of Andy Hyman.

I first heard about the Andy Hyman Award when its establishment was announced at the GIH conference in San Diego two years ago. I was attending my first-ever GIH conference that day.

I didn’t know Andy, but as GIH staff talked about him and about the award, I remember thinking that he must have been an extraordinary person: passionate, dedicated, visionary and collaborative. He was clearly someone who inspired others and was exceptional in his ability to further social justice through his work in government, on mental health issues and through his leadership in advancing health coverage and supporting consumer voices at the Robert Wood Johnson Foundation. I am honored to receive the award that was established in his name.

I want to acknowledge Andy’s family: his parents, Valerie and Dr. Allen Hyman, are here today. I am so sorry for your loss, but grateful that the work which was an integral part of Andy’s life continues.

I also want to thank the Colorado foundations that nominated me: the Colorado Health Foundation, The Colorado Trust, Rose Community Foundation, and Caring for Colorado Foundation. Over the years, these foundations have been steadfast, creative and flexible funding partners. Together, they have provided the financial foundation for much of the strong advocacy work that is a hallmark of the Colorado health policy landscape.

These four foundations have provided general operating and project-based support. They have made rapid response grants so that grantees might take advantage of unexpected opportunities and respond in a timely manner to changing circumstances. They have supported nonprofit organizations from their founding through their maturation and beyond, including by helping to develop emerging leaders. They have stood by their nonprofit partners, including my own organization, during times of stress and financial hardship.

In addition to funding nonprofit organizations, these foundations have helped to meet Colorado’s need for sound data and health policy analysis by creating and supporting the Colorado Health Institute. In the early 2000s, they strengthened the advocacy field by seeding and nurturing the establishment of the Colorado Consumer Health Initiative, now Colorado’s unified consumer voice for health access and coverage.  They increased access to health care by funding advocacy for coverage expansion and by supporting outreach and enrollment efforts. Also, they have strengthened Colorado’s ability to develop and implement good state policy by supporting a senior health policy position in the governor’s office.

I know many people on the staff of those foundations are here today and I want to salute them for their work and thank them for their partnership, their support and for thinking of me for this award.

Finally, my mom, Duane, is here today. I want to thank her for coming. I know that I have a long way to go before I am close to being as smart, as resilient, as adventurous or as tenacious as my mother. She is an extraordinary woman. Thanks for being here, Mom, and for your understanding and support.

I thought that I would focus the rest of my remarks on legacy and the power of community.

Anyone who spends their life working towards social justice follows in the footsteps of and works shoulder to shoulder with a lot of other people.  As I stand here today, because of Andy’s work, I can’t help but think about how many people I have admired, learned from, followed in the footsteps of, and worked with over my career.

We all draw strength from different sources. Mine comes from the people I work with today and those I have worked with over the years.

No one person or organization can accomplish much alone and I have been privileged to be part of a strong consumer advocacy community in Colorado.  Together, we have been able to get a lot done over the last twenty years to increase access to health care and expand coverage.

I also have had extraordinary mentors and staff who have supported and taught me.

It has been the honor of my lifetime to work with so many community members who have dedicated their lives to making a difference: people who are willing to tell their stories, work in community, lend a helping hand, organize, protest, litigate, testify and rally in order to promote fairness and oppose injustice; people who give of themselves to make things right- or at least better for themselves, their families and their communities.

Last year, when Ron Pollack received this award, it was uncertain whether the Affordable Care Act would survive the summer.  What was at stake then was our commitment as a nation to the principle of access to health care for all.

Many of us thought, when the ACA passed, that people would no longer have to drive across multiple states to stand in line in the rain to see doctors set up in animal stalls at a remote medical fair. No longer would someone who broke their arm not be able to get surgery that make it possible for them to work again, and no longer would people die because they could not access necessary treatment, services or medications.

While the ACA survived, we continue to see its unraveling. For example, 20 states now claim, in the case of Texas v. United States, that the ACA’s requirement to cover pre-existing conditions is no longer enforceable since Congress eliminated penalties for failing to have health insurance in the Tax Bill.

Regulatory changes and financing decisions have undermined the stability of the individual insurance market. And Medicaid – the core health insurance safety net program for the poor, the aged and the disabled – is likely to cover far fewer people as states are permitted to change the structure of the program, including enshrining in a health care program for the sick and the poor the idea that you must fulfill a work requirement in order to have access to necessary care.

And it’s not just the ACA and Medicaid that are under attack. We are grappling today with the fundamental political and moral question of the scope of our responsibilities to each other;whether we are better off as a society when we leave individuals alone to thrive or fail, or when we make sure that everyone receives help when they need it in order to meet their basic human needs.

Last year, Ron talked about the consequences of the growing wealth divide in the United States.  In addition, I believe we need to consider the growing hostility to the poor in our country- and the dog whistle that underlies the rhetoric about the need to weaken or eliminate our social safety net.

The war on poverty and the reasons why we established our biggest entitlement programs are distant memories as we grapple with the question of who should have access to adequate health care, enough food, affordable housing, and fair wages.

So, what is our role in this discussion?

Since I am an advocate, it’s probably not surprising that all of you sitting in this room together seems to me the perfect opportunity to call all of us to action.

There is so much work to do.

As we move forward, I think about words like community, cooperation, coordination, connection and continuum.

The core of our mutual work is rooted in these concepts. It is rooted in community and our connections with others. It depends on cooperation and coordination, and all of our work has its place on a continuum of effective strategies.

We maximize our ability to make a difference in people’s lives and facilitate systemic change when we learn from and build upon each other’s work.

We depend on individuals, organizations and foundations that help people to meet their basic needs. We work together to strengthen our communities and support our community leaders. We change hearts and minds through effective communications. We develop and deploy data and research to educate policy makers and ourselves.  We improve systems through policy advocacy and use the courts to challenge and change the law.

Great movements and great change depend on all of these and more, and the foundation community, working together, can do much to ensure that the full continuum of change strategies is available to nonprofits as they work to advance a social justice agenda.

Thinking again about last summer, the images that have stayed with me are those of members of the disability community being arrested for putting their wheelchairs and their bodies on the line to protest in the halls of Congress in order to protect all of our rights to health coverage.

My guess is that the images that will stay with us from this summer are those now coming from ICE and the Health and Human Services detention centers: pictures of young children separated from their parents and housed in warehouses and tents. Images of crying parents who thought they were doing the right thing by fleeing horrendous conditions in their home countries to seek asylum in the United States.

Ron Pollack cited Winston Churchill last year, reminding us that he said “the U.S. will always do the right thing after it has tried everything else.”

I am going to leave you with my guide-star quotation: Dr. Martin Luther King said “the arc of the moral universe is long, but it bends towards justice.”

I think if we are strategic, if we work together, if we support each other,if we build on our joint efforts and if we are resilient and hopeful, we will be amazed by the progress we can make.

-By Elisabeth Arenales

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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.