May 11, 2017

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2017 Legislative Wrap-up: Health Care

by | May 11, 2017

This year, CCLP’s Health Care program developed and supported successful efforts to address the shortcomings in client correspondence for Medicaid recipients. We mitigated punitive measures on low-income Coloradans in negotiations to establish an enterprise for the hospital provider fee. We also supported efforts to curb the rising cost of health care. On national issues, we took a leadership role in a coalition that communicated with Colorado’s Congressional delegation and urged Coloradans to make their concerns known about proposed sweeping policy changes that could compromise the access and affordability of health care for hundreds of thousands of Coloradans.

Here’s a brief recap of CCLP’s health care work during the 2017 legislative session:

Good news
Medicaid correspondence package — CCLP worked with its partners, including the Colorado Cross Disability Coalition, to pass three bills intended to address shortcomings in client correspondence and notifications when Medicaid health care and essential services are about to be changed or terminated. The bills were developed by an interim committee led by then Rep. Dianne Primavera because notices sent to Medicaid clients are often incorrect and incomprehensible. Such deficiencies violate basic due process requirements. House Bill 1126 strengthens the role of administrative law judges in safeguarding the rights of Medicaid clients by instructing the judges to automatically review the sufficiency of notices at the beginning of any appeal hearing. HB 1143 directs the state to audit communications with Medicaid clients for legal sufficiency, clarity and accuracy to prevent Medicaid notification issues from reoccurring. Finally, Senate Bill 121 makes notices more comprehensive and helpful by requiring plain-language statements, specific reasons for an adverse action and translations in a client’s preferred language. All three bills passed through the legislature with bipartisan support and, to date, two have been signed by Gov. John Hickenlooper.

Hospital provider fee enterprise — After three years of effort, legislators finally passed a bill authorizing the establishment of a hospital provider fee enterprise. SB 267 establishes an enterprise to collect and administer the hospital provider fee and provide other services to Colorado hospitals. It was essential that this bill pass, given that hospitals faced a reduction of $528 million in provider fee funding while the state faced the prospect of increasing reductions in available General Fund money because of the provider fee. That being said, SB 267 is by no means perfect. In addition to establishing an enterprise, the bill reduces the amount of revenue the state can raise to fund services by $200 million; requires the executive branch to work towards submitting a budget proposal for fiscal year 2018-19 that reduces state general fund expenditures by 2 percent across every department; and doubles Medicaid co-payments for pharmacy and out-patient hospital services. Ultimately, the bill will provide more funds for schools, transportation, and capital improvements and reduce personal property taxes on businesses. But, we are extremely disappointed that achieving that benefit could only be negotiated by imposing a cost on low-income Coloradans.

PACE ombudsman — Programs of All-inclusive Care for the Elderly (PACE) provide a range of services to people over the age of 55 who qualify for nursing-home level care but wish to retain their independence in the community. HB 1264 establishes a permanent PACE ombuds program. While the Disability Law Center and DRCOG took the lead, the bill is the culmination of work CCLP did in 2015 and 2016 on the conversion of InnovAge, Colorado’s largest PACE provider. As part of that conversion, the Colorado Attorney General ordered the establishment of an ombuds position to serve PACE programs for a three-year period. In 2016, the legislature codified that requirement and directed the Department of Human Services to make recommendations to make the program permanent. Those recommendations led to the passage of SB 264.

Codifying the Accountable Care Collaborative (ACC) program — In existence since 2011, the ACC program is Colorado’s mechanism for realizing delivery system and payment reform in Medicaid. While many states have adopted traditional Medicaid managed care, Colorado has maintained a managed fee for service program and implementation is moving slowly, based on the results of pilot programs, towards payment reform. The ACC has shown positive results both in improving care coordination, health outcomes and reducing costs. By codifying the program, HB 1353 ensures the stability of the ACC going forward.

Addressing the opioid crisis — Several bills this session targeted the growing epidemic of opioid overuse and addiction. SB 074 created a pilot program to increase access to treatment in certain areas of the state. SB 193 established a center at the University of Colorado for research into prevention, treatment and recovery support. HB 1351 appropriates funds to collect and analyze data to assess how to improve substance-use disorder treatment within the Medicaid program in Colorado. All three bills passed and are heading to the Governor’s desk. To cap off the session, Rep. Brittany Pettersen’s request for an interim committee on substance-use disorders in Colorado was approved.

Disappointments
Bills to reduce health care costs – Prompted by the extraordinarily high cost of insurance along Colorado’s I-70 corridor, Lt. Gov. Donna Lynne brought together a working group last fall to develop ideas to reduce the cost of health care. Unfortunately, all the bills proposed by the group were defeated — almost all of them in the Senate State Veterans and Military Affairs Committee (known under the dome as “the kill committee”). Cost containment strategies ranged from increasing transparency by requiring hospitals to submit audited financial statements and Medicare cost reports to the Department of Health Care Policy and Financing (HB 1236) to establishing a program for temporary relief from the high cost of health insurance for people just above eligibility for premium tax credits through Colorado’s health insurance exchange, Connect for Health Colorado (HB 1235). Among the others were: HB 1286, which would have required health plans contracted with the state to cover state employees to participate in additional markets to increase competition and choice; and HB 1318, which would have established an annual report on pharmaceutical cost data to better understand the underlying costs of prescription drugs. In every instance, industry interests coupled with reluctance to use government to reduce health costs resulted in failure of these bills.

Balance-billing bills — For the third year in a row, efforts to curb costs associated with free-standing emergency rooms failed (SB 64), as did yet another attempt to protect consumers from the practice of balance billing – charging consumers for the full cost of out-of-network services (SB-206).  These efforts were strongly opposed by the Colorado Hospital Association and the Colorado Medical Society.

Risk-pool reinsuranceSB 300 was a late effort to prepare Colorado for the potential availability of federal funds to establish a high-risk pool or reinsurance program. The bill would have given the Division of Insurance the authority to seek a waiver under Section 1332 of the Affordable Care Act. Such a waiver would create the opportunity for Colorado to establish a reinsurance program in order to reduce health insurance premiums in the individual and small-group market.  Unfortunately, while the bill was approved by both chambers and sent to the Governor, it was turned into a study to be completed by Oct. 1.

Challenges and opportunities ahead
The biggest unknown in health policy is what will happen in Congress with respect to the attempt to repeal and replace the Affordable Care Act. If approved by the U.S. Senate and President Trump in its current form, the American Health Care Act will dramatically change the health care landscape in Colorado — undoing more than a decade of work that has substantially reduced the number of people who are uninsured and ensured high quality care is available to every Coloradan.

We also don’t know, at this point, what Congress will do with the Children’s Health Insurance Program (or CHIP). The program’s funding expires in September 2017 and Colorado will run out of federal CHIP funds in February of 2018.

In addition to actions resulting from potential federal legislative changes, we note the following issues:

  • Establishment of the provider fee enterprise may enable policymakers to begin to plug gaps in coverage, for example with respect to substance-use disorder treatment. |
  • The Colorado Commission on Affordable Health Care will deliver its final report to the General Assembly this summer. While a proposed interim committee to examine its recommendations was rejected, we anticipate the report will generate discussion among policy makers about cost containment.
  • CCLP and its partners supported forming an interim committee to study the availability and accessibility of disability-support programs. While the request was denied by legislators, we are still exploring legislation that would achieve the results we would have through such an interim committee.

-By Elisabeth Arenales

Recent articles

CCLP’s 2024 legislative wrap-up, part 2

CCLP's 2024 legislative wrap-up focused on expanding access to justice, removing administrative burden, supporting progressive tax and wage policies, preserving affordable communities, and reducing health care costs. Part 2/2.

CCLP’s 2024 legislative wrap-up, part 1

CCLP's 2024 legislative wrap-up focused on expanding access to justice, removing administrative burden, supporting progressive tax and wage policies, preserving affordable communities, and reducing health care costs.

CCLP testifies in support of Clean Slate updates

Bethany Pray, CCLP’s Chief Legal and Policy Officer, provided testimony in support of House Bill 24-1133, Criminal Record Sealing & Expungement Changes. CCLP is in support of HB24-1133, as it is one of our priority bills.

HEALTH:
HEALTH FIRST COLORADO (MEDICAID)

To maintain health and well-being, people of all ages need access to quality health care that improves outcomes and reduces costs for the community. Health First Colorado, the state's Medicaid program, is public health insurance for low-income Coloradans who qualify. The program is funded jointly by a federal-state partnership and is administered by the Colorado Department of Health Care Policy & Financing.

Benefits of the program include behavioral health, dental services, emergency care, family planning services, hospitalization, laboratory services, maternity care, newborn care, outpatient care, prescription drugs, preventive and wellness services, primary care and rehabilitative services.

In tandem with the Affordable Care Act, Colorado expanded Medicaid eligibility in 2013 - providing hundreds of thousands of adults with incomes less than 133% FPL with health insurance for the first time increasing the health and economic well-being of these Coloradans. Most of the money for newly eligible Medicaid clients has been covered by the federal government, which will gradually decrease its contribution to 90% by 2020.

Other populations eligible for Medicaid include children, who qualify with income up to 142% FPL, pregnant women with household income under 195% FPL, and adults with dependent children with household income under 68% FPL.

Some analyses indicate that Colorado's investment in Medicaid will pay off in the long run by reducing spending on programs for the uninsured.

FOOD SECURITY:
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)

Hunger, though often invisible, affects everyone. It impacts people's physical, mental and emotional health and can be a culprit of obesity, depression, acute and chronic illnesses and other preventable medical conditions. Hunger also hinders education and productivity, not only stunting a child's overall well-being and academic achievement, but consuming an adult's ability to be a focused, industrious member of society. Even those who have never worried about having enough food experience the ripple effects of hunger, which seeps into our communities and erodes our state's economy.

Community resources like the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, exist to ensure that families and individuals can purchase groceries, with the average benefit being about $1.40 per meal, per person.

Funding for SNAP comes from the USDA, but the administrative costs are split between local, state, and federal governments. Yet, the lack of investment in a strong, effective SNAP program impedes Colorado's progress in becoming the healthiest state in the nation and providing a better, brighter future for all. Indeed, Colorado ranks 44th in the nation for access to SNAP and lost out on more than $261 million in grocery sales due to a large access gap in SNAP enrollment.

See the Food Assistance (SNAP) Benefit Calculator to get an estimate of your eligibility for food benefits.

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

Every child deserves the nutritional resources needed to get a healthy start on life both inside and outside the mother's womb. In particular, good nutrition and health care is critical for establishing a strong foundation that could affect a child's future physical and mental health, academic achievement and economic productivity. Likewise, the inability to access good nutrition and health care endangers the very integrity of that foundation.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides federal grants to states for supplemental foods, health care referrals, and nutrition information for low-income pregnant, breastfeeding and non-breastfeeding postpartum women and to infants and children up to age five who are found to be at nutritional risk.

Research has shown that WIC has played an important role in improving birth outcomes and containing health care costs, resulting in longer pregnancies, fewer infant deaths, a greater likelihood of receiving prenatal care, improved infant-feeding practices, and immunization rates

Financial Security:
Colorado Works

In building a foundation for self-sufficiency, some Colorado families need some extra tools to ensure they can weather challenging financial circumstances and obtain basic resources to help them and their communities reach their potential.

Colorado Works is Colorado's Temporary Assistance for Needy Families (TANF) program and provides public assistance to families in need. The Colorado Works program is designed to assist participants in becoming self-sufficient by strengthening the economic and social stability of families. The program provides monthly cash assistance and support services to eligible Colorado families.

The program is primarily funded by a federal block grant to the state. Counties also contribute about 20% of the cost.

EARLY LEARNING:
COLORADO CHILD CARE ASSISTANCE PROGRAM (CCCAP)

Child care is a must for working families. Along with ensuring that parents can work or obtain job skills training to improve their families' economic security, studies show that quality child care improves children's academic performance, career development and health outcomes.

Yet despite these proven benefits, low-income families often struggle with the cost of child care. Colorado ranks among the top 10 most expensive states in the country for center-based child care. For families with an infant, full-time enrollment at a child care center cost an average of $15,140 a year-or about three-quarters of the total income of a family of three living at the Federal Poverty Level (FPL).

The Colorado Child Care Assistance Program (CCCAP) provides child care assistance to parents who are working, searching for employment or participating in training, and parents who are enrolled in the Colorado Works Program and need child care services to support their efforts toward self-sufficiency. Most of the money for CCCAP comes from the federal Child Care and Development Fund. Each county can set their own income eligibility limit as long as it is at or above 165% of the federal poverty level and does not exceed 85% of area median income.

Unfortunately, while the need is growing, only an estimated one-quarter of all eligible children in the state are served by CCCAP. Low reimbursement rates have also resulted in fewer providers willing to accept CCCAP subsidies.