Jan 10, 2019

Bethany Pray currently serves as CCLP's Deputy Director. Her areas of expertise include regulatory analysis and advocacy for Medicaid and commercial coverage, access to behavioral health benefits, Medicaid eligibility and much more.Staff page ›

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2019 Legislative Preview: Health Care

by | Jan 10, 2019

In 2019, CCLP’s Health Care Program aspires to advance affordable health insurance options and address consumers’ out-of-pocket costs. We aim to ensure that nonprofit hospitals are accountable for their community benefit obligations. We will continue our work to reduce barriers to access for Medicaid participants in a range of areas, particularly behavioral health. We will support efforts to enhance the ability of the Division of Insurance to protect consumers.

This year, our health program priorities include:

Legislative Advocacy
Our legislative advocacy in 2019 centers on addressing the steep increase in health care costs in Colorado, ensuring that programs address inequities in access to benefits and services, and advocating for system changes that can reduce gaps in coverage and care.

Hospital Community Benefit Transparency
Colorado’s nonprofit hospitals receive federal, state and local tax exemptions that provide  hundreds of millions of dollars in financial benefit to them. They receive these massive financial benefits on the presumption that they will invest those funds in services that improve the health of the communities they serve. CCLP will work to advance legislation that makes it possible for Colorado policymakers and communities to assess whether community benefit spending is commensurate with the tax benefits hospitals receive and whether that spending adequately addresses the health needs of those populations who are experiencing health disparities.

Support Access to Federal Disability Support
CCLP will work to advance legislation that helps Aid to the Needy Disabled (AND) clients navigate the process of applying for federal disability support programs. With severe disabilities and only $217 in monthly income, AND clients are often homeless. Federal disability support programs, which provide over three times the income support of AND, help people with disabilities obtain stable housing and take care of their health needs. But the federal programs are notoriously hard to apply for – especially for people that need the support most. The legislation will fund services that help people successfully complete the application process.

Health insurance costs
CCLP strongly supports Senate Bill 4 and House Bill 1004.

SB 4 seeks to provide immediate relief from the high cost of health insurance in rural and mountain communities in Colorado by allowing individuals to buy insurance through the state employee health benefit plan and giving the Commissioner of Insurance additional authority to oversee consumer-driven insurance cooperatives.

Meanwhile, HB 1004 advances work on developing an insurance plan that uses state infrastructure to reduce the cost of health insurance in the individual and possibly the small group markets. The bill requires the Colorado Department of Health Care Policy and Financing (HCPF) to model and develop a proposal for legislative approval so that implementation could begin in 2020.

These proposals, in conjunction with passage of a reinsurance program, create a comprehensive framework for reducing the cost of insurance in Colorado.

Surprise billing
Too often, Coloradans who have had surgery or other services at in-network facilities find themselves on the hook for surprise bills from out-of-network providers. These bills may far exceed in-network costs. CCLP has supported efforts over the past four years to curtail the practice of surprise billing. We anticipate introduction of another bill addressing this issue in 2019 and hope to finally ensure consumers are protected from this practice.

Behavioral health
Coloradans seeking behavioral health services, whether through Medicaid or commercial plans, continue to encounter obstacles to care. CCLP expects that two bills will be introduced this session to address those obstacles. One bill emerged from an extensive stakeholder process this past summer. It aims to create a Children & Youth Behavioral Health Commission empowered to improve interagency collaboration, align funding and programs, and improve access to behavioral health services. A second bill would add state law protections for parity between behavioral and physical health, in alignment with the federal Mental Health Parity and Addiction Equity Act.

Medicaid defense
Concerns linger about the effect in Colorado of the federal focus on “work requirements” on health care and nutritional benefits, such as Medicaid and SNAP. Work requirements and increased costs to enrollees have been shown to limit access and increase administrative burden, without improving health outcomes.  We will continue to defend Medicaid at the state legislature as the need arises.

Non-legislative advocacy work, research and projects
Regional Accountable Entities (RAEs): Accountable Care Collaborative 2.0
CCLP will monitor the RAEs closely, push for better access to children’s Medicaid services, and work with the state to improve enforcement of parity in behavioral health. We continue to address ways to improve access to grievance and appeals processes. We partner with Colorado Consumer Health Initiative and Colorado Cross-Disability Coalition to improve consumer engagement in Medicaid and will continue to play a leadership role through our participation on the ACC Program Improvement Advisory Committee. As part of a project to evaluate compliance with federal parity requirements, CCLP will report on results of recent focus groups and surveys that identified limitations on access to behavioral health services in Colorado Medicaid.

Health equity
Access to basic needs like nutritious food, safe and affordable housing, parenting supports, and legal assistance fosters good health. Systemic racism and other forms of discrimination have resulted in disparate access to these social determinants of health. Innovative health care providers have created programs that address these disparities. As examples: one clinic provides access to legal assistance through a medical-legal partnership, another runs support groups for parents of at-risk youth, and another runs a nutritious food bank for diabetes patients. Through partnerships with communities and provider groups, CCLP will look for policy levers to scale up projects that address persistent and unfair racial, ethnic and cultural disparities in Colorado.

Medicaid program system changes
We continue to track the CBMS Transformation project, which involves both a new platform and user interface for the historically problematic Colorado Benefits Management System (CBMS). The majority of this large-scale move will be effectuated in late winter and early spring. We also are engaged in assessing coordination between the recently separated eligibility systems for Medicaid and Connect for Health Colorado and advocating for improvements.

Regulatory advocacy
The federal government continues to propose and adopt regulatory changes that threaten many of the protections embedded in the Affordable Care Act and the Medicaid program, including the potential to decrease access to affordable coverage and care, increase discrimination, and undermine equity.

We coordinate with national and local partners to weigh in on such proposals through the public comment process and work to educate partners and support community engagement on these issues.

This federal work supplements CCLP’s ongoing role in state-level regulation. Through the comment and hearing process, we aim to ensure that eligibility and appeals systems and Medicaid benefits work for Coloradans and inequities are addressed. At the Division of Insurance, we will engage in regulatory work that concerns non-discrimination protections, notice and appeals issues, behavioral health access, and market stability.

— By Bethany Pray

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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.