Jan 30, 2019

Bethany Pray serves as CCLP's Chief Legal and Policy Officer. 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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CCLP reaffirms immigrant access to health

by | Jan 30, 2019

Colorado has recognized the importance of extending coverage to populations that lack affordable access to health care, when federal rules allow. In 2009, Colorado’s General Assembly authorized the Colorado Department of Health Care Policy and Financing (HCPF) to adopt a federal option established under the Children’s Health Insurance Program Reauthorization Act (CHIPRA) that allowed states to include many lawfully present children and pregnant women under the Medicaid umbrella – and lifted the restriction that lawful immigrants reside in the country for five years before they are eligible for coverage. Colorado Center on Law and Policy strongly supported that change.

However, since the option was adopted, we heard through community partners that eligible non-citizens were being turned away in some parts of the state — without even the opportunity to apply. Denying these legal immigrants coverage violates state policy and federal law. Moreover, it deprives individuals of life-sustaining services, unnecessarily increases economic burdens for working families, and creates potential risks to public health. At the same time, the upswing nationally in anti-immigrant rhetoric and policy has created a whole range of additional obstacles for eligible non-citizens and their U.S.-born family members.

In 2018, CCLP’s Health Care Program — which regularly advocates through state rule-making processes for changes that can improve access to Medicaid services — worked with a family that had been turned away in the past, and oversaw their application as it moved through the process. Because the applicant had significant disabilities, an independent agency that assists families with Medicaid waivers was involved, as well as staff in El Paso County. Through conversations with staff in both the agency and county, we were able to document that certain staff members had in fact turned away eligible non-citizen applicants, and were disseminating inaccurate information about who was eligible. At that point, we informed the Department of Health Care Policy and Financing (HCPF) and connected the Department with those staff members, so that direct instruction could be provided. While it’s difficult to trace the roots of that misinformation or to evaluate the role of bias in workers’ judgments, we also recognized that the state Medicaid rules and some state materials and forms contained incorrect, outdated language that increased workers’ and applicants’ confusion. We think it’s likely that staff in other counties are similarly misinformed, and that children and pregnant women who could greatly benefit from access to coverage are going without.

Having identified the problem, our next step was returning to the state rules to address confusing and outdated language. At the Medicaid Services Board hearing in January, the Department agreed to make clarifying changes regarding eligibility, with further changes to occur in April around Social Security number requirements. State rules currently require that applicants provide a Social Security number (SSN) or evidence of application for an SSN in all cases; we have proposed that state rules instead conform with language in federal rules that exempts certain applicants who cannot apply for an SSN. We look forward to seeing those proposed changes.

HCPF has also concurred with CCLP about the need for improved training materials and revision of forms and online documents like this one, and will be rolling out new content in the coming months so that county and agency staff, as well as individuals seeking information, would have more accurate information about who is eligible for Medicaid coverage. (At our request, they have already helped correct statements on webpages posted by two CHP+ managed care organizations that erroneously stated children and pregnant women must be citizens to qualify for benefits).

The additional steps should be treated with the utmost urgency. People of color and people with low incomes have higher rates of disease and mortality, and disparities are especially acute for pregnant women and children – those that Colorado specifically aimed to bring into coverage under CHIPRA in 2009. Many families don’t know who to contact and are understandably apprehensive about asserting their rights. That means, unlike the applicant we worked with directly, many Coloradans are now paying out of pocket or going without medical care altogether.

We urge the state to be crystal clear in its communications that our economy and culture are richer because of the presence of immigrant communities, and therefore, that improving the health and wellbeing of immigrants is a priority.

Now we have to ensure that information is accurate and that every county treats every Coloradan seeking coverage, whether white, black or brown, equitably and in accordance with the law.

-By Bethany Pray

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.


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.


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.


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.


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.