Aug 18, 2021

Anthony Lux serves as CCLP's director of communications. His areas of expertise include institutional communications strategies, constituency growth and network activation for cause-driven organizations. Staff page ›

Recent articles

CCLP statement on new federal Medicaid guidance

by | Aug 18, 2021

Denver, CO – Colorado Center on Law and Policy applauds the new guidance from the federal Centers for Medicaid and Medicare Services (CMS) that clarifies how states should process Medicaid cases after the public health emergency (PHE) is lifted. CCLP also recognizes Colorado’s Department of Health Care Policy & Financing (HCPF) for their thoughtful leadership throughout this unprecedented time. The new federal guidance released on Friday creates unique opportunities for HCPF as it continues to support the many Coloradans who depend upon Medicaid for access to vital medical care, and CCLP looks forward to supporting the state of Colorado in making the most of this moment.

Currently, over half a million Coloradans who are enrolled in Health First Colorado, our state Medicaid program, face the possibility of losing health coverage at the end of 2021, when the federal requirement to maintain coverage and “lock in” all enrollees will expire. Nationally, advocates and states raised concerns about the anticipated workload and risks of erroneous termination. However, on Friday, CMS released guidance that increases the likelihood that more eligible Coloradans can retain Medicaid coverage, that those who are found to be over-income can be connected to other federal health programs, and that Colorado has the time and resources to process those cases accurately.

The half a million Coloradans maintained on Medicaid include pregnant women who would ordinarily have lost coverage postpartum, adults who earned extra income at some point during the public health emergency, people with disabilities whose paperwork may have lapsed, individuals who may have moved or cannot be located, and 19-year-olds who had met the requirements specific to children but not the requirements for adult enrollees. Having broad access to vital medical care not only reduced economic need for those individuals and their families, but also helped Colorado meet the unprecedented public health challenge of COVID-19.

Up to this point, Colorado and other states have adhered to Trump-era guidance that gave states just six months to redetermine the “locked-in” population. The former guidance also permitted states to terminate coverage at the end of the PHE based on old information, ignoring current circumstances. Three pieces of the new guidance are particularly important:

Reassessment of eligibility based on updated information

First, Colorado will have to redetermine a “locked-in” member’s information when the PHE ends, meaning that a recent job loss, pregnancy, or change in immigration status must be considered—potentially enabling the person to retain eligibility. Relying on old information to assess eligibility would have allowed states to process cases before the end of the emergency, but arguably would have violated federal rules that require states to consider eligibility based on up-to-date information.

Fortunately, Colorado’s Medicaid agency had already decided to take the more thoughtful approach of soliciting timely information once the emergency ends. However, this new, longer timeline puts less of a squeeze on county workers as well as the enrollees who need to update their information.

Improved electronic record-sharing across state programs

Second, the guidance emphasizes the requirement that states transfer a person’s electronic record to the right program, should they be found ineligible for Medicaid. For most, that program would be our state exchange, Connect for Health Colorado, where low- or no-premium plans may be available. A seamless connection to an affordable commercial plan prevents gaps in coverage that can be devastating, especially for people with chronic conditions. Data sharing between the state and Connect for Health Colorado has been problematic in the past, and we believe more work will be needed to improve that connection.

Extended period to redetermine eligibility for coverage

Third, states will now have a full 12 months to redetermine people’s eligibility for coverage. CCLP encourages the state of Colorado to adjust the plans already in place, to make the best use of the new 12-month span. More outreach is needed to ensure enrollees know how to update addresses and income information, and counties will benefit from the extra time to process the high volume of information coming in through the mail, the PEAK app, phone lines, and in person.

That extra time should also allow for a more thorough process when a member has moved and mail is returned. More than 55,000 Colorado renters may face eviction in the immediate future. Many will not be able to locate stable housing in the coming months. Colorado’s policy—for Medicaid, nutrition assistance and other benefits—is to terminate coverage after just a single piece of returned mail. The Census Bureau’s Household Pulse Survey data also shows higher rates of hardship for renters of color, so harsh returned mail policies like Colorado’s could result in disproportionate racial impact unless the state amends its process. With the additional time and available federal funds, CCLP believes returned mail processing can, and should, include more outreach to members before termination. We also encourage the state to establish processes to draw member contact information from a wider variety of sources, including MMIS, the state’s billing portal, providers, and state managed care entities.

We strongly support this new guidance from HHS and look forward to working with the state, community members and advocates to make sure that the transition post-emergency prevents widespread coverage losses, keeping Colorado on our current path toward improved economic and public health.

Media information

For media inquiries, or to request interviews with Colorado Center on Law and Policy subject experts, please contact Anthony Lux, CCLP Interim Communications Director at tlux@copolicy.org.

About Colorado Center on Law and Policy

Founded in 1998, Colorado Center on Law and Policy is a nonprofit, non-partisan organization that stands with diverse communities across Colorado in the fight against poverty through research, legislation, and legal advocacy. Driven by our core values of equity, integrity, strategic advocacy, collaboration, and community engagement, CCLP envisions a Colorado where everyone has what they need to succeed. Learn more at copolicy.org.

(PDF version of statement available here.)

Recent articles

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.