Oct 14, 2016

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 ›

Recent articles

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.

CCLP testifies in support of TANF grant rule change

CCLP's Emeritus Advisor, Chaer Robert, provided written testimony in support of the CDHS rule on the COLA increase for TANF recipients. If the rule is adopted, the cost of living increase would go into effect on July 1, 2024.

Coloradans must stand up for mental health parity

by | Oct 14, 2016

Despite recent efforts to address behavioral health issues, the incidence of poor mental health and substance abuse disorder is unacceptably high in Colorado.

Untreated, behavioral health problems impact physical health, school performance, jobs and incarceration rates. Nationally, mental illness affects roughly 20 percent of the population, and substance use disorder affects about 10 percent, but data suggests that Colorado numbers are higher, with a 27 percent increase from 2008 to 2015 in the use of heroin among 18- to 24-year-olds.

Access to mental health treatment is inadequate in large part because stigma and entrenched attitudes about behavioral health have historically resulted in poor coverage. In fact, only 41 percent of adults in the U.S. with a mental health condition received services for that condition in 2015. For African Americans and American Indians, access to treatment is even more limited. In Colorado and nationally, the primary reason people gave for lack of treatment was the misperception such services weren’t covered, and that treatment costs were prohibitively expensive.

This disparity can and must change. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) was meant to address the disparity between how illness of the body and illness of the mind are covered in private and public insurance.

The underlying principle of the MHPAEA and recently finalized regulations is that restrictions on access to mental health and substance use disorder treatments should be no greater than restrictions on access to medical and surgical treatments.

Since cost is a primary restriction on access, costs should be comparable for physical and behavioral health treatment. Additional hurdles like prior authorization or fail-first regimens should not be imposed on people seeking behavioral health services.  And higher levels of care for mental health or substance use disorder treatment — like residential treatment — should be no harder to access than time in a skilled nursing facility or physical rehabilitation facility.

State implementation of MHPAEA has only just begun. This year, the Colorado Center on Law and Policy is pressing the Colorado Division of Insurance and the Department of Health Care Policy and Financing to undertake comprehensive reviews of private insurance plans and Health First Colorado (also known as Medicaid) for parity, and to require changes where parity requirements are not met.

This past spring, the Division of Insurance took a major step in the right direction, issuing a regulation on Essential Health Benefits that requires access to residential benefits for mental health and substance use disorder treatment that is on a par with access to similar benefits for medical conditions. Still, too few resources are currently dedicated to this work and we believe that too many obstacles to treatment will remain in 2017.

Those who are covered by private insurance or Health First Colorado (Colorado Medicaid) can play a big part in changing that, by taking action when it appears that parity is lacking.

With help from our national partners, CCLP developed a document that can help identify potential “red flags” in mental health parity and provide information on helpful resources when there’s a problem.

Since good health pertains to the body and the mind, it’s critical to eliminate disparities in how physical and mental health conditions are covered by insurers. After all, it takes much more than sunshine and snow-capped mountaintops to ensure that Colorado lives up to its reputation of being one of the country’s healthiest states.

– Bethany Pray

Recent articles

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.

CCLP testifies in support of TANF grant rule change

CCLP's Emeritus Advisor, Chaer Robert, provided written testimony in support of the CDHS rule on the COLA increase for TANF recipients. If the rule is adopted, the cost of living increase would go into effect on July 1, 2024.


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.