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Mar 27, 2020

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Allison Neswood previously served as CCLP's Deputy Director of Strategic Priorities. She is an expert in public health insurance plans (Medicaid and CHP+), Aid to the Needy Disabled, immigrant access to services and health equity.

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COVID-19 resources for immigrant families

by | Mar 27, 2020

Equity work, Family Economic Security, Health

As we face the rapid spread of COVID-19 and its effect on our economy, one thing is clear: we are all in this together. This includes Coloradans who were born in other countries but who call this state their home. To Colorado’s immigrants — whether you had access to the legal immigration process or not — you matter, your families matter and your contributions to society matter.

Our social safety net programs are supposed to address the structural problems in our social and economic system that make it difficult for people to make ends meet. There are critical gaps in that safety net that leave many in our immigrant communities behind. But even as we advocate for solutions to those injustices, there are resources for you and your families.

COVID-19 testing and treatment
Testing for COVID-19 is available in Colorado but you must have an order from a doctor in order to get tested. If you are feeling sick, you should call your doctor’s office or a clinic in your area. Center for Health Progress has compiled a list of clinics by region, including contact information. You should only go to an emergency room if you think you have an emergency.

The testing at state laboratories is free of cost and staff don’t inquire about immigration status. People do have to provide identification in order to get tested, but testing sites must accept any form of ID.

CO-HELP, the Colorado Health Emergency Line for the Public, is a toll-free hotline set-up to provide information about COVID-19. Call 1-877-462-2911 with questions.

Public charge will be discussed in greater detail below, but U.S. Citizenship and Immigration Services has announced that immigrants who undergo medical testing for COVID-19 or treatment related to it will not be penalized when applying for green cards and visas under the newly enacted public charge rule.

Health care
Health insurance coverage to identify and treat illness is a critical need, especially during this crisis. It ensures that people can see a doctor or get prescriptions they need and helps protect people from financial crisis due to medical bills.

There are several federally supported health coverage programs available for Coloradans with low- to middling incomes: Health First Colorado, Colorado’s Medicaid program, is available to people with disabilities and those who meet certain income requirements. The Child Health Plan Plus (CHP+) is available to children and pregnant women who are just above the income limit for Medicaid. Finally, reduced-cost health insurance through Connect for Health Colorado is available to people that earn too much to qualify for Medicaid or CHP+.

Just about anyone with a green card can qualify for Medicaid if they meet the other eligibility requirements. The exception is non-pregnant adults, who can’t qualify until they’ve had their green card for five years. Children and pregnant women can qualify for Medicaid and CHP+ as soon as they get their green card or another legal status, such as a temporary visa. Anyone with their green card or with a temporary visa can qualify for reduced-cost insurance on Connect for Health Colorado. Refugees, asylees, and people with other statuses granted for humanitarian reasons can qualify for Medicaid, CHP+ and reduced-cost insurance.

Individuals with legal status who don’t qualify for Medicaid or CHP+ may qualify for the Colorado Indigent Care Program (CICP), which reduces the cost of certain hospital services. For those without legal status, the so-called emergency Medicaid program will pay for emergency services for anyone who meets the income requirements for Medicaid but can’t qualify for the program because of immigration status. Additionally, many hospitals offer financial assistance programs regardless of immigration status. Finally, there is a large network of community health centers and other primary care clinics across the state that provide discounted primary care services to everyone in their communities. During the COVID-19 crisis, many of those clinics have continued to see patients virtually using telehealth technologies.

Everyone has the right to apply for Medicaid and CHP+. You can apply for Medicaid and CHP+ any time of year. While people can generally apply in person, many county offices are closed at this time. You can also apply online by visiting this site. You can convert the language on that page to Spanish by clicking “Español” at the top of the screen.

People can apply for reduced-cost health insurance through Connect for Health Colorado through their website. Generally, enrollment in private health insurance is only available during open enrollment in December and January unless you have access to a special enrollment period because of a change to your job or household. However, because of the COVID-19 emergency there is a special enrollment period (SEP) available to everyone now through April 3, 2020.

You can apply for CICP, emergency Medicaid and hospital financial assistance programs in the hospital. If you or a family member receive hospital care, be sure to ask the hospital to assess you for those programs.

Food assistance
Food insecurity can be devastating. It is associated with higher rates of diseases like diabetes, high blood pressure and heart disease, and it makes it hard for children to succeed at school and for adults to maintain a job and build a career. As people lose work hours or get laid off due to the impacts of COVID-19, food insecurity in our state is likely to get worse and we encourage people to take advantage of food assistance programs that are available.

The Supplemental Nutrition Assistance Program (SNAP) provides a monthly benefit for households with limited financial resources. People enrolled in SNAP receive a benefit card that they can use like a credit card at the grocery store.

Coloradans with certain immigration statuses can qualify for SNAP. Green card holders can qualify once they have had their green card for five years, though adults that aren’t disabled and that don’t have children may need to meet work or job training requirements to stay on the program longer than three months. People granted refugee status, asylum, or certain other statuses granted for humanitarian purposes can also qualify for SNAP. In addition, children that meet all the eligibility requirements can qualify for SNAP benefits even if their parents do not qualify.

People that do not qualify for SNAP due to their immigration status still have options. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides a SNAP-like food benefit for pregnant women and moms with children under five, regardless of their immigration status. In addition, food pantries make food available to everyone in the community who needs it without inquiring about immigration status.

Individuals can apply for SNAP and WIC online through this link. People can get help connecting to food resources from Hunger Free Colorado’s Food Resource Hotline by calling 855-855-4626 (statewide) or 720-382-2920 (Denver-metro).

Unemployment insurance
Colorado’s unemployment insurance program provides cash payments to people that lose their job through no fault of their own. Payments are made once every two weeks as long as participants maintain their eligibility by meeting certain reporting and job-search requirements.

Coloradans in a wide range of immigration statuses can qualify for unemployment insurance. In general, Coloradans who are authorized to work in the United States can qualify for the program if they meet other program requirements. People with Deferred Action for Childhood Arrivals (DACA) status are among those that can qualify. Unfortunately, Coloradans without documentation cannot qualify for unemployment insurance. Advocates, along with many partners in the community are working to find solutions to this problem.

People can apply for unemployment insurance online. Over the past two weeks, the economic fallout from COVID-19 has led to an extremely high volume of unemployment claims. As a result, the Department of Labor is asking that people with last names that start with A through M apply on Tuesday, Thursday, or Sunday after noon and that people with last names that start with M through Z apply on Monday, Wednesday, or Friday before noon.

Rent and utility help
City and county governments may have other programs that help people meet their needs, especially during times of crisis. For example, the Temporary Rental and Utility Assistance program (TRUA) offers resources to Denver residents to help prevent eviction or displacement. Through Denver’s program, city residents that meet income requirements can receive assistance with utilities and up to 80 percent of rent. People can get more information about the program by dialing 311 in Denver and pressing 6.

Public charge
People deemed likely to become a “public charge” can be denied a green card or visa. Under a new rule, a person is more likely to be deemed a public charge if they use Medicaid, SNAP, certain federal housing benefits, or cash benefit programs that keep recipients at a certain level of income.

The new rule has led many people to fear using critical programs. But it is important to keep several facts in mind so that you can make the best choices for your families.

First, many government programs are not considered at all in the public charge test. The only programs discussed in this blog posting that, if used, could harm a person’s chances of being approved for a green card or visa are Medicaid and SNAP.

Second, not all uses of Medicaid are counted negatively under the public charge test. Use of Medicaid by children and pregnant women is not counted negatively when they apply for a green card. In addition, use of emergency Medicaid by anyone is not counted negatively.

Third, refugees, asylees and immigrants with certain other statuses granted for humanitarian purposes are not subject to the public charge test at all when they apply for their green card. In addition, people that already have their green card already passed the public charge test. They will not have to pass the test again when they renew their green card or when they apply for citizenship.

Fourth, parents are not more likely to be deemed a public charge for enrolling their children in public programs the children qualify for. Parents can apply for services on behalf of their children without receiving benefits for themselves.

Finally, as noted above, people will not be penalized under the public charge rule for seeking testing or treatment for COVID-19.

These are challenging times but there are programs in place that can help us meet those challenges and networks of advocates, community leaders, foundations, and others standing with your communities to demand those programs meet the needs of everyone in our communities. We know that you are part of the “us” that makes our communities whole.

-Allison Neswood

 

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HEALTH:
HEALTH FIRST COLORADO (MEDICAID)

Health First Colorado is the name given to Colorado’s Medicaid program. Medicaid provides public, low-cost health insurance to qualifying adults and children. It is an entitlement program funded by the federal, state, and county governments and is administered by counties in Colorado. Those who are required to pay must pay a small co-pay when receiving certain health care services.

State Department: Department of Health Care Policy and Financing

Eligibility: Most adults 18 to 64 are eligible for Medicaid in Colorado if their household income is at or below 133% of the federal poverty limit (FPL). Pregnant women are eligible with incomes of up to 195% FPL, while children under 18 may be eligible if the live in a household with income at or below 142% FPL. Some adults over 65 may also be eligible for Medicaid.

Program Benefits: Through Medicaid, low-income Coloradans are eligible for a range of health care services at little to not cost. Services provided include doctors visits, prescription drugs, mental health services, and dental care. Co-pays for certain individuals may be needed for certain services.

Program Funding and Access: Colorado funds our Medicaid program through state and federal dollars. Medicaid is an entitlement program, which means that all who are eligible for Medicaid can access the program, regardless of the funding level in a given year. This does not mean that it is always easy to access Medicaid, even when eligible. And since the program is administered by counties, funding levels for county staff and other administrative roles can make it easier or harder for Coloradans to access the program. On top of this, not all medical providers accept Medicaid which limits the ability of Coloradans to seek health services even if enrolled, such as if the nearest provider is a 2+ hour drive away.

Note: This data is from before the pandemic and does not reflect changes in enrollment rules during the COVID-19 pandemic and public health emergency.

Statewide Program Access 2015-19: Over the study period of this report, an average of 89.0% of the population at or below 133% of FPL (i.e., the population who is likely to be eligible for Medicaid) were enrolled in Medicaid in Colorado.

FOOD SECURITY:
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)

The Supplemental Nutrition Assistance Program or SNAP helps low-income Coloradans purchase food by providing individuals and families with a monthly cash benefit that can be used to buy certain foods. SNAP is an entitlement program that is funded by the federal and state governments and administered by counties in Colorado.

State Department: Department of Human Services

Eligibility: Currently, Coloradans qualify for SNAP if they have incomes below 200% FPL, are unemployed or work part-time or receive other forms of assistance such as TANF, among other eligibility criteria. Income eligibility for SNAP was different during the study period of this report than today—it was 130% FPL back in 2019 for example. The US Department of Agriculture uses the population at or below 125% FPL when calculating the Program Access Index (or PAI) for SNAP. We follow this practice in our analysis despite Colorado currently having a higher income eligibility threshold.

Program Benefits: SNAP participants receive a monthly SNAP benefit that is determined by the number of people in their household and their income. Benefit amounts decrease as income increases, helping households avoid a sudden loss of SNAP when their incomes increase, even by a minor amount. Benefits are provided to an Electronic Benefit Transfer (EBT) card that can be used to purchase eligible food items, such as fruits and vegetables; meat, poultry, and fish; dairy products; and breads and cereals. Other items, such as foods that are hot at their point of sale, are not allowable purchases under current SNAP rules.

Program Funding and Access: SNAP, like Medicaid, is a federal entitlement program. This means that Colorado must serve any Coloradan who is eligible for the program. As such, funding should not be a limit to how many Coloradans can be served by the program. However, funding for administration of SNAP at the state and county level can limit the ability of county human service departments to enroll those who are eligible. Other program rules and administrative barriers can make it difficult for Coloradans to receive the benefits they are legally entitled to receive.

Statewide Program Access 2015-19: Over the study period of this report, an average of 61.1% of the population at or below 125% of FPL (i.e., the population who is likely to be eligible for SNAP) were enrolled.

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

The Special Supplemental Nutrition Program for Women, Infants, and Children, also know as WIC, provides healthcare and nutritional support to low-income Coloradans who are pregnant, recently pregnant, breastfeeding, and to children under 5 who are nutritionally at risk based on a nutrition assessment.

State Department: Department of Public Health and Environment

Eligibility: To participate in WIC you must be pregnant, pregnant in the last six months, breastfeeding a baby under 1 year of age, or a child under the age of 5. Coloradans do not need to be U.S. citizens to be eligible for WIC. In terms of income, households cannot have incomes that exceed 185% FPL. Families who are enrolled in SNAP, TANF, Food Distribution Program on Indian Reservations (FDPIR), or Medicaid are automatically eligible for WIC. Regardless of gender, any parents, foster parents, or caregivers are able to apply for and use WIC services for eligible children.

Program Benefits: WIC provides a range of services to young children and their parents. These include funds to purchase healthy, fresh foods; breastfeeding support; personalized nutrition education and shopping tips; and referrals to health care and other services participants may be eligible for.

Program Funding and Access: WIC is funded by the US Department of Agriculture. The state uses these federal funds to contract with local providers, known as WIC Clinics. In most cases, these are county public health agencies, but that is not the case in all Colorado counties. Some WIC Clinics cover multiple counties, while others are served by multiple clinics. Private non-profit providers are also eligible to be selected as a WIC Clinic.

Statewide Program Access 2015-17: Between 2015 and 2017, an average of 52.2% of the population eligible for WIC were enrolled in the program in Colorado.

Financial Security:
Colorado Works

Colorado Works is the name given to Colorado’s program for Temporary Assistance to Needy Families or TANF. It is an employment program that supports families with dependent children on their path to self-sufficiency. Participants can receive cash assistance, schooling, workforce development and skills training depending on the services available in their county.

State Department: Department of Human Services

Eligibility: In general, Coloradans are eligible to enroll in TANF if they are a resident of Colorado, have one or more children under the age of 18 or pregnant, and have very low or no income. For example, to be eligible to receive a basic cash assistance grant through TANF, a single-parent of one child could not earn more than $331 per month, with some exclusions—and would only receive $440 per month (as of 2022). That said, there are other services provided by counties through TANF that those with incomes as high as $75,000 may be eligible for. In addition to these, participants in TANF are required to work or be pursuing an eligible “work activity” or work-related activity. Any eligible individual can only receive assistance if they have not previously been enrolled in TANF for a cumulative amount of time of more than 60 months—this is a lifetime limit that does not reset. Counties may have additional requirements and offer benefits that are not available in other counties in Colorado.

Program Benefits:  While the exact benefits that one is eligible for under TANF can vary, all qualified participants are eligible to receive a monthly cash payment, call basic cash assistance. Other than cash assistance, counties are have a lot of choice in how to use their TANF funding; generally a use of TANF funds is appropriate so long as it advances one or more of the four purposes of the program: (1) provide assistance to needy families so that children can be cared for in their own homes or in the homes of their relatives; (2) end the dependence of needy families on government benefits by promoting job preparation, work, and marriage; (3) prevent and reduce the incidence of out-of-wedlock pregnancies; and (4) encourage the formation and maintenance of two-parent families.

It is important to note that those eligible for TANF are also eligible for many of the other programs we’ve included in this report, such as SNAP, Medicaid, and CCCAP.

Program Funding and Access: Colorado funds its TANF program through funds received from the federal government through the Temporary Assistance for Needy Families block grant. Most of the federal funds are allocated by the state to counties, which are required to provide a 20% match of state funding. Federal and state rules allow the state and counties to retain a portion of unspent funds in a TANF reserve.

Statewide Program Access 2015-19: Over the study period of this report, an average of 50.7% of the population at or below 100% of FPL (i.e., the population who is likely to be eligible for TANF) were enrolled in TANF in Colorado.

EARLY LEARNING:
COLORADO CHILD CARE ASSISTANCE PROGRAM (CCCAP)

The Colorado Child Care Assistance Program provides child care assistance to low-income families and caregivers living in Colorado in the form of reduced payments for child care. It is a program funded by the federal, state, and county governments and is administered by counties in Colorado. The share owed by parents/caregivers is determined on a sliding scale based on the family’s income.

State Department: Department of Early Childhood Education

Eligibility: Counties set eligibility for families separately, but must serve families with incomes at or below 185% of the Federal Poverty Limit. Families accepted to the program are no longer eligible once their income exceeds 85% of the state median income. Parents or caregivers must be employed, searching for work, or engaged in another approved activity to be eligible for CCCAP. Parents and caregivers enrolled in Colorado Works (Temporary Assistance to Needy Families or TANF) or in the child welfare system are also eligible to participate in CCCAP. Generally, CCCAP serves families with children under 13, although children as old as 19 may be eligible under certain circumstances.

Program Benefits: If a family is eligible for CCCAP and has income, they may likely have to pay a portion of their child’s or children’s child care costs each month. The amount that families owe is based on their gross income, number of household members, and the number of children in child care in the household. As such, households tend not to experience a benefit cliff with CCCAP when they see their incomes increase

Program Funding and Access: Colorado funds the CCCAP program using federal dollars it receives from the Child Care and Development Block Grant program. The state allocates federal and state funds to counties using a formula that takes into account factors like current caseloads and the number of eligible residents. Assistance is available until the county’s funds are spent, so the number of families that can be served is often a function of how much funding is available and the income and composition of the household that applies. It is not uncommon for counties to overspend or underspend their allocations of funds. The state reallocates unspent funds from counties who underspent to those who overspent. While underspending could indicate a problem with the way a county administers its CCCAP program, it could just as likely be a sign that there are few providers in the county who participate in CCCAP—or a lack of providers generally.

Statewide Program Access 2015-19: Over the study period of this report, an average of 10.8% of the population at or below 165% of FPL and younger than age 13 (i.e., the population who is likely to be eligible for CCCAP) were enrolled in CCCAP.

Housing:
HUD rental assistance programs

The US Department of Housing and Urban Development (HUD) has three housing assistance programs that we look at together: Housing Choice Vouchers (Section 8), Project-based Section 8, and Public Housing. In Colorado, these programs provided assistance to over 90% of the households who received federal housing assistance from all HUD programs. Through federally funded, local or regional public housing agencies (PHAs) are the agencies that administer these programs, through not all are available in all counties. These are not the only programs available in Colorado that assist households afford the cost of housing, such as units funded through federal and state tax credit programs.

State Department: Department of Local Affairs

Eligibility: Generally, households with incomes under 50% of the area median income (AMI) of the county they live in are eligible for these rental assistance programs, although PHAs have discretion to select households with incomes at higher percentages of AMI. That said, HUD requires that 75% of new vouchers issued through the Housing Choice Voucher/Section 8 program in a given year are targeted to households with incomes at or below 30% of AMI. PHAs are also able to create criteria that give priority to certain types of households who are on waiting lists for these programs.

Program Benefits: These rental assistance programs help households afford the cost of housing by reducing their housing costs to around 30% of their household income. In the case of the Housing Choice Voucher program, the PHA pays the voucher holder’s landlord the remaining portion of the rent.

Program Funding and Access: Funding and access are both challenges for these rental assistance programs. In addition to limitations on the number of public housing units or housing vouchers a PHA can manage or issue, lack of funding compared to the need constrains the ability of PHAs to assist low-income households. In 2020, Coloradans were on waitlists for Housing Choice Vouchers for an average of 17 months. Waitlists also exist for the other rental assistance programs.

Statewide Program Access 2015-19: Over the study period of this report, an average of 21.1% of renter households with incomes at or below 50% AMI (i.e., the population who is likely to be eligible for HUD rental assistance programs) were living in subsidized housing.