Feb 21, 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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Good news about coverage in Colorado

by | Feb 21, 2019

Colorado has done something extraordinary in recent months. While enrollment through many state health exchanges is 4 percent lower than last year due to fast-moving and disruptive federal changes, Colorado’s numbers are up. More people have signed up for plans, and a higher percentage has been found eligible for financial assistance to help with costs.

How have we managed this? The wise decision by the Colorado legislature to create a state-based exchange, Connect for Health Colorado, gave our state flexibility. Our Division of Insurance used that flexibility to the advantage of state residents, giving them additional weeks to enroll in coverage, and establishing a consumer-friendly way to deal with the federal government’s failure to fund cost-sharing reductions that help people with out-of-pocket costs. And Connect for Health took the opportunity to make their application process more intuitive and to make it a bit easier to find out if you’re eligible for premium subsidies and cost-sharing reductions.

Despite this good news, there is still a lot of room to grow when it comes to helping working families and individuals get coverage they can afford. For those who are eligible for financial assistance under the ACA – with incomes between roughly $17,000 and $65,000 for an individual, or $25,000 and $100,000 for a family of four – it’s essential that they are connected with coverage. Colorado remains near the bottom of the pack nationally in the percentage of enrollees who enroll with financial assistance. In 2017, according to estimates derived from the American Community Survey, rates of uninsured Coloradans remain substantial. Almost 15 percent of those between 139 and 199 percent FPL, and another 13 percent of those between 200 and 299 percent are uninsured. The Colorado Health Institute reported last year, using 2016 data, that over 100,000 Coloradans who were eligible for assistance through Connect for Health were not enrolled in coverage.

Getting premium subsidies doesn’t just help with family finances. For families with less disposable income, affordable coverage may mean the difference between stability and homelessness. A recent study by Emily Gallagher at the University of Colorado concludes that going from being uninsured to receiving subsidized coverage has “a profound impact on the likelihood of making timely home payments.” When families with young children are already paying nearly half their income on housing and child care, as we describe in the 2018 Self-Sufficiency Standard, a health shock due to illness or injury can have catastrophic results for uninsured households. And those catastrophic results have a ripple effect on communities.

For those families and those communities, we need to invest as a state in reaching all who are eligible for assistance but not enrolled. We need better systems for getting people into coverage when they lose Medicaid due to earning higher incomes. Targeting certain groups that face particular obstacles to coverage — such as rural Coloradans and the Latinx population — may require more funding for trusted community partners and more training for county workers. State agencies, county human services offices, and Connect for Health need to acknowledge and counter the fear and confusion that has resulted from federal anti-immigrant rhetoric, so that eligible non-citizens, people with limited English proficiency, and people in mixed-status households have the same ability to enroll as other eligible populations.

Getting more people enrolled in subsidized coverage really is a win-win for Colorado. Being covered means better health and a greater likelihood of economic stability. But there’s more! Legislative efforts like reinsurance and a public option are underway this session and aim in part to help those in high-premium areas who make more than 400 percent of the federal poverty level – about $100,000 for a family of four, and close to $50,000 for an individual. We support those goals.  One or both plans will rely on a mechanism for re-purposing federal dollars spent on premium subsidies; the more premium subsidies Coloradans receive, the more dollars those new programs have to work with.

So let’s do this.  Planning for the next open enrollment begins now.

– By Bethany Pray

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.