Sep 7, 2018

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.

Recent articles

Good news for Coloradans struggling with disabilities

by | Sep 7, 2018

Today, the State Board of Human Services unanimously voted to approve a rule that will make important changes to Colorado’s Aid to the Needy Disabled (AND) program.

But before I expand on the good news, I want to provide some background:

The federal cash assistance programs, Supplemental Security Income (SSI) and Social Security Disability Income (SSDI), help to ensure that people living with disabilities can meet their basic needs. The programs provide a monthly income of about $730 – or more for SSDI – that help people with disabilities avoid homelessness, engage in health-maintenance activities and experience wellbeing.

But it can take a year or longer for an eligible person to get approved for these programs. Delays ensue in large part because the application process is complex and applicants must navigate it while contending with debilitating mental and/or physical health conditions. As a result, applicants are often denied multiple times due to submitting applications deemed incomplete or insufficient, even when they meet the eligibility requirements.

This is where Colorado’s AND program comes in. AND is a state program that provides just $189 per month – $217 per month starting this November – to people who cannot work due to a severe mental or physical disability. The program was created to put some desperately needed cash in the hands of people living with disabilities while they are applying for SSI/SSDI.

Given the eligibility requirements for the program, the $189 benefit is generally the only cash AND clients have available to cover the costs of their basic needs. Many AND clients are homeless and report using the benefit to buy hygiene products, food and transportation. The rule approved by the State Human Services Board today will make this critical program more accessible with a number of changes.

First, the new rule will give clients more time to prove that they have a qualifying disability. In order to qualify for AND, applicants must have a medical provider certify that the individual has a disability that prevents them from working. The current rules give AND applicants just 10 days to obtain the certification and return it to their county office. The rule will increase that timeline to 30 days.

Second, the rule will give clients more time prove that they have applied for SSI/SSDI. To receive AND, applicants must verify that they have applied for federal benefits.  As with the disability verification, the current rules allow clients only 10 days to submit the verification to their county office. The new rule will increase that timeline to 60 days.

Third, the new rule will allow clients to receive AND payments while they work on their SSI/SSDI application. Under the existing rule, most AND applicants must demonstrate that they have applied for SSI/SSDI before they can receive AND. Under the new rule, once all other eligibility requirements are met, every AND client will be able to receive AND payments while they take advantage of the new 60-day timeline to complete and verify their application for federal benefits.

Fourth, the new rule will not rely on county workers to score an applicant’s functional capacity to work. Currently, county administrators are required to assess the extent to which an applicant’s disability, in combination with certain social factors, limits the functional capacity of the applicant to work. To make that assessment, county administrators — without relevant expertise and at their first meeting with the applicant — must score a client’s functional capacity to work using the “Residual Functional Capacity Scoring Matrix” or “Social Factors Matrix” currently found in rule. Under the new rule, the Social Factors Matrix will be eliminated and health care providers will make the functional capacity assessment.

Finally, we are thrilled that one additional change made it in just before the finish line: The change will improve access to health care providers who can verify that an AND applicant has a qualifying disability. Under current law, Licensed Clinical Social Workers (LCSWs) and Licensed Professional Counselors (LPCs), are not able to verify that an AND applicant has a disability that prevents them from working. LCSWs and LPCs, providers who are often more accessible to the AND population than other providers, will have the ability to verify an AND applicant’s disability status.   

Streamlining the AND application process is not merely about convenience. These changes are about making AND accessible to the people who need it most: those who aren’t able to verify their disability in 10 days because they live on the streets, lack transportation, have a severe disability and haven’t yet established a relationship with a doctor. These changes are about giving people a real chance to gather the extensive medical and vocational documentation needed for a successful SSI application, so they can begin receiving the income that might help them afford to rent a home. These changes are about making AND work for the people it is supposed to serve.

The team behind the relentless push for these reforms included advocates, people that live with disabilities and people with disability in their family. They represented lived experiences and knowledge from their work with clients at the Colorado Cross-Disability Coalition, Bayaud, Easter Seals, the Colorado Coalition for the Homeless, and the Denver Chapter of the National Alliance on Mental Illness. I am ever grateful for all that I learned from this committed team and I couldn’t be more proud of the work we did over the course of two years to help the Colorado Department of Human Services understand the client experience and ultimately embrace and work with us toward our vision for change.

We use one word – disability – to refer to a wide range of mental or physical characteristics that can limit functioning in many different ways and to varying degrees. A disability might make it difficult or impossible for someone to lift themselves out of bed or to enter a building, sidewalk or bus without ramps. A disability might make it challenging or impossible for someone to vocalize words or to see or hear the world around them. A disability might make it difficult or impossible for someone to organize or remember information; to discern hallucinations from events perceived with their eyes and ears; to manage troubling emotional responses to stimuli or perceived events.

While it can mean many different things, disability does not mean the inability to participate in social life. To the extent social life is inaccessible to people with disabilities it is because sidewalks, buses, buildings, learning environments, and programs are designed in a manner that excludes them.

But it doesn’t have to be that way. When we build shared spaces and social programs in partnership with people living with disabilities, our communities can accommodate an ever broader range of physical and mental ability and our neighbors with disabilities can share in the opportunity to thrive. I want to live in that world and I’m grateful for the opportunity to work towards it in partnership with my friends.

-By Allison Neswood

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.