Oct 26, 2017

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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Got health coverage? Connect with the exchange

by | Oct 26, 2017

Being part of a community, whether it’s Colorado as a whole, your farming community, Glenwood Springs or Denver’s Westwood neighborhood means that you give and you get. You give your labor, your taxes, your neighborly advice, your willingness to turn the music down, and you get in return the many benefits a thriving community can offer.

Despite that, many of us may not be getting the health care we want and need. During an Oct. 19 presentation by Colorado’s Division of Insurance and individual carriers, consumers spoke with dismay about huge hikes in premium costs for 2018, and about deductibles that make it hard to access care. Six percent or more of those hikes can be attributed to the White House decision to cut off funding to carriers for consumers’ cost-sharing reductions (CSR), as reported recently by CCLP, but the remaining 30 percent stems from high medical costs and continuing federal uncertainty about federal support for the Affordable Care Act’s principles and systems.

Despite the political turmoil, many households can afford coverage if they take advantage of what Connect for Health Colorado offers between Nov. 1 and Jan. 12 during the state’s open enrollment period.

Over half of Colorado residents who lack access to employer-based coverage can get credits that make coverage affordable. Despite skyrocketing premiums, households that receive premium assistance will end up with lower premiums in 2018 than in 2017 on average, because tax credits will rise too, according to the recent Wakely report. The figures have shifted since the news on CSR, but the result remains: most eligible enrollees can have lower premiums in 2018 than in 2017.

Coloradans can qualify for credits at much higher income levels than they realize.  Households surveyed by Connect for Health were way off when asked to estimate how much they could make and still qualify for help with premiums. On average, respondents said individuals would have to make under $28,000, though $48,240 is the actual maximum. How about a family of four? Households with income up to $98,400 can qualify, but respondents thought families could make only half as much.

Deductibles, cost-sharing, and out-of-pocket maximums can be sharply reduced for individuals and households with lower incomes. Despite the White House decision to cut off CSR funds to carriers, the program is still fully available to those who purchase a silver plan through the exchange and have income under 250 percent of the federal poverty level (FPL). Individuals who earn less than $30,150 can benefit, with a $2500 silver plan deductible shrinking to just $25 for someone making $18,000 or less, like the dishwasher who works 35 hours a week, year-round, at minimum wage.

Tens of thousands of Coloradans could get coverage for less. So why have so many eligible Coloradans failed to get tax credits in the past? Some don’t know that they might qualify. For others, the lengthy and historically buggy application process is an issue, and they prefer to purchase coverage without getting screened for eligibility. With a potential annual benefit worth more than the used car you have your eye on, it’s worth it to get screened. On top of that, the IRS will be rejecting tax returns unless taxpayers indicate whether they had coverage, were exempt from the requirement, or made the individual shared responsibility payment.

For those who can’t qualify, coverage will cost a whole lot more. One primary reason is that high health care costs drive up premium prices. The reasons range from lack of cost transparency to out-of-network billing, and from soaring drug prices to lack of carrier competition in western counties. Fixes for those problems will require bipartisan action from our state legislators. That action could yield results that benefit all Coloradans, from those who access coverage through employers and public programs, to the many who need affordable and usable individual coverage.

 

-By Bethany Pray

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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.