Jan 13, 2016

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.

Legislative and Policy Preview 2016: Health Care

by | Jan 13, 2016

In 2016, the Colorado Center on Law and Policy will work to ensure that Medicaid expansions are protected and that program is available to all eligible applicants and participants. CCLP will protect the interests of low-income Coloradans as Colorado moves forward with payment and delivery system reform. We will also work to ensure that benefits in the private insurance market are provided on a non-discriminatory basis.

This year, our health care priorities include:

Healthcare legislation
The state budget and the hospital provider fee  — CCLP will work to ensure that Medicaid is protected as legislators make decisions about how to address this year’s budget shortfall. We support the proposal to move hospital provider fee funds into a state enterprise. We oppose the Governor’s proposal to reduce Medicaid primary care provider rates and believe doing so is antithetical to the goals of Colorado Medicaid’s Accountable Care Collaborative.

Surprise billing — Too often, Coloradans who have had surgery or other services at in-network facilities may find themselves on the hook for surprise bills from out-of-network providers. These bills may far exceed in-network costs. Last session, Sen. Irene Aguilar introduced a bill that was intended to protect consumers from surprise bills. While the legislation failed as a result of strong opposition from the Colorado Medical Society (CMS), CCLP and its partners have continued to work with health insurance carriers and the CMS to develop a similar proposal. It is not clear whether legislation will be introduced on the matter this year.

Formulary transparency — CCLP has long been concerned about the affordability of healthcare as many middle- and low-income families experience significant hardship when faced with substantial out-of-pocket medical expenses. The increase in the number of high-deductible health insurance plans and the requirement that many health plans impose on their customers to pay their full deductible before the plans pay for medical care means that more people face high out-of-pocket costs. This is particularly true for people with chronic health conditions. In early 2015, after months of advocacy by CCLP, the Chronic Care Collaborative and the Colorado Consumer Health Initiative, the Colorado Division of Insurance issued a draft bulletin setting more reasonable cost parameters for insurers. One benefit of the bulletin was expanded use of copays, which allows for both greater transparency and more manageable costs for those with chronic health issues. This legislative session, CCLP will continue to work to improve transparency regarding formulary benefits for Coloradans.

Cost analysis for continuous Medicaid eligibility for adults — States have the option to provide children with 12 months of continuous eligibility for Medicaid and Child Health Plan Plus (CHP+), even if enrolled families experience an income change during the course of a year. Colorado exercises the option for children but adults are still eligible for Medicaid on a month-to-month basis only. As a result, increases in income can make adult recipients ineligible for Medicaid benefits. Additionally, there’s often a delay when people switch from Medicaid to private insurance that creates a gap in coverage, which means people may go without needed healthcare. Colorado can seek a federal waiver to provide continuous eligibility for adults. The first step is to study the costs of adopting continuous eligibility. Last year, the Colorado Department of Health Care Policy and Financing (HCPF) proposed a budget item to undertake that study, but the Joint Budget Committee rejected their request. CCLP anticipates there will opportunities to raise this issue again this session.

Aligning income and household definitions between Medicaid and Advance Premium Tax Credits (APTC) — While Medicaid expansions have helped hundreds of thousands of Coloradans access health care services, the potential for gaps in coverage remain significant. Currently, Medicaid calculates income eligibility for adults on a monthly basis, while the APTC is calculated based on annual income. Medicaid could help to alleviate churn between Medicaid and APTC eligibility by aligning better definitions of income and household. CCLP supports HCPF’s proposal to the Joint Budget Committee to move in this direction, although we want to ensure that Medicaid-eligible, low-income individuals and families are not locked into private insurance when their incomes drop.

Non-legislative advocacy work, research and projects
PACE conversions — With the prospect of an aging Colorado quickly becoming a reality, virtually everyone would prefer to remain at home and independent. CCLP has been representing the public interest in the matter of the proposed conversion from nonprofit to for-profit status of InnovAge, a Colorado Program of All Inclusive Care for the Elderly (PACE) provider. PACE offers a range of services to people over 55 who qualify for nursing-home level care but wish to remain independent.

During the 2015 Colorado legislative session, CCLP and its allies worked to ensure that language regarding PACE conversions was added to the bill (Senate Bill 137) that authorized Colorado PACE programs to operate as for-profit entities. InnovAge operates one of the largest PACE programs in the nation and this is the first conversion proposed since Congress authorized PACE programs to operate as for-profit entities. Issues to watch include whether the assets of the nonprofit InnovAge are valued fairly; whether the proceeds of the sale (to a private equity firm) are directed to an independent nonprofit entity that will use them to benefit the frail elderly and disabled in Colorado; and whether there are adequate oversight provisions following the conversion to ensure that PACE enrollees are protected. PACE serves dually eligible Medicaid and Medicare enrollees over the age of 55, among the most frail served by public health insurance programs.

InnovAge filed its Master Plan of Conversion with the Colorado Attorney General on Oct. 30. The public comment period in the proceedings ended on Jan. 8. For more information, visit the Attorney General’s website. T

The Colorado Commission on Affordable Health Care  — In 2014, CCLP strongly supported Senate Bill 187, which established the Colorado Commission on Affordable Health Care. Formed in mid-2014, the Commission will work until June 30, 2017, to identify, examine, report on and make recommendations to address the principle healthcare cost drivers in Colorado while maintaining the value and quality of health care for Coloradans. CCLP’s Elisabeth Arenales is an appointed member. The commission delivered its first report to the General Assembly in November. We hope the commission will be able to address the ongoing problem of healthcare affordability, particularly for low- and middle-income Coloradans.

Ensuring full access to the pediatric Medicaid benefit  — CCLP continues to work with community partners and HCPF to ensure that children get the benefits to which they are entitled under the federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. After working with CCLP during 2014 and 2015, HCPF promulgated new regulations putting into effect the personal care benefit for children. And though we supported lifting the enrollment cap on the Medicaid waiver for children with autism, we are pleased that a September 2015 letter by CMS informed HCPF that behavioral health therapies will have to be provided for all children — not just waiver recipients — under EPSDT. CCLP will continue to work to ensure that the EPSDT benefit is available to all children for whom it is medically necessary.

The intersection of health and poverty —  CCLP is developing a new report to replace the health chapter historically included in the “State of Working Colorado” report. This report will examine the intersection of poverty and health through a place and race lens and will highlight data on economic security and opportunity, health access and costs, and health outcomes. A

Also on our radar
Aid to the Needy and Disabled (AND)
  — AND provides a very small cash stipend (about $180 per month) and some medical benefits to disabled individuals with little to no income. The program was implemented primarily to serve as a temporary support for individuals that are likely to be approved for Supplemental Security Income (SSI). CCLP is leading an effort to get an AND pilot program that provides SSI application assistance to AND applicants extended for an additional four to six months.

Parity for Mental Health and Addiction Treatment  — CCLP continues to work with Colorado’s Coalition for Parity to address the need for better enforcement of the Mental Health Parity and Addiction Equity Act of 2008. Federal rules for private insurance were finalized in 2014, but enforcement is complex and data-dependent, and many states have yet to take a hard look at carriers’ compliance. CCLP commented on the draft rule regarding Medicaid programs, and awaits its finalization.

Medicaid for refugees, asylees and other protected immigrants — Everybody should be able to access benefits to which they are entitled. Last fall, CCLP learned that HCPF’s policy regarding refugees, asylees and other protected status immigrants is to terminate Medicaid eligibility after they have been in protected status for seven years. But HCPF created this policy based on what CCLP believes to be an incorrect interpretation of federal law. CCLP will continue to advocate for a change in that policy so that refugees, asylees and other protected-status immigrants are not deprived of their benefits.

– By Elisabeth Arenales

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.

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.