Jan 10, 2018

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Legislative Preview 2018: Health Care

by | Jan 10, 2018

In 2018, CCLP’s Health Program will work to preserve access to Medicaid and Child Health Plan Plus (CHP+), which are both cost-effective public programs. In addition, we will participate in efforts to increase pricing transparency and reduce costs in the private insurance market. We anticipate continuing discussion about the impact of federal action on health care access and potential state solutions.

This year, our health care priorities include:

Prescription drug transparency
We have long been concerned about pharmaceutical companies’ increasing share of the health care dollar, and cost trends that outstrip most other categories of care. That’s why we have joined the Colorado Consumer Health Initiative and Healthier Colorado in supporting legislation that will expand Coloradans’ understanding of which drugs contribute to the rising cost of insurance premiums and the basis for those increases.

Assistance with applications for federal disability programs
Coloradans with disabilities — especially those who lack stable housing and those with mental illness — encounter substantial difficulties in applying for federal support that helps them survive. This session, we are working on two bills designed to improve the application process. The first will add psychologists, social workers, and licensed professional counselors to the list of health care providers that can verify that an Aid to the Needy Disabled (AND) applicant cannot work due to a disability. The second bill will provide funding for a statewide program that will help AND applicants and recipients navigate the complex process of applying for federal Social Security disability benefits.

During 2017, CCLP participated in a stakeholder process led by the Division of Insurance to explore the feasibility of a reinsurance program in Colorado. We anticipate at least one bill that would give the state authority to apply for an ACA waiver. Through the waiver, Colorado would establish a fund to help defray the expense of more costly enrollees, thus allowing carriers to charge lower premiums. The fund would be composed of millions in federal premium tax credit funding along with state funding from as-yet-undetermined sources. CCLP’s position on the bill will depend on the degree of benefit and the potential impact of funding mechanisms on Colorado consumers.

Preventing and treating substance use disorders
The Opioid and Other Substance Use Disorders Interim Committee chaired by Rep. Brittany Pettersen, D-Lakewood, resulted in a set of six bipartisan bills aimed to reduce dependence on opioids and other substances and increase access to treatment. We support this broad-based approach to an epidemic of addiction both nationally and in Colorado. The slate includes bills focused on prevention and education, clinical practice, harm reduction, the shortage of treatment providers, Medicaid residential treatment and payment reform.

Health care costs
We will work to implement some of the recommendations of the Commission on Affordable Health Care created by legislation that CCLP developed during the 2014 legislative session. We are particularly interested in ensuring the availability of data that would allow communities to better understand the reasons their health care costs are high. We are also interested in exploring whether Colorado might pursue a hospital payment model similar to Maryland’s efforts to control costs — particularly in high-cost regions of the state. At this point, we do not know whether these ideas will evolve into legislation this year.

Surprise billing
Too often, Coloradans who have had surgery or other services at in-network facilities find themselves on the hook for surprise bills from out-of-network providers. These bills may far exceed in-network costs. CCLP has supported efforts over the past three years to curtail the practice of surprise billing. We anticipate introduction of a bill addressing this issue in 2018 that will include notice to consumers about their rights and the risk of out-of-network bills.

Regulating free-standing emergency departments
We anticipate a set of three bills that propose to regulate and license free-standing emergency departments (ED) and provide notice of potential costs to consumers. CCLP strongly supports these efforts, which were redesigned after similar efforts failed in 2016 and 2017. Free-standing EDs have continued to proliferate in Colorado driving up health care costs and often leaving consumers with high out-of-pocket costs.

Protecting coverage gains
We are working with colleagues in Colorado and nationally to encourage preservation of public programs, including CHP+, that keep our schools, workplaces and communities healthy and functioning.

We will continue the fight against Congressional efforts to repeal or undermine the ACA and to substantially cut funding to the Medicaid programs upon which Coloradans with disabilities, the low-income elderly, children, and adults rely upon. CHP+ remains endangered, with continuing resolutions by Congress delaying the question of long-term funding for this program that has historically enjoyed broad bipartisan support, and causing turmoil for state systems and CHP+ families.

Federal regulatory changes continue, from reducing the open-enrollment period on the health insurance exchanges to letting individual and group markets offer skimpy plans that would attract healthy customers while leaving older and sicker consumers with much higher premiums. We will continue to support innovation by Connect for Health Colorado, which as a state exchange retains flexibility that federal exchanges lack. We note that despite a somewhat shortened 2018 open enrollment period in Colorado, projected enrollment remains at or above last year’s level,  signaling a general consensus among those who lack employer-based health care that they need and want health insurance.

CCLP remains concerned about the impact on Colorado’s Medicaid program of possible federal efforts to increase obstacles to receiving Medicaid services. Work requirements and increased costs to enrollees have been shown to limit access and increase state bureaucracy, without improving health outcomes. We will continue to monitor Congressional proposals and send out regular updates and action alerts,

– By Elisabeth Arenales

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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.


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.


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.


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.