Oct 28, 2020

Bethany Pray serves as CCLP's Chief Legal and Policy Officer. 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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Give Medicaid clients the process they are due

by | Oct 28, 2020

Health First Colorado, the state’s Medicaid program, is critical to the health and well-being of the over 1.4 million Coloradans who qualify based on income or disability. Unfortunately, getting enrolled and staying enrolled in the program can be very challenging.

According to a recent audit of 100 Colorado Medicaid notices related to eligibility, two-thirds of notices sampled were found to have errors, omissions or other problems. Such notices are intended to inform applicants about their eligibility, to explain their appeal rights and to let them know what additional information might be needed for them to get or stay enrolled. Inaccurate notices can be a life-or-death issue for some, but for all enrollees, they complicate access to health care and economic security and cause anxiety and frustration.

The Colorado Department of Health Care Policy and Finance (HCPF) has described steps they’ve taken to address these ongoing concerns, but there is clearly much room for improvement. Moreover, the state’s failure to provide accurate, clear notices may in some circumstances violate Coloradans’ constitutional rights.

Giving ‘due process’ its due
Though it’s not a household concept, “due process” is a matter we at Colorado Center on Law and Policy take seriously in the context of public programs. Your property rights – your right to a license, to some types of civil service jobs, and to certain public benefits, are protected under the 14th Amendment of the U.S. Constitution and under our state constitution. Because of those constitutional protections, an individual is entitled to notice and a hearing before that property can be taken away. For example, you can’t be deprived of either your Medicaid benefits or your license to provide physical therapy unless the state gives you adequate notice and an opportunity to be heard.

We understand that the state’s job is not an easy one. Medicaid eligibility is extremely complicated due to federal requirements, despite changes in the ACA that streamlined rules and processes. Eligibility depends on who resides in your household, monthly income, residence and citizenship or immigration status. It can also hinge on a disability determination, what assets you have, whether you qualify for Medicare and pregnancy.  Federal rules and requirements change frequently. Unlike most commercial coverage and Medicare coverage, your Medicaid eligibility in Colorado can change month to month unless you are a child; this means the state must track changes throughout the year and not just annually.

Other problems
Accuracy of notices also depends on a functioning computer system and well-trained workers. Roughly half of the errors identified in the audit were attributed to human error. Providing training on federal and state requirements to all 64 counties is a challenging task for Colorado’s very low-overhead state agency. If, for example, the state learns that workers have filled in the blanks of a Spanish-language notice with English, or have failed to update case information, the next step for the state may be training or clarified guidance. County autonomy, however, means that there is no guarantee that all workers will complete the new training or that internal processes will change immediately.

Most of the remaining errors involved the state’s computer systems. The complex set of data points described above – income, residence, household, assets, and more – is maintained by  the Colorado Benefits Management System (CBMS), a system that was technologically out of date when we bought it in 2004. System errors included plugging in out-of-date financial information and plugging in the wrong due date for a response. When mistakes are made, the state is subject to pressure and potentially disastrous financial penalties from the federal government.

Enrollees who have variable income or household changes must live with the related uncertainty. Inaccurate notices add significantly to members’ stress and frustration and can undermine their trust in government — even if they are able to sort through the problem and keep coverage. Notice problems also contribute to a false narrative about the competence of government, with that narrative failing to take into account administrative complexity and a history of inadequate funding for infrastructure.

Hope for the near future?
Despite these daunting challenges, there’s still hope for improving notices and reducing the administrative burdens on Coloradans who are eligible for the Medicaid program. HCPF is about to launch a new program that will improve their ability to oversee and assist counties with eligibility processing. That approach should allow the state to have a better view of where help is needed. That might include developing a process to make sure that Spanish-speakers don’t receive form notices in Spanish that contain crucial language in English, a problem identified in the audit; or training for staff on lesser-known income rules that govern self-employed workers.

The program is a start but not enough to address the many changes needed to ensure that Coloradans can get critical access to health care. While working to improve county processes, the state must ensure that people get the due process to which they’re entitled. If errors are identified, the state should quickly restore coverage until proper notice can be issued. The next audit of Medicaid correspondence, scheduled for 2023, should include other state programs, like Supplemental Nutrition Assistance Program (SNAP) and Colorado Works, because those programs rely on the same IT system and county staff when communicating with enrollees.

We believe that the state needs to look hard at our funding for the system infrastructure that close to a quarter of our state’s residents rely on to achieve better health, that helps fund our clinics and hospitals, that brings in federal dollars that keep our economy running even in hard times like these. If we can make a successful system a priority, more Coloradans will be able to access the health care they need when they need it, and to see the state as a partner in their ability to achieve better health.

– By Bethany Pray

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CCLP’s 2024 legislative wrap-up, part 2

CCLP's 2024 legislative wrap-up focused on expanding access to justice, removing administrative burden, supporting progressive tax and wage policies, preserving affordable communities, and reducing health care costs. Part 2/2.

CCLP’s 2024 legislative wrap-up, part 1

CCLP's 2024 legislative wrap-up focused on expanding access to justice, removing administrative burden, supporting progressive tax and wage policies, preserving affordable communities, and reducing health care costs.


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.