Aug 19, 2020

Recent articles

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.

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Lived Experience: Colorado advocates fight for denied essential health benefits

by | Aug 19, 2020

Editor’s note: This vignette is part of the Lived Experience series, which highlights how Coloradans benefit from advocacy efforts led by CCLP and its partners.

Though largely intended for individuals and families with low incomes or disabilities to provide health coverage, Health First Colorado (Colorado’s Medicaid program) supports families with high-acuity children – with a more flexible definition of financial need – to help them cover the costs of essential treatments and services. For many families, however, meeting the criteria for and accessing these benefits can be a logistical and legal nightmare.

Chris Russell, a family advocate who works in pediatric home care, is familiar with this situation. Chris has spent many of the last 39 years navigating the complex Medicaid system to ensure that her son, who has a physical disability, can receive essential services that he requires.

“His disability is quite severe,” Chris says. “He’s extremely intellectually capable and not too recently [earned] his Ph.D.… but his body has been a challenge…[He’s] pretty much had everything go wrong that could go wrong in 39 years with the system in terms of going through IEPs in the schools and going through all manner of Medicaid misery.”

Armed with her experience as an attentive mother, Chris has spent 29 years working at a pediatric home health agency to ensure that eligible families receive the medical coverage and services they need. Through her work, Chris is exposed to systemwide issues related to accessing certain Medicaid benefits. When Chris comes across a particularly difficult legal problem, she consults Bethany Pray, Legal Director at Colorado Center on Law and Policy, to help solve it.

“The lawyers at CCLP – they have the status, they have the title, they have the vast knowledge and the Department listens to them,” Chris explains.

Correcting immigration misconceptions
Recently, Chris worked on two cases involving families with children who had severe disabilities. Each of the families qualified for Medicaid waivers but were being denied based on citizenship — despite having legal status in the U.S. “Both families were here on some kind of a work visa,” Chris says. “There were two separate counties involved and in neither case did the county acknowledge that that the children should be able to get on Medicaid.”

Chris continues, “there was actually a lot of conflicting information in various documents that [the Colorado Department of] Health Care Policy and Financing [or HCPF] put out, that the counties put out, and when I would call [the county human services offices and single entry point case management agencies]  just to research this—whether immigrant children could access Medicaid… One-hundred percent of them said no… Basically, what I found out was that when a misconception gets started people just repeat the misconception until it virtually becomes the law. It’s not the law — it’s wrong — but it gets disseminated so widely that everybody believes it’s true. So, the counties don’t believe that these kids can get Medicaid, [and] that’s what they tell the case managers.”

Thanks to CCLP’s legal advocacy efforts, both children’s families were rightfully able to access Medicaid and Department application language was changed to ensure that people without Social Security Numbers were not inappropriately screened out. According to Chris, “Even though those were individual cases, they manifested in a change…and a better understanding of what was true and what wasn’t true across all the counties… That’s an example of a situation where one individual’s miserable situation manifested in correction of an entire policy that affects many, many people.”

Fighting unlawful process changes
It is common for the problems that Chris identifies within Medicaid to be systemic and affect a very large number of families. Last year, Chris noticed a particularly widespread problem among children who applied to receive home nursing services: “Out of the children that we had previously gotten 100 percent approval on, about 40 percent of those children got denied suddenly,” Chris says. “And so that precipitated panic, big panic on my part because there’s so many children that we see in that boat.”

These denials were due to a sudden change in the way children’s eligibility for services was being considered by the group that oversees the authorization process for Certified Nurse Aide (CNA) and private duty nursing services.

Chris continues, “So I went through, I interviewed each of those people and set them up for hearings at the administrative law court… If I ever had a question, then I could ask Bethany the answer to the question.” For Chris, Bethany was a valuable resource for providing options on how to proceed.

At the same time, CCLP found that the notices families had received were lacking vital information. The constitution guarantees people due process — specifically notice and a hearing — before they lose a benefit or service. Successfully arguing that services could not be denied without due process, CCLP worked to get benefits restored to all children who had gotten the flawed notices.  Then, with help from Colorado Legal Services, CCLP resolved legal hearings for many of the children who had appealed.

This was a tremendous win for families who would have otherwise been denied services. However, each family has only been temporarily approved until Sept. 30, 2020.

Chris explains how the re-approval process this year will be much more challenging: “Now they corrected those [procedural] errors…We’re going to have to go to court and argue that clinical merits of the case…It’s going to be very challenging, and I’m not looking forward to it, but honestly none of these things would have happened – in terms of any defense of these families, defense of these children, in terms of their care and in the services that have been denied — I  don’t think it would have happened without CCLP.”

The Medicaid system saves lives every day but is far from perfect. Eligibility requirements, approvals, and enrollment can often be incredibly confusing and challenging to navigate. Continued advocacy from individuals like Chris and organizations like CCLP is crucial not only for ensuring that Coloradans receive the coverage they deserve, but also for holding actors within the Medicaid system accountable for adhering to the law.

“It makes you feel extremely good to be able to help somebody,” Chris says. “It’s just such a painful situation to have a child and know that they need something to flourish medically and they can’t get it for some unfair reason, from a mistake or misunderstanding, or the parents just don’t have the knowledge to navigate this incredibly complex Medicaid system, or whatever the reason is… I absolutely couldn’t possibly be more grateful for my job — it’s the best job in the whole wide world. But my job is made a whole lot better by the fact that if I have a legal question, CCLP always knows the answer.”

-By Andra Metcalfe

Recent articles

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.

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.

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.