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News

Mar 22, 2018

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Allison Neswood previously served as CCLP's Deputy Director of Strategic Priorities. She is an expert in public health insurance plans (Medicaid and CHP+), Aid to the Needy Disabled, immigrant access to services and health equity.

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Medicaid work requirements advance a harmful narrative

by | Mar 22, 2018

Health, Legislative Updates

Man holding blue helmet close up
Man holding blue helmet close up

Our state’s Medicaid program, Health First Colorado, is an investment in the health of our communities. The program exists to ensure that poverty is not a barrier to the health care services that Coloradans need to concentrate in school, excel in the workplace, and take care of themselves and their families.

Introduced earlier this week, Senate Bill 214 would undermine Health First Colorado’s mission by requiring program administrators to divert significant time and resources to tracking the job status of enrollees, and cutting our neighbors off the program if they are unable to comply with the reporting requirements or find a job. The price tag of SB 214 alone should compel us to reject this harsh, potentially harmful and costly legislation. Implementing similar requirements in Kentucky is expected to cost close to $374 million over the next two years.

But the even bigger problem here is the assertion that this type of legislation makes about Coloradans living in poverty. The monitoring SB 214 envisions is based on the flawed assumption that poor people will not work unless they are forced to work. But findings from Colorado Department of Health Policy and Financing (HCPF) indicate that 75 percent of Medicaid adults already have a job. In reality, those who live below the poverty line in our state work hard to support themselves and their families — often working multiple jobs while earning wages that are insufficient to put food on the table, cover rent and utilities, and pay for doctor’s visits without public support.

Non-working Coloradans living below the poverty line find themselves in challenging circumstances because they are living with a mental or physical disability, struggle with addiction, have a criminal record or face other substantial barriers to employment that work requirements do not address. The loss of health care coverage will only exacerbate these setbacks.

Moreover, poverty is many times more likely to create barriers for those that experience racism and other forms of oppression in our society. The inability to get by in Colorado is not only the result of insufficient resources but is also the result of systemic oppression of people of color, people with non-conforming gender identities, people that live in poorly resourced neighborhoods, and people that live in the rural regions of our state. Undermining a critical safety-net program like Health First Colorado will hurt these populations most, and by causing that harm, will undermine the strength of our entire state.

While voluntary work support programs have been successful in helping benefit recipients secure and maintain employment, conditioning public support on employment has not worked in other states in the past, nor will it work in Colorado in the future. In a study done in Ohio, 52 percent of employed Medicaid recipients reported that Medicaid coverage made it easier for them to continue working. If the goal is to get people back to work, the state should give Coloradans the skills they need to get a job, not penalize them for their inability to work, as Laurie Harvey, the retiring President and CEO of the Colorado Center for Work Education and Employment (CWEE) explained in this recent commentary.

CCLP joins its partners, including health care providers, patient groups, and advocates for people with disabilities in strongly opposing SB 214. Scheduled to be heard by the Senate Health & Human Services Committee on Thursday, March 29, the bill is a thinly veiled attack on the Medicaid program that comes just months after Congress repeatedly rejected the Trump administration’s efforts to cap and deeply cut Medicaid. We call on all Coloradans to voice their opposition.

– By Allison Neswood

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CCLP’s legislative watch for April 5, 2024

Apr 5, 2024

For the 2024 legislative session, CCLP is keeping its eye on bills focused on expanding access to justice, removing administrative burden, preserving affordable communities, advocating for progressive tax and wage policies, and reducing health care costs.

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.