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Jun 22, 2018

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Recent articles

National group honors CCLP’s health care heroine

by | Jun 22, 2018

Development and Promotion, Health

Elisabeth (center) stands with foundation members at the award ceremony in Chicago, Il.

Relentless. Definitive. Unparalleled.

Those are just a few adjectives that colleagues have used to describe Elisabeth Arenales, now Director of Colorado Center on Law and Policy’s Health Care Program.

On June 22, Grantmakers In Health honored Elisabeth’s work in health care policy with the prestigious Andy Hyman Award for Advocacy during its annual conference on health philanthropy in Chicago. She was nominated by representatives from the Colorado Health Foundation, The Colorado Trust, Rose Community Foundation and Caring for Colorado Foundation. You can read her acceptance speech here.

Starting in the nonprofit world as a teenager, Elisabeth’s focus sharpened on public health insurance and statewide implementation of the Affordable Care Act over the past two decades.

Having grown up overseas as the child of a foreign-service officer, she has spent time all over the world, including Tehran, Brazil, and the Dominican Republic.

Elisabeth’s induction into the nonprofit world began with the Clean Water Action Project in Washington, D.C. when she was just 19. She spent months knocking on doors — a job that started out as a summer commitment but extended to her taking time off from undergraduate studies. Her grassroots work extended to a two-year stint at Greenpeace in Denver, where she educated younger generations of children on environmental issues.

“In retrospect, environmental justice wasn’t really a concept at the time,” she reminisces. Nonetheless, she organized boycotts around whaling issues and protests of toxic-waste depositories, among other campaigns.

She developed a long-lasting love of Colorado, grounded in both its physical beauty and vibrant policy environment. “Colorado’s community is an endlessly interesting place to work on public policy issues… We really have been at the cutting edge of a big range of issues, both progressive and conservative.”

Career-wise, her interest in policy solutions for vulnerable populations didn’t begin until after client work with the Boulder County Probation Department as the only Spanish-speaking probation officer.

“I was overwhelmed by how challenged people were with respect in their interactions with the justice system,” she recalls. “They didn’t understand what was happening to them, and it was so difficult for them to navigate their environment.” These interactions persuaded her that she wanted to devote her life and education on the root causes of social problems and how to address them.

After working in Boulder County, she attended the University of Colorado to earn her law degree. Shortly afterwards, she joined the Colorado Lawyers Committee to work on rural education projects, traveling around communities in the San Luis Valley, the Four Corners region and the Eastern Plains. Her work was focused on reaching agreements with a multitude of relevant players on how people could get equal access to education.

“I was amazed by people that I worked with who were able to accomplish so much and be leaders in their communities despite or because of all the challenges they were facing in their own lives,” she says. “I developed a deep and lifelong appreciation for the people I worked with during this time.”

Over three years of at least monthly visits, Elisabeth became intimately acquainted with the problems that faced these communities every day. For example, “In Durango, folks literally lived on the wrong side of the tracks. Smoke from the Silverton-Durango train caused many asthma cases on the side where the smoke blew, which just happened to be the area where predominantly low-income people of color lived,” she remembers.

Elisabeth also had the opportunity to work for eight years on historic land rights litigation in the San Luis Valley. The case had to do with the rights of property owners in and around Colorado’s San Luis Valley to make traditional uses of land that had originally been part of a Mexican land grant. She formed bonds with community members and her fellow pro-bono lawyers. “I got to be a part of a community that outsiders generally didn’t have access to. We were supported by the community. A local priest once held a mass for the lawyers on the case right before our first trial.”

By the time Elisabeth arrived at the doors of CCLP in 1999, years of experience working on a range of issues and with diverse communities had pushed Elisabeth’s interests more towards working on access to education. However, she was asked to fill in temporarily on the organization’s health care program.

“What I learned pretty quickly is that there was a similarity between different kinds of social justice work – you work with great people; the issues are complex and range from detail orientated administrative work to ground breaking constitutional issues,” she said. “Health care was fascinating and there was so much room for change.”

The serendipitous career move officially ushered Elisabeth’s journey on to the health care policy track that would guide her career for the next two decades. From her previous work, Elisabeth knew a lot about putting together an organization and how to build capacity to do policy work. She helped to found the Colorado Consumer Health Initiative in 2000, just one year after beginning at CCLP. Elisabeth remained as a board chair for CCHI’s first seven years. Today, CCHI is regarded as one of the most influential health care advocacy organizations in Colorado, and has been involved with, among other issues, the implementation of the Affordable Care Act, controlling insurance costs, and affordable hospital care.

Over the years, Elisabeth has played a major role in some of the most significant health policy milestones in Colorado. Many of these highlights are captured in CCLP’s history; from ensuring that community assets from nonprofit health care conversions remain in the community to ensuring that the tenets of the Affordable Care Act were effectively implemented.

In the words of CCLP’s Executive Director Claire Levy, “Elisabeth is known for always including the populations on whose behalf CCLP works in her efforts to change the system. She consistently asks the important questions about how policy changes will enhance or diminish equity and access to health care.”

When asked about her proudest accomplishment at CCLP was, Elisabeth cites her work following the 2004 General Assembly’s vote to cut certain lawfully present immigrants from Medicaid.

“We did lots of on-the-ground work, from working with the ACLU, to locating legal resources and potential plaintiffs, to hearing the stories of affected people.” Some of these people were Holocaust survivors with concentration camp tattoos living at a Jewish Family Services facility in Denver. In Elisabeth’s words, these people were “as brokenhearted as you could be that the country that had offered them protection was stripping them of medical care based on who they were.”

Although Elisabeth and her team did not prevail in court, these people did not lose access to health coverage during the litigation. Ultimately, the state provided funding for their Medicaid coverage as part of a tobacco tax increase.

Elisabeth also was on the frontlines of CCLP when the Colorado Benefits Management System (CBMS) failed to make timely, accurate determinations of eligibility for public benefits – leaving tens of thousands of people without access to health care, medications, cash assistance and food.

“One time I was on the phone with a client who had lost her food stamps,” she recalls. “I could imagine her so clearly as she spoke — she was in her kitchen – with three cans of food left in her cupboard and three children to feed. She didn’t know where she was going to get their next meal… Things like that keep me going, there are always problems, and you can’t always fix them, but you can often make a difference.”

Elisabeth’s work over the years has earned her a multitude of awards. Among them, she is a recipient of the Robert Wood Johnson Foundation Community Health Leader award and a recipient of the Colorado Health Foundation’s John K. Iglehart Award for Leadership in Health Policy. Elisabeth has also received awards from the Colorado Bar Association, the Colorado Hispanic Bar Association, the Colorado Lawyers Committee and the University of Colorado School of Law. Among her community awards are: Land Rights Council of San Luis (Special Award for Lobato v. Taylor Team) and the Colorado Cross Disability Coalition’s ADA Access Award.

As the longest-serving employee of CCLP, Elisabeth understands better than most that change takes time. Yet a guiding principle of hers is that everything is connected. “Our system is interwoven, and you have to understand how pushing one lever impacts the entire system. You must think about the broad design of what you’re doing vs. focusing on one narrow issue.”

This understanding of systems informs her coalition work as well. As Claire Levy says, “Elisabeth is nothing if not humble. She is a consummate collaborator and knows that no one has a monopoly on knowledge. She refuses to take sole credit for success and insists on sharing credit and applause.”

– Duranya Freeman

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Recent articles

HEALTH:
HEALTH FIRST COLORADO (MEDICAID)

Health First Colorado is the name given to Colorado’s Medicaid program. Medicaid provides public, low-cost health insurance to qualifying adults and children. It is an entitlement program funded by the federal, state, and county governments and is administered by counties in Colorado. Those who are required to pay must pay a small co-pay when receiving certain health care services.

State Department: Department of Health Care Policy and Financing

Eligibility: Most adults 18 to 64 are eligible for Medicaid in Colorado if their household income is at or below 133% of the federal poverty limit (FPL). Pregnant women are eligible with incomes of up to 195% FPL, while children under 18 may be eligible if the live in a household with income at or below 142% FPL. Some adults over 65 may also be eligible for Medicaid.

Program Benefits: Through Medicaid, low-income Coloradans are eligible for a range of health care services at little to not cost. Services provided include doctors visits, prescription drugs, mental health services, and dental care. Co-pays for certain individuals may be needed for certain services.

Program Funding and Access: Colorado funds our Medicaid program through state and federal dollars. Medicaid is an entitlement program, which means that all who are eligible for Medicaid can access the program, regardless of the funding level in a given year. This does not mean that it is always easy to access Medicaid, even when eligible. And since the program is administered by counties, funding levels for county staff and other administrative roles can make it easier or harder for Coloradans to access the program. On top of this, not all medical providers accept Medicaid which limits the ability of Coloradans to seek health services even if enrolled, such as if the nearest provider is a 2+ hour drive away.

Note: This data is from before the pandemic and does not reflect changes in enrollment rules during the COVID-19 pandemic and public health emergency.

Statewide Program Access 2015-19: Over the study period of this report, an average of 89.0% of the population at or below 133% of FPL (i.e., the population who is likely to be eligible for Medicaid) were enrolled in Medicaid in Colorado.

FOOD SECURITY:
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)

The Supplemental Nutrition Assistance Program or SNAP helps low-income Coloradans purchase food by providing individuals and families with a monthly cash benefit that can be used to buy certain foods. SNAP is an entitlement program that is funded by the federal and state governments and administered by counties in Colorado.

State Department: Department of Human Services

Eligibility: Currently, Coloradans qualify for SNAP if they have incomes below 200% FPL, are unemployed or work part-time or receive other forms of assistance such as TANF, among other eligibility criteria. Income eligibility for SNAP was different during the study period of this report than today—it was 130% FPL back in 2019 for example. The US Department of Agriculture uses the population at or below 125% FPL when calculating the Program Access Index (or PAI) for SNAP. We follow this practice in our analysis despite Colorado currently having a higher income eligibility threshold.

Program Benefits: SNAP participants receive a monthly SNAP benefit that is determined by the number of people in their household and their income. Benefit amounts decrease as income increases, helping households avoid a sudden loss of SNAP when their incomes increase, even by a minor amount. Benefits are provided to an Electronic Benefit Transfer (EBT) card that can be used to purchase eligible food items, such as fruits and vegetables; meat, poultry, and fish; dairy products; and breads and cereals. Other items, such as foods that are hot at their point of sale, are not allowable purchases under current SNAP rules.

Program Funding and Access: SNAP, like Medicaid, is a federal entitlement program. This means that Colorado must serve any Coloradan who is eligible for the program. As such, funding should not be a limit to how many Coloradans can be served by the program. However, funding for administration of SNAP at the state and county level can limit the ability of county human service departments to enroll those who are eligible. Other program rules and administrative barriers can make it difficult for Coloradans to receive the benefits they are legally entitled to receive.

Statewide Program Access 2015-19: Over the study period of this report, an average of 61.1% of the population at or below 125% of FPL (i.e., the population who is likely to be eligible for SNAP) were enrolled.

FOOD SECURITY:
SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC)

The Special Supplemental Nutrition Program for Women, Infants, and Children, also know as WIC, provides healthcare and nutritional support to low-income Coloradans who are pregnant, recently pregnant, breastfeeding, and to children under 5 who are nutritionally at risk based on a nutrition assessment.

State Department: Department of Public Health and Environment

Eligibility: To participate in WIC you must be pregnant, pregnant in the last six months, breastfeeding a baby under 1 year of age, or a child under the age of 5. Coloradans do not need to be U.S. citizens to be eligible for WIC. In terms of income, households cannot have incomes that exceed 185% FPL. Families who are enrolled in SNAP, TANF, Food Distribution Program on Indian Reservations (FDPIR), or Medicaid are automatically eligible for WIC. Regardless of gender, any parents, foster parents, or caregivers are able to apply for and use WIC services for eligible children.

Program Benefits: WIC provides a range of services to young children and their parents. These include funds to purchase healthy, fresh foods; breastfeeding support; personalized nutrition education and shopping tips; and referrals to health care and other services participants may be eligible for.

Program Funding and Access: WIC is funded by the US Department of Agriculture. The state uses these federal funds to contract with local providers, known as WIC Clinics. In most cases, these are county public health agencies, but that is not the case in all Colorado counties. Some WIC Clinics cover multiple counties, while others are served by multiple clinics. Private non-profit providers are also eligible to be selected as a WIC Clinic.

Statewide Program Access 2015-17: Between 2015 and 2017, an average of 52.2% of the population eligible for WIC were enrolled in the program in Colorado.

Financial Security:
Colorado Works

Colorado Works is the name given to Colorado’s program for Temporary Assistance to Needy Families or TANF. It is an employment program that supports families with dependent children on their path to self-sufficiency. Participants can receive cash assistance, schooling, workforce development and skills training depending on the services available in their county.

State Department: Department of Human Services

Eligibility: In general, Coloradans are eligible to enroll in TANF if they are a resident of Colorado, have one or more children under the age of 18 or pregnant, and have very low or no income. For example, to be eligible to receive a basic cash assistance grant through TANF, a single-parent of one child could not earn more than $331 per month, with some exclusions—and would only receive $440 per month (as of 2022). That said, there are other services provided by counties through TANF that those with incomes as high as $75,000 may be eligible for. In addition to these, participants in TANF are required to work or be pursuing an eligible “work activity” or work-related activity. Any eligible individual can only receive assistance if they have not previously been enrolled in TANF for a cumulative amount of time of more than 60 months—this is a lifetime limit that does not reset. Counties may have additional requirements and offer benefits that are not available in other counties in Colorado.

Program Benefits:  While the exact benefits that one is eligible for under TANF can vary, all qualified participants are eligible to receive a monthly cash payment, call basic cash assistance. Other than cash assistance, counties are have a lot of choice in how to use their TANF funding; generally a use of TANF funds is appropriate so long as it advances one or more of the four purposes of the program: (1) provide assistance to needy families so that children can be cared for in their own homes or in the homes of their relatives; (2) end the dependence of needy families on government benefits by promoting job preparation, work, and marriage; (3) prevent and reduce the incidence of out-of-wedlock pregnancies; and (4) encourage the formation and maintenance of two-parent families.

It is important to note that those eligible for TANF are also eligible for many of the other programs we’ve included in this report, such as SNAP, Medicaid, and CCCAP.

Program Funding and Access: Colorado funds its TANF program through funds received from the federal government through the Temporary Assistance for Needy Families block grant. Most of the federal funds are allocated by the state to counties, which are required to provide a 20% match of state funding. Federal and state rules allow the state and counties to retain a portion of unspent funds in a TANF reserve.

Statewide Program Access 2015-19: Over the study period of this report, an average of 50.7% of the population at or below 100% of FPL (i.e., the population who is likely to be eligible for TANF) were enrolled in TANF in Colorado.

EARLY LEARNING:
COLORADO CHILD CARE ASSISTANCE PROGRAM (CCCAP)

The Colorado Child Care Assistance Program provides child care assistance to low-income families and caregivers living in Colorado in the form of reduced payments for child care. It is a program funded by the federal, state, and county governments and is administered by counties in Colorado. The share owed by parents/caregivers is determined on a sliding scale based on the family’s income.

State Department: Department of Early Childhood Education

Eligibility: Counties set eligibility for families separately, but must serve families with incomes at or below 185% of the Federal Poverty Limit. Families accepted to the program are no longer eligible once their income exceeds 85% of the state median income. Parents or caregivers must be employed, searching for work, or engaged in another approved activity to be eligible for CCCAP. Parents and caregivers enrolled in Colorado Works (Temporary Assistance to Needy Families or TANF) or in the child welfare system are also eligible to participate in CCCAP. Generally, CCCAP serves families with children under 13, although children as old as 19 may be eligible under certain circumstances.

Program Benefits: If a family is eligible for CCCAP and has income, they may likely have to pay a portion of their child’s or children’s child care costs each month. The amount that families owe is based on their gross income, number of household members, and the number of children in child care in the household. As such, households tend not to experience a benefit cliff with CCCAP when they see their incomes increase

Program Funding and Access: Colorado funds the CCCAP program using federal dollars it receives from the Child Care and Development Block Grant program. The state allocates federal and state funds to counties using a formula that takes into account factors like current caseloads and the number of eligible residents. Assistance is available until the county’s funds are spent, so the number of families that can be served is often a function of how much funding is available and the income and composition of the household that applies. It is not uncommon for counties to overspend or underspend their allocations of funds. The state reallocates unspent funds from counties who underspent to those who overspent. While underspending could indicate a problem with the way a county administers its CCCAP program, it could just as likely be a sign that there are few providers in the county who participate in CCCAP—or a lack of providers generally.

Statewide Program Access 2015-19: Over the study period of this report, an average of 10.8% of the population at or below 165% of FPL and younger than age 13 (i.e., the population who is likely to be eligible for CCCAP) were enrolled in CCCAP.

Housing:
HUD rental assistance programs

The US Department of Housing and Urban Development (HUD) has three housing assistance programs that we look at together: Housing Choice Vouchers (Section 8), Project-based Section 8, and Public Housing. In Colorado, these programs provided assistance to over 90% of the households who received federal housing assistance from all HUD programs. Through federally funded, local or regional public housing agencies (PHAs) are the agencies that administer these programs, through not all are available in all counties. These are not the only programs available in Colorado that assist households afford the cost of housing, such as units funded through federal and state tax credit programs.

State Department: Department of Local Affairs

Eligibility: Generally, households with incomes under 50% of the area median income (AMI) of the county they live in are eligible for these rental assistance programs, although PHAs have discretion to select households with incomes at higher percentages of AMI. That said, HUD requires that 75% of new vouchers issued through the Housing Choice Voucher/Section 8 program in a given year are targeted to households with incomes at or below 30% of AMI. PHAs are also able to create criteria that give priority to certain types of households who are on waiting lists for these programs.

Program Benefits: These rental assistance programs help households afford the cost of housing by reducing their housing costs to around 30% of their household income. In the case of the Housing Choice Voucher program, the PHA pays the voucher holder’s landlord the remaining portion of the rent.

Program Funding and Access: Funding and access are both challenges for these rental assistance programs. In addition to limitations on the number of public housing units or housing vouchers a PHA can manage or issue, lack of funding compared to the need constrains the ability of PHAs to assist low-income households. In 2020, Coloradans were on waitlists for Housing Choice Vouchers for an average of 17 months. Waitlists also exist for the other rental assistance programs.

Statewide Program Access 2015-19: Over the study period of this report, an average of 21.1% of renter households with incomes at or below 50% AMI (i.e., the population who is likely to be eligible for HUD rental assistance programs) were living in subsidized housing.