Jun 22, 2018

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National group honors CCLP’s health care heroine

by | Jun 22, 2018

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

Recent articles

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.