Nov 6, 2019

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NEWS ALERT: Analysis examines decline in Medicaid, CHP+ enrollment

Over 1.2 million Coloradans rely on Medicaid or Child Health Plan Plus (CHP+) for comprehensive health services that foster child development, help adults maintain employment, deliver needed mental health and substance use treatments and keep people with disabilities in their communities.

Unfortunately, Colorado saw an 8 percent decline in Medicaid and CHP+ enrollment between March 2017 and March 2019, as national enrollment fell by more than 2.3 percent or 1.7 million participants. Falling unemployment does not explain the extent of the drop, and policy changes spurred by federal pressure are a more likely explanation.

A new analysis from Colorado Center on Law and Policy examines data on economic changes, as well as other factors contributing to the state’s enrollment decline. Among the findings:

Since 2017, federal policy changes on Medicaid determinations increased reporting and documentation burdens on enrollees, and on state agencies and county workers as well. When paperwork requirements increase, some will lose coverage despite meeting income and other requirements, especially those who have unstable housing or serious health conditions or disabilities.

Several states, including Colorado, have introduced policies that make it harder to stay enrolled. Since the peak enrollment in 2017, the state has begun requiring a response from more individuals at re-enrollment and terminating coverage when state mailings are returned to sender. The problem was documented in a recent report by Kaiser Health News.

Half of individuals with income below 200 percent FPL move in or out of Medicaid eligibility during the course of a year. Even though the state has aimed to improve retention by adopting policies that help Coloradans with fluctuating incomes enrolled — such as continuous enrollment for children and a mechanism to spread seasonal or commission income – more investigation is needed to determine whether systems are functioning as intended.

Even though proposed federal rule changes affecting immigrant Coloradans haven’t yet gone into effect, state and national partners report that eligible individuals are avoiding programs like Medicaid because they fear consequences to themselves or household members, related to their immigration status. Colorado agencies and county workers need to make it clear that immigrants are welcome to apply for these benefits, and that the state supports its residents in using available programs in their journey toward financial security.

“This analysis suggests that many former enrollees may have lost coverage despite their income-eligibility — a development that could have a long-lasting negative effect on public health and Colorado’s economy,” said Bethany Pray, Esq., Director of CCLP’s Health Program.

Developed by Pray, CCLP Health Attorney Allison Neswood, Esq. and CCLP Research and Policy Analyst Charlie Brennan, the 14-page analysis is available on CCLP’s website.

For more information, contact Bob Mook, CCLP’s Director of Communications at or at 303-573-5669, ext. 311.

Founded in 1998, Colorado Center on Law and Policy is a nonprofit research, legislative and legal advocacy organization committed to promoting racial equity and economic security for Coloradans facing poverty. Learn more at

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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.