Nov 2, 2022

Bethany Pray currently serves as CCLP's Deputy Director. Her areas of expertise include regulatory analysis and advocacy for Medicaid and commercial coverage, access to behavioral health benefits, Medicaid eligibility and much more.Staff page ›

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November Letter from Bethany Pray, Interim Executive Director

by | Nov 2, 2022

Last month I wrote about CCLP’s engagement along the full spectrum of advocacy, from community engagement to policy creation, from implementation to enforcement.

My mind, today, is on community engagement and how that connects to the rest of the cycle. I sat down this week for lunch with a colleague and advocate, a leader of an organization that works directly with people in communities around the Front Range. They organize and build power, have direct conversations that help build consensus around where change is needed, and provide people with the information and tools they need to step into the policy sphere and be heard. It was inspiring.

The nature of policy work necessarily involves a great deal of time in meetings with policy makers and staff of state departments. This work can often feel a step removed from the individual Coloradans whose kids could benefit from a healthy school meal, who find ballot measures inscrutable, or who can’t find a provider who can communicate in their language. But what we do in those meetings intersects with my friend’s work in powerful ways. And of course the policymakers in the meetings we attend are making decisions every day that directly affect those Coloradans.

Since I started at CCLP in 2014, we have worked hard to grow our engagement with community members and with grass-roots organizations, like the one my friend leads. This past year, when we were contacted about the struggle of families to find bilingual behavioral health providers, we spoke directly with Spanish-speaking parents who were open to sharing their experience. We went with those parents through the slow — and only somewhat successful — bureaucratic steps to connect their child to Medicaid-guaranteed services.

That journey led us to connect with other community groups — both those that provide translation for medical services and providers who struggle to provide optimal care to people with limited English proficiency. Through their struggles we discovered a world where reimbursement is limited or non-existent for interpretation. And because we have staff with legal training, we began to analyze whether Colorado Medicaid and other federally-funded entities were falling short in providing language access. (The Affordable Care Act’s Section 1557 lays out those requirements. Proposed federal rules that are now under consideration are likely to clarify that obligation.) Armed with that information, we have begun brainstorming solutions with staff of Colorado’s Medicaid agency. We will then re-engage the community groups to share what we’ve learned and to ensure that the output of that collaboration continues to align with the needs of those most impacted.

Over two decades of policy work, CCLP has had access to power that many community members don’t enjoy. While we have strived to directly support issues that arise from community work, I left that lunch thinking about how we can simultaneously improve how we share that access itself more effectively with community, too. That can range from sharing emails and meeting invites, to providing training on how to influence rulemaking, to expanding community voice in the advisory boards or committees that we attend. Things are changing. It’s hard; it requires creativity. But it’s going to be amazing.

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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.