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News

Dec 8, 2023

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As a CCLP policy fellow, Milena helps organize and coordinate public policy development, assisting in coalition-building, community outreach, legislation, litigation, and administrative advocacy.

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On the ground: From social work to healthcare advocacy

by | Dec 8, 2023

COVID-19, Health, Lived Experience

For a long time, I was certain social work was my calling. I believed that no other work would be as fulfilling, that this was where I could make the most difference. Certainly, the need was great, and I knew I wasn’t choosing an easy career path, but I was determined to help people through some of the hardest life challenges. 

Right out of my bachelor’s degree program I obtained employment as a case manager for a non-profit behavioral health provider in Arapahoe and Douglas counties. I assisted individuals stepping down from inpatient levels of care to outpatient services. I worked with clients to get them connected to appointments, behavioral health services, housing vouchers, food stamps, Medicaid/Medicare, social security, and so much more, ensuring individual stability and helping them reach their goals for self-sufficiency. 

Helping people of all ages, from four years old to 98, filled my cup. This is what I felt I was destined to do. 

Then came the COVID-19 pandemic. 

The virus brought a public mental health crisis of a scale never seen in modern history. It also brought new policies, new technologies, new ways of doing things. Telemedicine was supposed to solve for some of the issues. But it didn’t always work. It was brand new for most of our agency. Trying to reach clients who did not have internet access or phones proved nearly impossible, and necessitated going home to home after all, in the midst of a dangerous public health emergency. But the needs were great, and growing day by day. Caseloads increased. Appointments had to be booked further and further out, even months apart. 

For a typical case manager in the social work field, the maximum caseload one can reasonably manage works out to no more than 75 clients. Beyond that point, the quality of care suffers, availability diminishes, and social workers themselves begin to burn out. By the time I reached my two-year anniversary at the agency, my caseload was 148 clients. 

Social worker turnover has always been high; though it is meaningful, important work, it’s also incredibly difficult and emotionally taxing. And for a line of work requiring a bachelor’s degree education at minimum, the pay is shockingly low, insufficient to cover basic necessities, let alone pay back expensive student loans. For my part, I realized I could not help others when I could not help myself. Despite long hours, I couldn’t pay my bills. I felt my own mental health disintegrating. And so, I left the agency to do indirect care at a behavioral health hospital. I went from a non-profit to a for-profit organization in order to be paid a living wage. I still wanted to help, but knew I needed something different. 

I thought that my social work training would be more effective in an inpatient setting, where I would be able to get to the root causes and help in crisis situations. But if anything, the systemic problems I saw in this environment were even worse than what I saw at the agency. I encountered patients trying to show they were “suicidal enough” to be approved by Medicaid in order to access inpatient level of care, only to then be denied coverage because they had a “criminal” history. To the system I witnessed, it didn’t matter that the patient needed care, that the patient wanted to live, that the patient wanted to thrive. All that mattered was what insurance, if any, they had. 

The failures were frustrating, outrageous, and incessant. I realized they couldn’t be addressed one patient at a time — certainly not in a system that so often refused to provide care to those who needed it. That was when I realized that systemic issues required systemic solutions. With my MSW in tow, I knew where I was supposed to go next: into policy. 

Shifting to policy work, and coming to CCLP in particular, has given me the opportunity to take what I know is happening on the ground, and to use my knowledge to advocate for those patients I couldn’t help in the field. Today, I’m working alongside colleagues at CCLP and around the state to decrease disparities and increase access for behavioral health services across Colorado. 

This is only the beginning of my engagement in healthcare policy. I know maneuvering through the behavioral health system is an ongoing battle for so many Coloradans. I learned so much through the challenges of my direct care experience. But I have only begun to learn how the system really works as a whole, and how much the on-the-ground reality truly differs from how the systems were designed and intended to work. My direct care service work provided me insight into how our systems currently work, and where the gaps in care and equity are. 

At CCLP, we’ve been examining just how state laws and regulations compare to individual and family experiences with accessing behavioral health services. Understanding the nature of the problems gives us the best opportunity to make policy changes to improve access and outcomes for Coloradans. Stay tuned for the next entry in this series, where I’ll share some of the findings of that work.

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Recent articles

CCLP testifies in support of TANF grant rule change

Apr 15, 2024

CCLP's Emeritus Advisor, Chaer Robert, provided written testimony in support of the CDHS rule on the COLA increase for TANF recipients. If the rule is adopted, the cost of living increase would go into effect on July 1, 2024.

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.