Aug 16, 2023

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A first look at the Medicaid unwind: August 2023

by | Aug 16, 2023

Katie Wallat, CCLP’s Senior Attorney, provided testimony at the August 11, 2023, meeting of the Medical Services Board. 

 

Good morning Mr. President and members of the board, 

My name is Katie Wallat and I’m an attorney at the Colorado Center on Law and Policy, a statewide anti-poverty nonprofit organization. I wanted to take a quick moment this morning to provide additional perspective on how the Medicaid unwind process is going. 

The Department has shared data on the first two months of the unwind process in public meetings, online, and to this board. This point-in-time data is often presented in comparison with what happened before the pandemic. However, while the pre-pandemic data provides a baseline, the state’s processing problems before 2020 were such that this is not a goal we think the department should be shooting for. The reported average rate of disenrollments for 2018-2019 was 40%, which is very high. We know that our Medicaid rolls did not dwindle by 40% each year before the pandemic, so many of these people must have been re-enrolled. This means that a large portion may have been terminated inappropriately or could not navigate the process of remaining enrolled. We know that we all have a shared goal of making sure this happens as little as possible.  

I’d like to revisit the data for the past two months of renewals—by the end of June, a staggering 112,792 people have been disenrolled from Medicaid, which represents 45.7% of all of the people who were up for renewal. We know from our conversations in the community that this number includes not just those in the income-based categories, but many people with disabilities who rely on daily services to remain at home and in the community. 

Unfortunately, Colorado is not doing very well relative to other states so far. A nonpartisan, independent source of health policy research called KFF, formerly the Kaiser Family Foundation, has been tracking each state’s reported data and providing comparisons. Colorado has the 15th highest rate of disenrollments in the nation. So, 35 other states, plus the District of Columbia, have had a lower rate of disenrollments during these first two months of the unwind.  

 

Another important data point is the rate of what are called procedural disenrollments, which are distinct from disenrollments for an eligibility reason, where the state has sufficient information to determine that the person is ineligible. Procedural disenrollments, on the other hand, are those where the state terminates enrollment because it lacks sufficient information—either because they didn’t get a renewal packet back or information was missing—or because the county was unable to process the information received by the deadline. We have heard that many counties are currently overwhelmed with a backlog of applications and renewal packets. 

In May alone, 50,253 people were disenrolled from Medicaid. The data from the Department show that 62% of them, or 31,000, were disenrolled for procedural reasons. In June, nearly half of the people who were up for renewal, or 62,539 people, were disenrolled. Of these, nearly 44,000, or 70% of them, were disenrolled for procedural reasons. We’re not drawing conclusions about trends from just two months of data, but we are frankly distressed about what this means for the 75,000 Coloradans with procedural denials over just the first two months of the unwind process. The Centers for Medicare and Medicaid Services has also expressed concerns about that rate in a letter to the state that was publicly posted yesterday. 

 

CCLP is among the community organizations that have been contacted on a near-daily basis by families who have been disenrolled.  I want to paint a picture of some of these individuals that the data are describing.   

Thanks to the outreach that the department and case management agencies have undertaken to spread the word about the unwind, one family we’re in contact with was aware of the upcoming need to fill out the renewal paperwork for their disabled child, but report that they never received a renewal packet in the mail. Instead, the family went to the county office in person, to fill out their packet before their renewal deadline. Despite their vigilance, the paperwork was not processed in time by the county and the child’s Medicaid was terminated. As a result, the family was unable to get the G-tube supplies needed and had to pause therapy appointments until the child was reinstated. According to the data, this person would have been considered one of the people who were procedurally disenrolled because of a failure to complete the renewal packet.   

Another child has been on Medicaid for 8 years. The parents also reported not receiving a renewal packet, but they did receive a letter asking for additional information. She submitted that information before the deadline and confirmed by phone with the county that it had been received. But because the information was not processed in time, her child was disenrolled from Medicaid, for the procedural reason of “failing to provide verification.” A major surgery had to be put on hold because of this.  

More terminations are pending, and advocates are scrambling to prevent them from taking place. One parent has learned that her infant, born prematurely and dependent on oxygen, will lose Medicaid at the end of the month. She has been told that the county will be unable to process his application before the renewal deadline—meaning that he, too, will be counted among those who “failed to complete the renewal process” when data is tabulated, unless advocates can help her stop that from happening. 

 

I could share a dozen more stories, and other community members could as well. Our goal in sharing these stories is to give a more nuanced perspective of what these categories can and do mean for real families. We recognize how hard the Department is working to conduct what can only be described as a herculean task, which is complicated by having to work with eligibility staff in 64 different counties. 

HCPF has been responsive to resolve individual cases that we and others bring to them. But for every case we hear of, we know there are many times as many people terminated in the last three months who don’t know who to call. We have had promising conversations with the Department about working together to fix some of these problems but want to emphasize that fixing these issues may call for fundamental changes to how eligibility applications are processed. We know that good communication channels, hands-on assistance with renewal packets, and timely processing can help keep procedural disenrollments to a minimum. We thank the Department for their ongoing partnership and will continue to share information with this board, as the unwind continues. Thank you for your time and attention.

 

Sincerely,

Katherine Wallat

Senior Attorney

Colorado Center on Law and Policy

 

Click here to learn more about the Public Health Emergency (PHE) Unwind, including a Medicaid survey, guides, webinar, and more.

Recent articles

CCLP’s 2024 legislative wrap-up, part 2

CCLP's 2024 legislative wrap-up focused on expanding access to justice, removing administrative burden, supporting progressive tax and wage policies, preserving affordable communities, and reducing health care costs. Part 2/2.

CCLP’s 2024 legislative wrap-up, part 1

CCLP's 2024 legislative wrap-up focused on expanding access to justice, removing administrative burden, supporting progressive tax and wage policies, preserving affordable communities, 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.