Mar 6, 2017

Bethany Pray serves as CCLP's Chief Legal and Policy Officer. 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 ›

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.

Proposed rule could lock Coloradans out of coverage

by | Mar 6, 2017

Health care is, indeed, complicated. On top of the changes to the ACA now brewing at the House of Representatives, a lengthy proposed federal rule would create a whole host of obstacles to enrollment, beginning later this year. Provisions of the rule may look like mere technicalities, but could decimate enrollment unless people speak up. We’ve explained the basics below:

Proposed Health and Human Services rules released in early February and open to public comment just through March 7 have the stated goal of market stabilization, and may even help insurers’ bottom lines. However, they are likely to result in lower enrollment, higher out-of-pocket costs for consumers, smaller premium tax credits, and significant burdens on state systems. Affordability will worsen, particularly in the rural parts of the state where premiums are highest.

Some key provisions in the 70-page rule:

  • The proposed shortened open enrollment period would run from Nov. 1 to Dec.15, 2017 for the 2018 plan year. This will require moving 180,000 people through the enrollment process in half the time typically provided.
  • Connect for Health uses the Medicaid system’s Colorado Benefit Management System (CBMS) to determine applicants’ eligibility for federal assistance, so an overloaded system would affect not just those seeking premium tax credits, but also Health First Colorado and CHP+ enrollees. The result could be widespread delays, customer service problems, and higher IT costs.
  • The shorter window may result in lower enrollment by younger and healthier Coloradans, since that group often enrolls late, while those with greater health needs typically enroll earlier.
  • The actuarial value (AV) of metal-level plans will be able to dip lower, meaning that a 2018 plan would be termed “silver” but provide less coverage than a 2017 silver plan. The same goes for gold and bronze plans. That means that deductibles and cost-sharing will rise. Customers should expect higher out-of-pocket costs, with some estimating that silver-plan households could pay an additional $1,000 per year.
  • If a lower AV range is approved and silver plans accordingly become skimpier, the amount of advance premium tax assistance (APTC) could be reduced.
  • The rule could require that customers provide additional documentation if they enroll through a Special Enrollment Period (SEP). Colorado may not be required to make this change immediately, if state exchanges are given leeway to implement this aspect of the rule.
  • Other provisions might require that applicants demonstrate continuity of coverage in order to enroll in a SEP, or to get coverage for pre-existing conditions, and would allow applicants to be rejected if they failed to pay premiums in the past. Because billing errors are common, this provision could be an obstacle for many applicants.
  • Life-change events that allow SEPs – like marriage, the birth of a child, a move – are common for younger Coloradans. If obstacles to enrollment deter those healthier people, risk pools will worsen and premium costs will rise.
  • Regulation of networks, meaning the providers and facilities included in a plan, could be weakened in many states. Colorado is likely to be able to retain authority over network adequacy requirements, thanks to the extensive work done by the state’s Division of Insurance in 2016 to set standards around provider networks.
  • And though the rules, if finalized, may very well result in additional costs to Colorado, it appears that no federal money will be provided to assist with the changes.

Rarely do regulations impose such an abbreviated timeline for comment and implementation. If finalized, the additional time given to carriers to design and submit plans will result in curtailed schedules for our Division of Insurance and state exchange, with less time allowed for evaluating, adjusting, and loading plans on to the exchange system. These are time-intensive, technical tasks, and not easily rushed.

Measures like these don’t make the ACA work more smoothly. Instead, they undermine it, by creating barriers to enrollment. Coupled with the existing order that will  minimize enforcement of the individual mandate, these rules, if finalized, will result in a shrinking risk pool that includes fewer healthy people. That means higher prices for those who want to retain coverage.

The ACA has provided Colorado with access to health care for all but 6 percent of residents. Let’s keep them covered and reject these new regulations.

 – Bethany Pray

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.


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.