Apr 22, 2016

Allison Neswood previously served as CCLP's Deputy Director of Strategic Priorities. She is an expert in public health insurance plans (Medicaid and CHP+), Aid to the Needy Disabled, immigrant access to services and health equity.

Recent articles

CCLP testifies in support of TANF grant rule change

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

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.

Provider-fee enterprise would relieve state budget problems

by | Apr 22, 2016

Critical programs and services in Colorado perennially face cuts even in times of prosperity because of the budgetary constraints under the amendment known as Taxpayers Bill of Rights (or TABOR). This paradox is inadvertently exacerbated by the hospital provider fee established by lawmakers. The fee was created in 2009 to let Colorado’s Medicaid program draw matching federal dollars to fund health services for indigent patients and to expand Medicaid programs to better meet the needs of vulnerable Coloradans.

Due in part to the economic recovery, Colorado last year collected revenues that exceeded TABOR’s spending limits triggering, tax rebate. The rub is that while the state is issuing tax rebates, budget shortfalls are forcing the state legislature to cut government programs and under-fund priorities like K-12 education and transportation in order to balance the budget.

To rectify this situation, lawmakers introduced legislation in 2015 that would create a state enterprise to collect and administer the fee –exempting the revenue from TABOR’s spending limits. The legislation failed late in the 2015 session, amid concerns about whether it complied with the state constitution. Still, the idea of creating an enterprise was widely discussed in the months before the 2016 session convened.

With the end of the 2016 legislative session approaching and Colorado’s Attorney General affirming that such a move would be legal, House Speaker Dickey Lee Hullinghorst, D-Boulder and Sen. Larry Crowder, R-Alamosa, re-opened the enterprise discussion with House Bill 1420, which is currently working through the Colorado legislature.

CCLP strongly supports HB 1420 because it will eliminate the pressure to reduce the hospital provider fee to avoid refunds that harm services paid for by the general fund. The hospital provider fee allows Colorado to increase hospital reimbursements for care provided to Medicaid and indigent clients; increase the number of insured Coloradans by funding the Medicaid expansions; and improve the quality of care for Medicaid clients by incentivizing hospitals to make quality improvements. Increased funding in these areas as a result of the hospital provider fee greatly improves access to care for low-income Coloradans and reduces the need among hospitals to shift the cost of uncompensated care to other payers.

Due to this year’s budget constraints, Gov. John Hickenlooper proposed a $73 million cut to the hospital provider fee that was incorporated into the state budget. Such a cut will result in Colorado foregoing $73 million in federal matching funds for Medicaid and indigent care. Under HB 1420, such cuts might not be necessary in future years.

In addition, HB 1420 will allow greater General Fund expenditures for important government priorities. The Colorado Constitution limits the amount of money the state government can collect from tax revenues and fees. Any revenues and fees collected over that limit must be returned to taxpayers in the form of individual tax rebates. Due in part to last year’s strong economy, this constitutional scheme resulted in tax refunds totaling approximately $190 million with average individual refunds ranging between $34 and $108 per taxpayer. That means that, while the governor was forced to propose cuts to higher education and hospitals and continue underfunding K-12 education and transportation, the government had to provide $190 million in tax refunds.

The hospital provider fee generates about $600 million annually. That $600 million is counted toward the constitutional revenue limit but none of those funds can be used to pay refunds, nor would we want them to be. Placing the hospital provider fee into an enterprise would exempt the $600 million dollars from the Constitutional revenue limit and would, thereby free up that space in the budget for other government priorities.

Whether or not the House and Senate leadership can negotiate a successful path for HB 1420, at some point, the legislature will need to address this serious financial quandary that continues to take away money from other critical programs and services outside of health care.

– Allison Neswood

Recent articles

CCLP testifies in support of TANF grant rule change

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

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.


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.