Today, Colorado Center on Law and Policy (CCLP) and the National Health Law Program (NHeLP) filed a complaint with the U.S. Department of Health and Human Services Office for Civil Rights and the U.S. Department of Justice.
Bethany Pray provided testimony for Senate Bill 24-093, Continuity of Health-Care Coverage Change. CCLP is in support of SB24-093.
CCLP Policy Fellow, Milena Castañeda testified at the Medical Services Board meeting regarding emergency rules for the NEMT.
Chaer Robert provided testimony against House Bill 24-1065, Reduction of State Income Taxes. CCLP is in opposition of HB24-1065.
State budget requests provide a hopeful glimpse to Colorado’s future
Colorado Center on Law and Policy (CCLP) is encouraged by many of the requests outlined in Gov. John Hickenlooper’s proposed budget for fiscal year 2019-20 – particularly the recommendations that pertain to the economic security, health and career opportunities for low-income Coloradans.
This year’s $33.4 billion budget request reflects a 4.8 percent increase in total funds – of which 41 percent is earmarked for “strategic investments” intended to improve health care, make child care and college more affordable and build a strong workforce for the economy of the future.
We believe many of these requests warrant careful consideration when the General Assembly convenes in January.
Family Economic Security
Requests from Colorado’s Department of Human Services include:
* An annual 1.5 percent Cost of Living Adjustment (COLA) for Colorado Works’ Basic Cash Assistance (BCA). BCA recipients are among the lowest-income residents of the state and usually have no other source of income. Earlier this year, CCLP and its partners successfully urged Colorado’s Human Services Board to increase BCA for the first time in 10 years by 10 percent. Unfortunately, since the time Colorado Works (the state’s Temporary Assistance to Needy Families [TANF] program) was established in 1997, the purchasing power of Colorado’s BCA has decreased by 35 percent because the grant amount has not kept pace with inflation. On average, a single-parent family with two children receives a maximum BCA payment of $508 a month (providing income that puts them at just 29 percent of the federal poverty level). CCLP’s Chaer Robert pointed out that this low funding level causes “an economic fragility that hurts kids and families’ quest to get back on their feet,” so an ongoing raise would help.
* An increase in $1 million total funds to solidify outreach, access and delivery of Supplemental Nutrition Assistance Program (SNAP) for a three-year project by increasing the state’s general fund dollars by $465,000 for matching federal dollars. The program would support programmatic activities to increase SNAP enrollment in rural and underserved communities. Robert said continuing the work of this expiring grant is a smart investment that benefits the state, local economies and hungry kids.
* The Department of Human Services also requested $966,977 in federal TANF funds in fiscal year 2019-20 and $1.8 million in fiscal year 2020-21 to provide employment services to low-income, non-custodial parents struggling to pay child support. The funds for county offices will serve up to 5,200 parents at an average cost of $300 per participant. Robert said the pilot programs make sense because they switch the emphasis from child-support “enforcement” to child-support “services,” which will help parents find and keep employment.
Regarding the governor’s tax credit proposals, Robert acknowledged that providing a match to the federal American Opportunity Tax Credit and the Lifelong Learning Credit can be helpful to some Colorado families. She notes that because the credits deal with current higher education expenses, they don’t address the student-debt problem – except to diminish some potential debt for students moving forward.
The budget also proposes increasing a state tax credit to individuals making $60,000 or less for child care expenses from a 50 percent match to the federal credit to 100 percent – while expanding the income cap to families making more than $60,000 but less than $150,000. Robert was disappointed that that increase would not include those covered by the Low-Income Child Care Tax Credit. Families earning less than $24,000 a year or single parents earning under $18,000 only benefit from this credit because their income is too low to owe federal taxes, and thus do not qualify for the regular Child Care Tax Credit. Robert added that CCLP is working on legislation to make the Low-Income Child Care Tax Credit permanent, rather than sunset every three years.
Finally, Robert said that a proposal to increase the state Earned Income Tax Credit (EITC) and pay the increased amount from funds that TABOR would otherwise require to be refunded would be good if the EITC remains permanent at 10 percent of the federal credit with an additional match in years of TABOR surplus. But she cautioned that structuring the EITC as only a TABOR refund mechanism would be a step back for Coloradans. The original state EITC was a TABOR surplus refund mechanism. Consequently, low-income working families did not receive an EITC between 2002-2014 because there was no TABOR surplus.
Requests from the Colorado Department of Health Care Policy and Financing (HCPF) include:
* Funding to design and adopt a new tool to measure the need for long-term home health care for adults and private-duty nursing services for Medicaid-enrolled children and adults. While CCLP supports the idea of using clinically validated tools to measure clients’ service needs, CCLP’s Elisabeth Arenales said she’s concerned by what appears to be HCPF’s presumption that the tool will generate substantial cost savings. “No tool used to determine medical necessity should be designed with cost savings as the goal,” Arenales said. “Cost savings may or may not result, but the tool should be used to determine how best to meet a client’s medical needs.”
* Using general fund dollars to support the All Payer Claims Data Base (APCD) – a tool intended to control and analyze health care costs through data collection. CCLP supports the budget request on the premise that the APCD was established to inform policy decisions based on independent, reliable data and data analysis. Unfortunately, without a reliable funding source, the Center for Improving Value in Health Care (or CIVHC, contracted by HCPF to develop the APCD) is limited in what it can do to benefit the state. CCLP notes that the budget request seeks additional HCPF oversight over the APCD. We do not support that request, believing that current levels of statutory oversight are sufficient.
* Consolidating processes for mail sent to Medicaid clients and returned as undeliverable. HCPF reports that more than 3 million pieces of mail are returned each year to Colorado counties and medical assistance sites – endangering clients’ access to services and imposing an administrative burden on counties. According to HCPF, the proposal to let the state handle returned mail for Medicaid recipients from counties to the state will free up county resources devoted to handling these cases and allow for increased consolidation and oversight by the state. While CCLP supports these requests in principle, we are concerned that the volume of returned mail is due (at least in part) to delays in updating address information in the Colorado Benefits Management System (CBMS), a statewide computer network whose initial failure put hundreds of thousands of Coloradans in jeopardy without access to health care, medications, cash assistance and food. CCLP does not support this change until and unless sufficient protections are in place to ensure that clients are served. For example, there must be meaningful protocols for searching for client addresses and the state must be certain that counties are timely in entering new address information into CBMS.
* Providing additional funding for an IT project intended to expedite payments to health care providers for serving Medicaid clients. While CCLP supports the request, we remain concerned about HCPF IT management decisions that resulted in significant problems with the roll out of the COMMIT payment system project last year – resulting in considerable distress among Medicaid providers who went without payments for long periods of time. This put significant pressure on the Medicaid provider network and ultimately resulted in some small providers going out of business or dropping Medicaid clients. It appears this budget request is designed to continue to provide supports required because of a problematic IT roll out.