Aug 31, 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 testifies in support of Clean Slate updates

Bethany Pray, CCLP’s Chief Legal and Policy Officer, provided testimony in support of House Bill 24-1133, Criminal Record Sealing & Expungement Changes. CCLP is in support of HB24-1133, as it is one of our priority bills.

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.

Statement: Bipartisan health plan deserves consideration

by | Aug 31, 2017

This morning, Governors John Hickenlooper, John Kasich and six other Governors  released a plan to stabilize the private insurance market, to reinforce  requirements under the Affordable Care Act (ACA) that ensure that coverage remains robust and affordable, and to provide greater flexibility for state innovation.

We recognize that a politically polarized Congress will inevitably struggle to develop and pass legislation, and appreciate this important, bipartisan effort.

Here are the key components of the plan:

* The plan proposes reforms to the ACA but lets stand — and sometimes reinforces — aspects of the ACA that have been proven to increase enrollment, improve risk pools, and improve affordability. Chief among those reinforcements is the continuation of Cost Sharing Reduction (CSR) funding for a minimum of two years. Any fewer than two years of funding would create turmoil for carriers, and make it impossible for them to set premium levels. Because ACA markets would cease to function without CSR, it’s our recommendation that CSR be funded permanently.

* Another welcome aspect of the plan is support for risk adjustment mechanisms in the ACA, including full funding for the risk-corridor program. Carriers that lost money in the early years of the ACA were not fully reimbursed, and as a result, carriers may have been deterred from entering new markets. Full funding could change that, bringing more carriers to counties that have few options. The Hickenlooper-Kasich plan would supplement those existing programs with a federal stability fund that states could use to start programs that help defray the costs of individuals with greater health care needs.

* By proposing to fix the “family glitch,” the plan seeks to bring additional lives in to the risk pool while opening up options for people who cannot afford coverage today. The family glitch has made it impossible for family members of employees who cannot afford employer sponsored health insurance to seek premium tax credits in the exchange.

* For those counties that may have no or only one carrier option, the plan also provides consumers with an additional choice – specifically opening up the federal employee benefit program to people in those counties. Evidence shows that the presence of more plan and carriers helps lower costs for consumers.

* Though it isn’t always popular, the plan proposes continuation of the individual mandate. Accompanied by measures that help keep coverage affordable – access to Medicaid and Children’s Health Insurance Plan (CHIP), premium tax credits and cost-sharing reductions – there is every reason to require that people get covered. The need for health care is often unpredictable, and it serves all of us to live in a county or town or state where our kids and their classmates have access to preventive care and treatment, where employees and co-workers can get care when they are sick, where we and our parents and neighbors can stay healthy as we age and get assistance when we need it. On top of that, having everyone covered means that all of us pay less.

The plan also proposes changes. It calls for more transparency, so that consumers can assess the quality of coverage and understand the cost of care. More flexibility is proposed for states in how they structure ACA waivers, also known as 1332 waivers. We support that as well, keeping in mind that the plan maintains the requirements that waivers keep coverage just as affordable and comprehensive as the standard ACA program. We are interested in any proposed regulatory changes, and would want to make sure that consumers are not harmed and that coverage of essential health benefits remains robust.

Thankfully, the plan does not include changes to the Medicaid program, which had been illogically roped into ACA repeal efforts this past spring and summer. Medicaid Works, both in terms of what it provides and by serving as the foundation for the private market. This is a set of proposals that Congress should take seriously. And though there is more to learn about the plan and how it might affect Coloradans in coming years, it is clearly the product of analysis and discussion, rather than rhetoric and dogma. And for that, we’re grateful.

-By Bethany Pray

Recent articles

CCLP testifies in support of Clean Slate updates

Bethany Pray, CCLP’s Chief Legal and Policy Officer, provided testimony in support of House Bill 24-1133, Criminal Record Sealing & Expungement Changes. CCLP is in support of HB24-1133, as it is one of our priority bills.

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.


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.