A final 2024 letter from our Chief Executive Officer, Lydia McCoy.
Recent articles
Poverty, technology and the stories we tell
An interview with Dr. Virginia Eubanks, CAP 2024 keynote speaker
A letter from our CEO: November 2024
A letter from CCLP's CEO on the results of the 2024 elections.
CCLP Policy Forum: Tax credits & you recap
CCLP presented our fourth Policy Forum event discussing tax credits in Colorado.
Systemic failure in Colorado’s PHE Unwind
During this post-COVID year of Medicaid renewals, known as the Public Health Emergency (PHE) Unwind, Colorado is terminating members at rates that are among the highest in the country. Many of these terminations are for procedural—as opposed to eligibility-based—reasons. Thousands of eligible children and adults have lost coverage due to errors and delays in county processing, leading to missed surgeries, postponed treatments, and unfilled prescriptions. Chronically flawed Medicaid communications about vital issues —such as which documents a recipient needs to submit, when a termination will occur, or the due date for filing an appeal — create enormous confusion and stress for the members who receive them, and extra work for county offices who must respond to member questions that arise.
Failures of communication aren’t mere inconveniences — these issues undermine the constitutional rights of Medicaid recipients. In cases of Medicaid denials or terminations, legal due process protections require the member receive adequate notice of the decision made. This notice, usually in the form of a letter, must include the date the termination or denial will go into effect, a clear and accurate reason for the decision, and an opportunity for a hearing.
Advocacy by the disability community and actions by the federal Centers for Medicare and Medicaid Services (CMS) have resulted in some important policy changes, listed below. Much more is needed, particularly when it comes to communications, but these changes are a first step in addressing problems caused by chronic underinvestment in eligibility systems and an archaic online benefit management platform. To their credit, state eligibility staff members have hustled to implement those changes, update county workers, and address individual problems brought to their attention. They will need a lot more resources to prevent a public health catastrophe, however.
Colorado applied for, and received, special waivers from the federal agency (CMS) to allow the following policy changes throughout the PHE Unwind.
- Counties have an additional 60 days to process renewal packets for people with disabilities who are on programs that provide long-term services and support. This policy is triggered when someone has not returned their renewal packet or if the county has received the packet through the mail, in person, or through PEAK (the online portal) but has not yet touched it. (However, if the packet has been processed but other requested information is outstanding, the person can still be terminated.)
- Thousands of children and others who could have been approved based on information already available to the county but were terminated during the first months of the PHE Unwind, have had coverage restored. All who are eligible for those so-called “ex parte” renewals should see their coverage fully restored as of mid-November and should have received a letter in the mail or in PEAK that informed them of their eligibility. The state should also be ensuring that this group actually returns to care, potentially by informing primary care practices about those reinstatements.
- All people who request a Medicaid hearing during the 60-day appeal period will have their benefits restored or maintained for the duration of the appeal process and will not risk having the value of benefits recouped — even if they lose their appeal. This is usually the quickest way to get benefits back on after they’ve been lost.
Through our collaboration with Covering Kids and Families, enrollment assisters, and disability advocates, CCLP will continue to help surface problems in the PHE Unwind process and push for improvements. Stay tuned for additional policy developments in the coming months.