Jul 25, 2019

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.

The Long, Winding Road to Implementing Health and Economic Justice Legislation

Legislators passed, and the governor signed, a number of good bills into law during the 2019 Colorado legislative session – including 13 that Colorado Center on Law and Policy led. If implemented correctly, we believe these bills will improve the health and well-being of many Coloradans and advance the goal of equity in the state.

Once a bill is signed, the questions we ask to guide our work include: How do we ensure the implementation reflects the intent of the bill? Who is charged with enforcing the new rules? And who will inform those affected by the law? Getting to the heart of these questions will determine the success of these policies as they move forward.

The volume of successful bills from the last legislative session has kept CCLP staff busy with implementation efforts well underway. Our implementation efforts have included weighing in on the structure of waiver applications to federal agencies and addressing rulemaking by state agencies, including the Division of Insurance (DOI), the Department of Health Care Policy and Financing (HCPF), the Colorado Department of Human Services (CDHS), and the Colorado Department of Labor and Employment (CDLE).

Among other things, we’re participating in agency-led stakeholder committees tasked with developing new state government programs. Grounding our work in research is a critical part of those efforts, and equally important is continuing to engage members of the community – particularly those who may benefit directly from the new laws – through townhall meetings, printed collateral, media, etc.

Here’s a sampling of what’s ahead with our implementation efforts in the months and years to come:

HEALTH
Health Care Public Option (House Bill 1004) –
Passage of the public option bill kicked off an intensive five-month plan by HCPF and the DOI to develop an affordable health coverage option that uses state health infrastructure. A series of public meetings has begun, with the state agencies dedicating July and August to hearing about the wishes and needs of community members outside the Denver metro area. Consumer groups are working closely together so that our recommendations represent Coloradans’ diverse interests and address the needs of uninsured and underinsured households. In 2020, we can expect more legislation, a possible federal waiver application, or rulemaking – and possibly all three.

State Reinsurance Program (HB 1168) – The state reinsurance program is making rapid progress, with public meetings held and a waiver already under consideration by the U.S. Department of Health and Human Services. Provisional 2020 rates show the program has already reduced individual plan rates for next year by an average of more than 18 percent. CCLP has submitted comments in support of the waiver and will work with other advocates and our state exchange, Connect for Health Colorado, to ensure that its approval translates into thousands of uninsured and underinsured Coloradans having more access to affordable health care.

Primary Care Investment (HB 1233) – Compared to many other countries, the United States spends more overall on health care (particularly specialty care) but does a poorer job coordinating care and preventing disease. HB 1233 seeks to shift that balance by creating a mechanism to increase health care dollars spent on primary care. CCLP is represented on a statewide, DOI-led collaborative that will work over the next several months to advise on standards and targets for improving investment in primary care services.

State Behavioral Health Parity (HB 1269) – This legislation aims to reduce barriers to accessing behavioral health services in Medicaid, as well as in commercial coverage regulated by the DOI. The DOI has moved swiftly on new regulations that require carriers to demonstrate that their plans provide parity between behavioral health and medical benefits, and more are in process. The state’s Medicaid program, Health First Colorado, has yet to introduce rules to implement the bill, and CCLP and consumer groups will continue to urge them to act quickly. Our priorities include clear, enforceable regulations requiring that the entities delivering behavioral health services have adequate networks and ensure prompt access to follow-up treatment, that people with co-occurring diagnosis like developmental disabilities or substance use disorder are not shut out of coverage and that criteria used to approve or deny care are appropriate and consistent statewide.

Hospital Community Benefit Accountability Bill (HB 1320) – This legislation requires nonprofit hospitals to report the community benefit they provide in exchange for substantial tax breaks and ties those efforts to health disparities identified in federally required health needs assessments conducted every three years. CCLP is engaged with HCPF to urge a user-friendly electronic reporting format that will allow the public to compare their local hospitals’ efforts to identify and address community priorities with others in the state.

HOUSING
Eviction Legal Defense Fund (Senate Bill 180) –
As the lead organization behind SB 180, which created a $750,000 fund to provide legal services for Coloradans facing eviction, we provided recommendations to State Court Administrators Office about what criteria should be included on grant applications. This is not a competitive process, so multiple entities could be funded to provide legal help beginning Oct. 1, 2019.

Extend Notice Prior to Eviction (HB 1118) – This bill gives families the chance to avoid eviction or find other housing by extending the eviction notification period from three to 10 days for non-payment of rent. Since the legislation became effective immediately after the governor signed it, CCLP staff talked with the State Court Administrator’s Office to ensure that court staff was notified and online official forms regarding eviction notification were updated.

Mobile Home Park Oversight Act (HB 1309) – This legislation was designed to level the playing field for homeowners residing on rented lots. The act contained many elements but adding an administrative remedy to address complaints of violation of the Mobile Home Park Act will require the most work. The Department of Local Affairs will need to add additional staff to provide an administrative process by May, 2020 so that mobile home park residents will not need to hire an attorney to register a complaint.

Expand Supply of Affordable Housing (HB 1322) – With the passage of the largest-ever influx of funding for affordable housing — $30 million a year for three years from the state’s unclaimed property fund – communities have a chance to develop their own proposals for next year when funds become available. CCLP will join its partners in the Colorado Coalition for the Homeless’ State Disparities Grant by visiting 10 communities in the state over the next year to call out the funding opportunity while emphasizing the role of housing as a social determinant of health.

INCOME
Ban the Box (HB 1035) – Members of CCLP staff will meet with the CDLE staff charged with implementing the new law, which prohibits most employers from asking about criminal history on an initial employment application. Discussions will focus on how to inform the public and employers about the change and how it will be enforced. Though the law takes effect in September, businesses with fewer than 11 employees have until September, 2021 to be in compliance.

Emergency Employment Support Services (HB 1107) – This bill appropriates $750,000 to establish a three-year pilot program to provide small-dollar emergency transactions for Coloradans trying to get into the workforce or improve their skills to get a better-paying job. CCLP staff has met with those at CDLE charged with implementation to discuss the bill and concerns about implementation. We’ve made suggestions for what criteria should be for the entity administrating the fund. We also volunteered to review the bids. Since the funding is very modest, CCLP will develop a resource guide to other support service funds and look for opportunities to increase available funding.

Wage Garnishment Reform (HB 1189) – This bill will reform the state’s wage-garnishment laws by requiring clearer and more-timely notice of garnishment. It also will reduce the amount subject to garnishment to help people meet household needs while paying their debts. The implementation timeline was extended on this legislation to allow notice to creditors of new notification requirements. The bill applies to writs of garnishment issued on or after Oct. 1, 2020 Wage garnishment notices and legal forms will need to be revised and court staff notified.

SSI/SSDI Application Assistance (HB 1223) – Navigating the complex disability application for Social Security is a challenge for any applicant. For applicants living on the minimal state dollars available through the Aid to the Needy Disabled program – many of whom lack a stable address or have mental health conditions – the process is even more daunting. HB 1223 funds counties to provide application assistance and also requires stakeholder engagement in upcoming rulemaking. CCLP has been meeting with partner organizations to develop priorities and will be engaged in rulemaking this fall regarding how funds are distributed, how counties can qualify for them, and how the effectiveness of the program will be measured.

— By Bethany Pray and Chaer Robert

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.

HEALTH:
HEALTH FIRST COLORADO (MEDICAID)

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.

FOOD SECURITY:
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)

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.

FOOD SECURITY:
SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC)

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.

EARLY LEARNING:
COLORADO CHILD CARE ASSISTANCE PROGRAM (CCCAP)

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.