May 19, 2020

Christina Yebuah previously served as Research & Policy Analyst for Colorado Center on Law and Policy.

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Understand your behavioral health care rights in the COVID-19 era

by | May 19, 2020

The COVID-19 crisis has created a devastating national health crisis, and the impacts are not just on physical well-being. Over half of Americans reported that they are experiencing increased mental health challenges because of issues associate with COVID-19.

Job furloughs and layoffs, unstable housing, social isolation and uncertainty about the future add to mental health and substance-use problems. Even before the pandemic hit, Colorado ranked No. 44 in prevalence of mental health conditions, indicating a higher prevalence of mental health issues and lower rates of access to care when compared to other states.

As we mark National Mental Health Awareness Month, all Coloradans need to know that state-regulated health plans and Health First Colorado (our state Medicaid program) cover the full spectrum of health services – not just physical health, but mental health, substance-use disorder and other behavioral services – and that state partners are ready to step in if higher cost or other limitations get in the way.

Many of us remember when mental health and substance-use treatment were not covered by health insurance at all; or only at great cost. But in recent years, there have been great strides in both federal and state policies towards ensuring that behavioral health care is treated the same way as physical health care. Under the Affordable Care Act and the Mental Health Parity and Addiction Equity Act, as well as our 2019 State Parity Act, those enrolled in state-regulated plans or Medicaid have as much of right to therapy for depression during a furlough as they do for a heart disease evaluation.

Coloradans should not face greater barriers to care when they need help with mental health or substance-use problems: What you pay out of pocket, the availability of providers in your plan’s network, pre-authorization requirements and visit limits should not make it harder to get the care needed.

New emergency state rules on telehealth also require parity, so arranging an affordable Zoom session with a social worker should not be more of a challenge than the session with the nurse practitioner to check out a rash. However, parity violations can be hard for individuals to spot.

If you or someone you know is having trouble getting or affording the mental health or substance use treatment they need, that could indicate a violation of the Parity Act. Check out CCLP’s Parity Red Flags document to help identify potential parity violations. Potential violations and questions, even if you’re not sure your health coverage is state-regulated, can be addressed by contacting the Division of Insurance (DOI).

To do their jobs enforcing parity, the DOI staff needs to know what problems you’re seeing. They have the tools to address many complaints quickly and can direct you to the right people, should the issue not involve a state-regulated plan.

Another great source — regardless of your type of coverage — is the state’s behavioral health ombudsman, who serves as a neutral party to help consumers and providers navigate issues related to consumer access to care for mental health and substance-use issues.

Whether or not you need to access behavioral health care services in these anxious and uncertain times, please well, and be good to yourself and those around you.

– By Christina Yebuah

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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.