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Gap Map

HUMAN SERVICES GAP MAP

Improving access and fiscal performance of state programs to ensure a healthy foundation for all Coloradans

Human services programs ensure that Colorado communities have the building blocks for a prosperous future. The Human Services Gap Map provides a window into how effectively Colorado is delivering the basic building blocks needed for lifelong health and well-being. The maps and graphs below present a county-by-county comparison of enrollment, allocations and costs for the following programs:
 
  • Food Security: Supplemental Nutrition Assistance Program (SNAP)
  • Food Security: Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
  • Early Learning: Colorado Child Care Assistance Program (CCCAP)
  • Financial Security: Colorado Works
  • Health: Health First Colorado (Medicaid)
While these programs are funded and supervised by the state and federal government, Colorado counties are responsible for day-to-day administration.
 
Recognizing that each Colorado county is unique, the Human Services Gap Map is intended to spark a dialogue among human service directors, their staff, advocacy organizations and community leaders about the most effective strategies for closing gaps in enrollment vs. eligibility, allocation vs. spending, and improving the overall effectiveness and efficiency of our limited resources. Improving access to and administration of these programs will ensure Coloradans of all ages and zip codes can weather life’s storms and thrive, while also boosting our state’s economic health.
 
The map below provides county rankings of access to these human services programs. Counties with the highest rate of access among the eligible population in the county hold the top spots. Click on a county to begin learning more about what’s happening in your community. For a complete explanation of the data sources and methods, see Gap Map Methodology.
Top counties for program access
Middle counties
Bottom counties for program access
Geography Name

HUMAN SERVICES GAP NO. 1:
PROGRAM ACCESS

The interactive graph below shows the gap between the number of Coloradans enrolled and the number estimated to be eligible for enrollment by county for food assistance (SNAP), nutrition assistance for women, infants and children (WIC), child care assistance (CCCAP), Colorado Works and Medicaid.

For many reasons, gaps in program access exist in all five programs across all counties. Some counties have a much larger gap between the people eligible for basic needs programs and those who actually receive assistance than other counties. The size of a gap may point to a missed opportunity to meet residents’ needs or more efficiently use available resources.

For child care assistance (CCCAP) and Colorado Works, the access gap is also a function of funding caps. This is a powerful visual example of how block-granted programs fall short in providing necessary services to help Americans build strong foundations: even if counties spend 100% of their program allocation, they seldom help even half of all eligible families in their communities.

Place:
Program:
County:

County:
Caseload and Estimated Eligibility, 2014-16

:
, 2014-16
(Counties with an estimate of the population eligible for WIC have red bars)

Scroll over the graph to see the number of those who are eligible but not enrolled vs. the county’s caseload.
Eligibility estimates were developed using census data. For a complete explanation of data sources and methods, see Gap Map Methodology.

HUMAN SERVICES GAP NO. 2:
PROGRAM ALLOCATIONS VS. ACTUAL SPENDING

The State of Colorado appropriates money for public benefit programs that is divided among the counties. Allocations are based on a formula that considers historical caseloads, poverty rates and population. Counties generally have a high degree of discretion in how funds are spent within state and federal laws applicable to each program. This interactive graph shows the gap between the program allocations for CCCAP and Colorado Works versus the actual spending by county.

Place:
Year:
Program:
County:

Big 10 Counties:
Percent of County Allocation Over or Under-Spent, SFY

County:
Allocation Expenditures and County Reserves, SFY 14-16

Some counties overspend their allocation while other counties underspend.Overspending may enable a county to more fully meet the community needs for assistance and may signal that the county needs additional state funds to support its residents.

Counties that underspend their allocation might leave money on the table that could help address the needs of their residents and stimulate the economy. Through a relatively complicated process, the state takes back unspent money from counties that did not spend their full allocation and redistributes it to the counties that are overspent.

From year to year, there is always some level of over- and underspending for many reasons. Caseloads fluctuate as community needs change making it difficult for county human services agencies to balance expenditures. Some communities face a shortage of child care providers and organizations to provide job placement, education, internships, and case management which has implications for counties fully expending their allocation. The data provided here is intended to be a resource for having these conversations about how to best manage county allocations and expenditures for these critical human services programs.

HUMAN SERVICES GAP NO. 3:
COST PER CASE & BENEFITS
PROVIDED PER ADMINISTRATIVE DOLLAR SPENT

Eligibility, allocation and spending may provide clues about how counties can align their enrollment efforts or better manage their human services resources. But variability in administrative costs per case and benefits provided per administrative dollar spent might say more about a county’s efficiency than overall expenditures. The interactive graph below provides two measures of administrative and fiscal efficiency.

Cost per case is the amount of administrative dollars spent per case to enroll a client, and for some programs, to manage the administrative aspects of the case. A lower cost per case is an indicator of more efficient systems for enrolling and processing client cases. Larger counties may benefit from economies of scale on this measure.

Benefits provided per administrative dollar spent (abbreviated as ROI below) is a measure of how much in program benefits (i.e., cash, cash equivalent and/or services) are distributed per administrative dollar spent. This measure can be influenced by many factors, including efficiency of enrollment procedures, staffing costs driven by cost of living in a community, and the type of services provided. For example, administrative costs for the WIC program include nutrition education by registered dieticians, increasing the cost of the services provided especially compared to the cash benefits provided to participants.

Place:
Measure:
Year:
Program:
County:

Big 10 Counties:
,

County
,

MAPPING THE GAPS IN MEDICAID AND SNAP ENROLLMENT

To support thriving communities and individuals, we need to promote and align key human-service programs to support the health and well-being of all Coloradans. The interactive map below shows enrollment rates for Colorado’s two largest human services programs: Medicaid focused on access to health care and SNAP focused on access to food security. We provide an in-depth window into participation in these two vital programs for a few key reasons.

We know that food security reduces health care costs, improves health and education outcomes for children and stabilizes our state’s workforce. And yet, Colorado ranks 44th in the nation for SNAP enrollment. At the same time, enrollment in Medicaid has grown substantially across the state.

The data in this map provides a detailed picture of where enrollment in one program may be strong but is lagging in the other. Communities can use this information to begin asking questions about why enrollment is lagging, identify barriers to enrollment, and develop strategies and partnerships to improve access to food security and health care.

See the Food Assistance (SNAP) Benefit Calculator to get an estimate of your eligibility for food benefits.

Higher Enrollement Rate   Lower Enrollement Rate
Percent of the estimated eligible population enrolled in Medicaid
Percent of the estimated eligible population enrolled in SNAP
First check an option above,
then Search by Zip or Tract:

GAP MAP SOLUTIONS

While the challenges of enrolling qualified Coloradans in human service programs and controlling administrative costs can be daunting, some recent breakthroughs in policy highlight how we can make a difference in closing the gaps so that more Coloradans can meet their basic needs.

With broad support from a diverse array of stakeholders, Senate Bill 190 was passed in 2016, which aimed to increase the efficiency and effectiveness of the state-supervised, county-administered food assistance program (SNAP).

The legislation clarified the expectations for administration of the program at the state and county levels, and created incentives for meeting and exceeding the federal standards for the timely and accurate processing of SNAP applications.

It also authorized a study of how Colorado’s 64 counties can implement best practices to increase their efficiency and effectiveness in delivering a number of public assistance programs and the support they will need from the state to do so.

The bill was passed unanimously by Colorado legislators and was signed into law by Gov. John Hickenlooper on June 1, 2016.

For more information on strategies being developed to end hunger for all Coloradans, see the Blueprint to End Hunger. It’s a multi-year plan developed by stakeholders across the state and includes efforts to maximize enrollment of income-eligible Coloradans in both WIC and SNAP.

See the Food Assistance (SNAP) Benefit Calculator to get an estimate of your eligibility for food benefits.

With enrollments in decline since 2009, nutrition assistance for women, infants and children (WIC) is focusing on identifying the potentially eligible population by census tract and county. This will enable prioritization of geographic areas with high levels of potentially eligible participants in order to strengthen outreach and referrals in specific areas.

Colorado WIC has partnered with the U.S. Census Bureau to receive detailed information on people who are eligible for WIC but not yet enrolled by census tract. This data, while valuable, will be somewhat outdated.

To rectify the situation, Colorado WIC is partnering with Medicaid to get monthly counts of enrolled pregnant women and children who are 0-5 years old to compare with counts of WIC clients as a real-time proxy measure for participation.

For more information on strategies being developed to end hunger for all Coloradans, see the Blueprint to End Hunger. It’s a multi-year plan developed by stakeholders across the state and includes efforts to maximize enrollment of income-eligible Coloradans in both WIC and SNAP.

CCCAP helps families build a foundation of self-sufficiency by providing child care assistance to families who are working, searching for employment or participating in training. But not everyone who could benefit from the program has been able to use it.

Unfortunately, some families with the highest need for child care assistance have been effectively barred from CCCAP because of a policy that requires recipients to identify both parents in order to qualify. For example, a teen mother might be unable to continue her education because she is unwilling to identify the father of her child. This refusal may be an effort to protect him or to protect their relationship. On the other hand, she or her family may want to protect the baby and the young mom by avoiding the creation or continuance of an unhealthy relationship. According to the National Campaign to Prevent Teen and Unplanned Pregnancy, one of the leading barriers that prevent teen mothers from graduating from high school is access to child care.

Fortunately, House Bill 1227 lifted the requirement for teenagers and victims of domestic violence to disclose the identity of the other parent when applying for child care assistance. The legislation was passed by the Colorado House and Senate during the 2016 legislative session was signed by Gov. John Hickenlooper. The legislation went into effect in the 2016-17 fiscal year.

Single parents who receive Temporary Assistance for Needy Families (TANF) Basic Cash Assistance (also known as Colorado Works) will no longer have to choose between receiving payments from the program and child support thanks to a law approved by legislators and the governor in 2015.

Previously, child support payments were “retained” by the state and used to help reimburse the federal, state and county governments for the cost of human services, including child support enforcement and services.

Developed by the Colorado Center on Law and Policy, Senate Bill 12 allows TANF recipients to receive child support payments without reducing their benefits from the program. Furthermore, non-custodial parents are more likely to comply with child support orders when they know that their child support payments directly increase the financial support available to their children.

The law went into effect in April 2017.

Medicaid recipients and administrators often face the challenge of “churn” – a word that describes the movement between health coverage programs due to fluctuations of income and household size. Unfortunately, churn often results in temporary loss of coverage when recipients’ statuses change, but it also has negative effects on health outcomes and increases administrative costs associated with enrolling and re-enrolling individuals into coverage programs.

To reduce churn and encourage better continuity of care, the Colorado Department of Health Care Policy and Financing, with the support of advocates, adopted a federal option that would allow recipients who are at risk of losing Medicaid due to seasonal, commission-based or self-employment income to annualize that income over the rest of the year.

For example, if a person is found ineligible for Medicaid based on monthly income due to seasonal work at a ski resort, projected income can be spread out over the remainder of the year and prevent the person from losing coverage. This saves the system administrative costs and prevents a lapse of coverage that could potentially affect the individual’s health.

The new rule went into effect in Colorado on June 31, 2016.

HUMAN SERVICE PROGRAMS

Health: Medicaid

Food Security: SNAP

Food Security: WIC

Financial Security: Colorado Works

Early Learning: CCCAP

ABOUT THE GAP MAP

The Human Services Gap Map is a project of the Colorado Center on Law and Policy developed in partnership with Hunger Free Colorado. The Human Services Gap Map aims to increase accountability, transparency and planning to build public and political will, in order to improve access, effectiveness and integration of core health and work support programs.

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.