As Director of CCLP’s Health Care program, Bethany works with staff on setting the program’s priorities and leads its advocacy work. 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 ›

Jan 30, 2019

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CCLP reaffirms immigrant access to health

by | Jan 30, 2019

Colorado has recognized the importance of extending coverage to populations that lack affordable access to health care, when federal rules allow. In 2009, Colorado’s General Assembly authorized the Colorado Department of Health Care Policy and Financing (HCPF) to adopt a federal option established under the Children’s Health Insurance Program Reauthorization Act (CHIPRA) that allowed states to include many lawfully present children and pregnant women under the Medicaid umbrella – and lifted the restriction that lawful immigrants reside in the country for five years before they are eligible for coverage. Colorado Center on Law and Policy strongly supported that change.

However, since the option was adopted, we heard through community partners that eligible non-citizens were being turned away in some parts of the state — without even the opportunity to apply. Denying these legal immigrants coverage violates state policy and federal law. Moreover, it deprives individuals of life-sustaining services, unnecessarily increases economic burdens for working families, and creates potential risks to public health. At the same time, the upswing nationally in anti-immigrant rhetoric and policy has created a whole range of additional obstacles for eligible non-citizens and their U.S.-born family members.

In 2018, CCLP’s Health Care Program — which regularly advocates through state rule-making processes for changes that can improve access to Medicaid services — worked with a family that had been turned away in the past, and oversaw their application as it moved through the process. Because the applicant had significant disabilities, an independent agency that assists families with Medicaid waivers was involved, as well as staff in El Paso County. Through conversations with staff in both the agency and county, we were able to document that certain staff members had in fact turned away eligible non-citizen applicants, and were disseminating inaccurate information about who was eligible. At that point, we informed the Department of Health Care Policy and Financing (HCPF) and connected the Department with those staff members, so that direct instruction could be provided. While it’s difficult to trace the roots of that misinformation or to evaluate the role of bias in workers’ judgments, we also recognized that the state Medicaid rules and some state materials and forms contained incorrect, outdated language that increased workers’ and applicants’ confusion. We think it’s likely that staff in other counties are similarly misinformed, and that children and pregnant women who could greatly benefit from access to coverage are going without.

Having identified the problem, our next step was returning to the state rules to address confusing and outdated language. At the Medicaid Services Board hearing in January, the Department agreed to make clarifying changes regarding eligibility, with further changes to occur in April around Social Security number requirements. State rules currently require that applicants provide a Social Security number (SSN) or evidence of application for an SSN in all cases; we have proposed that state rules instead conform with language in federal rules that exempts certain applicants who cannot apply for an SSN. We look forward to seeing those proposed changes.

HCPF has also concurred with CCLP about the need for improved training materials and revision of forms and online documents like this one, and will be rolling out new content in the coming months so that county and agency staff, as well as individuals seeking information, would have more accurate information about who is eligible for Medicaid coverage. (At our request, they have already helped correct statements on webpages posted by two CHP+ managed care organizations that erroneously stated children and pregnant women must be citizens to qualify for benefits).

The additional steps should be treated with the utmost urgency. People of color and people with low incomes have higher rates of disease and mortality, and disparities are especially acute for pregnant women and children – those that Colorado specifically aimed to bring into coverage under CHIPRA in 2009. Many families don’t know who to contact and are understandably apprehensive about asserting their rights. That means, unlike the applicant we worked with directly, many Coloradans are now paying out of pocket or going without medical care altogether.

We urge the state to be crystal clear in its communications that our economy and culture are richer because of the presence of immigrant communities, and therefore, that improving the health and wellbeing of immigrants is a priority.

Now we have to ensure that information is accurate and that every county treats every Coloradan seeking coverage, whether white, black or brown, equitably and in accordance with the law.

-By Bethany Pray

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