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May 17, 2011

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The Elder Economic Security Standard Index for Colorado

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The Colorado Center on Law and Policy recognizes that many Colorado elders age 65 and over struggle to make ends meet. Living costs are high, especially for housing and health care. In the face of rising expenses, many elders receive only a modest cost-of-living adjustment each year; thus, they are spending down retirement savings and/or facing growing debt. At the same time, older people face a challenging future if their life circumstances change due to illness, loss of a spouseor partner and/or growing needs for help with daily tasks. Older women are particularly challenged with income and assets that are typically lower than men’s. Their longer lifespan also means that they more often live with chronic illnesses and high health costs.
In an effort to address these issues, the Colorado Center on Law and Policy joins the National Elder Economic Security Initiative launched by Wider Opportunities for Women in Washington, DC. Critical to the work is a new measure of income adequacy—the Elder Economic Security Standard Index (Elder Index). In contrast to the federal poverty level, which measures income inadequacy, the Elder Index is a measure of well-being identifying the income and supports needed for older adults to live modestly in the community. The Elder Index for Colorado was tabulated using the WOW—University of Massachusetts Boston Gerontology Institute (GI) national methodology.

Key Findings:

1. In Colorado, elders cannot meet their basic living expenses if they live at the federal poverty level or the level of the average Social Security benefit. This is true of elders statewide, whether they rent or own a home.
•     About 9% of Colorado’s older adults live at or below the federal poverty level.
•     Social Security is the only source of income for more than one out of four older adults in Colorado, the majority of whom are women (AARP 2008).
•     Expenses vary widely across types of communities. For example, elder homeowners with no mortgage who live alone in Teller County need $16,584 per year to cover basic living expenses. In contrast, elder renters living alone in Pitkin County need as much as $27,312 and elder homeowners with a mortgage living in Grand, Gunnison, Hinsdale, Mineral, Ouray and Pitkin Counties need as much as $40,248 to cover basic expenses. The statewide average for single older adults is $17,664 for an owner with no mortgage, $21,828 for a single renter and $28,260 for an owner with a mortgage.
•     Elder couples who own a home with no mortgage and live in Teller County need $26,760 per year to cover basic living expenses. In contrast, couples who rent a home in Pitkin County need as much as $38,364 to meet their basic household budgets and elder couples who own a home with a mortgage living in Grand, Gunnison, Hinsdale, Mineral, Ouray and Pitkin Counties need as much as $51,300 to cover basic expenses. The statewide average for an older couple is $28,080 for owners with no mortgage, $32,244 for couples who rent and $38,676 for owners with a mortgage.
2. Housing costs (mortgage or rent, taxes, utilities and insurance) put a heavy burden on some elder households, representing as much as half of their total expenses.
•     The Elder Index reflects wide variation in housing costs depending on whether older adults own or rent, and by county. Older owners without a mortgage typically have the lowest housing costs, while owners still paying a mortgage typically have the highest housing costs.
•     The monthly housing costs for elder homeowners without a mortgage range from a low of $279 per month in Mesa County to a high of $497 per month in Clear Creek and Gilpin Counties.
•     The monthly housing costs for older adults paying fair market rent for a one-bedroom apartment range from a low of $468 per month in Logan County to a high of $1,093 per month in Pitkin County.
•     The monthly housing costs for elder homeowners with a mortgage range from a low of $899 per month in Alamosa, Baca, Conejos, Costilla, Huerfano, Las Animas, Otero, Rio Grande and Saguache Counties to a high of $2,171 per month in Eagle, Grand, Gunnison, Hinsdale, Lake, Mineral, Ouray, Pitkin and Summit Counties.
3. The Elder Index shows the significance of health care costs for Colorado elders who must purchase supplemental health and prescription drug coverage to Medicare.
•     The Elder Index includes premium costs of supplemental health and prescription drug coverage to Medicare, which provide critical protection against high medical and prescription drug costs.
•     Older adults in Colorado who are in good health face combined health care costs (insurance premiums plus co-pays, deductibles, fees and other out-of- pocket expenses) of $375–$434 per month to have protection against high medical and prescription drug costs.
•     Retired couples are unable to purchase supplemental health insurance through a “family plan;” rather, they must each buy coverage as an individual. Thus, combined health care costs are doubled for elder couples, totaling $750–$868 per month.
4. Even elders who are currently making ends meet face an uncertain future if their life circumstances change, such as loss of a spouse/partner or a decline in health status.
•     An elder paying market rate rent in Colorado has expenses reduced by only 32% when a spouse dies, yet his or her income mix of Social Security and/or pension income may decrease substantially.
•     Older adults often face a rise in health care expenses when their health declines. While adding supplemental health and prescription drug coverage to Medicare provides protection against unanticipated health care expenses, average out- of-pocket expenses rise by $2,232 a year for an individual in poor health.
5. The need for home and community-based long- term care can more than double an elder’s expenses, significantly increasing the income needed to meet basic needs.
•     The need for home and community-based long-term care can double or even triple an elder’s expenses. Adding a low level of care for one person adds $7,920 per year to living costs. Requiring a medium level of care adds $21,008 and needing a high level of care adds $36,144 to $43,632.
•     As a comparison, national market surveys report an average annual rate of $72,234 for nursing facility care (semi-private room) in Colorado.
The key findings are amplified for older women, as their incomes and assets tend to be lower, they live longer than men and they disproportionately experience costly disabilities and chronic conditions.

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May 17, 2011

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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.