Hundreds of thousands of Coloradans who rely on government-subsidized health insurance programs could lose coverage beginning next year, many of them children whose families otherwise can’t afford the checkups, vaccines and preventive care kids need in their earliest years.
It’s a problem bearing down on families across the country with the federal public health emergency set to expire Jan. 11. The federal declaration, issued at the start of the coronavirus pandemic more than two years ago, barred states from releasing anyone from Medicaid rolls during the health crisis. Unless the federal government extends the emergency order — it previously extended the order to mid-October — about 700,000 Coloradans could lose access to Medicaid and Child Health Plan Plus, a public health insurance option for people whose income is too high to qualify them for Medicaid.
About 220,000 of those people are kids, according to data provided by the Colorado Department of Health Care Policy & Financing.
The department estimates that about 55% of the 700,000 people at risk of being cut from a government health insurance plan will actually lose their coverage. Many of those children and families could be dropped from health insurance coverage despite still being eligible for government assistance. That might be because the state doesn’t have their correct address on file to send them a renewal package or because families send back incomplete forms or don’t return forms at all, said Erin Miller, vice president of health initiatives for the Colorado Children’s Campaign. State health officials are developing strategies to make sure families maintain coverage, something they say is crucial to financial stability.
“It’s the building block on which financial security can be built, and it provides access to the health care system, which is important, too,” Miller said. “But a family cannot build financial security if they lack health care coverage, because you’re always one hospital visit away from financial ruin.”
Nationwide, about 5.3 million children under age 18 could lose coverage from a government health insurance plan, according to a federal report from August, with three out of four kids losing coverage while still eligible.
It’s an alarming prospect for Miller and other health care advocates like Shoshi Preuss, a senior policy analyst for the Colorado Community Health Network, a membership association for 20 community health centers that care for low-income residents in the state.
“I think it’s a really scary thing to think about,” Preuss said. “We know that having access to health coverage produces better health outcomes across the board. We know that losing health coverage will create these disruptions in care so maybe kids will (have) delayed care, get less preventative care. It really across the board creates challenges for the families, for the providers trying to deliver continuous care.”
Preuss is particularly concerned about maintaining coverage for any children and families who will still qualify for assistance. She is urging Medicaid and Child Health Plan Plus recipients to update their address with state agencies, verify that other contact information on file is accurate and open mail from the state.
“That’s where we can make the biggest impact and really reduce any of that loss of coverage,” she said.
Trying to reach families without sparking fear
Miller, a mother of two young children, understands the frenzy that comes with navigating each day and the stacks of mail that can easily pile up in the midst of other priorities.
“You spend a lot of time wiping bottoms and zipping coats and washing blankets for child care and packing lunches and getting through the mechanics of the day,” she said.
It is especially complicated for those facing housing instability, which the pandemic made worse for many families. Miller noted that many of the kids at risk of losing health insurance through a government plan have moved during the past two-and-a-half years.
The Colorado Department of Health Care Policy & Financing, which runs the state’s Medicaid program and Child Health Plan Plus, is taking steps to prevent families from unnecessarily being dropped from a government insurance plan after the public health emergency expires. When the federal order ends, the department will spend a year on renewal processes, said Marivel Klueckman, eligibility division director at the Colorado Department of Health Care Policy & Financing.
“People will maintain coverage until their renewal period comes up,” Klueckman said. “So everyone already has an established renewal period that is set 12 months from when they had applied.”
The department will automatically renew anyone whose information they are able to verify and that shows they are still eligible for a government health insurance plan. For others whose information is missing or who appear to no longer be eligible for a government health insurance plan, the department will send them a renewal package to review, update, sign and return, Klueckman said.
Additionally, the department offers a 90-day reconsideration period so that if a person loses coverage because they did not take action on their renewal, they have 90 days to follow up with the department and confirm their eligibility without having to reapply.
To spread the word about the need for people to complete the renewal process, the department rolled out an “update your address” campaign with partners, including the Colorado Community Health Network, food banks and community centers. The campaign used email blasts and posters in more than 11 languages to encourage people to update their address with the state and pay attention to notices and paperwork they receive, Preuss said.
The department also appointed a vendor to validate addresses before the department sends out renewal packets. And the department is taking advantage of a statewide consolidated return mail center in Prowers County, which receives mail that has been returned back to the center. The center’s staff then tries to contact those people to get their updated address.
Additionally, the department has collaborated with the Colorado Department of Education to send out alerts to families through school newsletters and is preparing to launch a broader campaign with state funds to make people aware of the need to complete their renewal package. The department also plans to begin reaching out directly to people through text messages, mail and email and leaning on its regional accountable entities — organizations within the Medicaid program that assist members with accessing primary and behavioral health care and create regional strategies to help members — to follow up with individuals and families multiple times.
“We’re trying to really choose our timing and our wording very carefully,” department spokesperson Natalie Coulter said. “We’re trying to be really careful about how we message renewals because we don’t want to incite fear and confusion when the (public health emergency) actually hasn’t unwound yet.”
The department is also creating an overflow processing center, a state-run center that can help any of Colorado’s 64 counties that are struggling to keep up with processing renewals, Klueckman said.
Health care advocates are pushing for Colorado to follow other states in adopting policies that extend people’s eligibility during normal times. For instance, some states are seeking waivers from the federal government to allow children to be covered by Medicaid until age 6 without their families having to reapply, Miller said. Once a Colorado child is deemed eligible for coverage, they are guaranteed coverage for one year.
Some states are also looking at extending eligibility for adults, particularly vulnerable populations. In Colorado, adults and children using Medicaid have to be re-evaluated for their eligibility every year during normal times.
Oregon, which is one of the states where children can be covered by Medicaid until age 6, also recently received federal approval that will grant two years of eligibility to those on Medicaid, up from one year. Additionally, Massachusetts has been cleared to extend Medicaid eligibility to one year for adults who are homeless or transitioning out of jails and prisons.
Colorado advocates like Miller are eyeing the next legislative session as an opportunity to pass policies that would lengthen coverage for residents most in need, including young children, kids in foster care and young adults exiting the foster care system.
Scrambling to find money for medical expenses
Colorado families who will be ineligible for Medicaid coverage once the public health emergency ends and they reach their renewal period have a few alternatives to secure health insurance. They can purchase a plan through Connect for Health Colorado, the state’s health insurance marketplace, and can apply for a tax subsidy to reduce the cost of their premiums, Klueckman said. They can also purchase a plan through their employer, if one is offered.
Some Colorado families no longer eligible for Medicaid will qualify for Child Health Plan Plus, which caters to children and pregnant women whose household income is too high to qualify for Medicaid but too low for them to afford private health insurance. An individual earning less than about $30,000 a year qualifies for Child Health Plan Plus. A family of four whose household income is less than about $63,000 a year also qualifies, according to the department.
Community health centers are another resource for Colorado residents, no matter their insurance status, Preuss said. The state has more than 200 community health centers, including 67 school-based clinics, where people can access primary care, including dental care and behavioral health care, as well as apply for new coverage or apply for a discount program that reduces the cost of their health care at the centers based on their income.
That doesn’t mean it will be an easy transition for people like Maria Galvan, whose 6-year-old daughter has been enrolled in Medicaid since June. Galvan, who lives in Evans, is a single mom and scrapes together enough money to keep her and her daughter afloat. Relying on Medicaid for her daughter’s doctor visits, dentist appointments and glasses has helped her be able to seek medical care “without having to worry about a bill,” she said, adding that it’s given her “peace of mind knowing she’s covered.”
But that all could change next year once her renewal period pops up after the end of the public health emergency. Now a food and community specialist at the Fort Morgan nonprofit Kids At Their Best, Galvan suspects she earns too much money to qualify her daughter for Medicaid. She anticipates applying for coverage through Child Health Plan Plus, which she previously relied on.
Still, she’ll need to save up extra money in case any emergency medical expenses surface in the future. Last year, while her daughter was covered through Child Health Plan Plus, Galvan had to purchase glasses for her. Her budget forced her to pick between buying the glasses and being on time with one of her bill payments. She chose the glasses.
Galvan, 27, doesn’t know how she’ll build up a cushion of savings for medical expenses down the road, and the question constantly nags her as the end of the public health emergency looms.
“How am I going to come up with extra money if my daughter’s not going to qualify for Medicaid?”
CORRECTION: This story was updated at 1:55 p.m. on Nov. 1, 2022, to correct how often adults must reapply for Medicaid coverage during normal times. Adults must be re-evaluated for their eligibility for Medicaid coverage every year.