HomeMy WebLinkAbout20022030.tiff Colorado
Legislative
!r' • Room 029 State Capitol.Denver,CO 80203-1784
•
Council (303)866-3521 FAX: 866.3855 TDD: 866-3472
Staff
TRANSMITTAL MEMORANDUM
July 5, 2002
TO: Interested Persons
FROM: Whitney Gustin, Research Associate, 303-866-4789
Jeanette Chapman, Research Associate, 303-866-6136
SUBJECT: Health Care Resource Book, 2002
Enclosed is a copy of the most recent addition of the Health Care Resource Book.
The book was first published in 2000 to give state legislators an overview of major health
care issues and programs. The 2002 Resource Book has three sections which provide
information on:
• six health care issues, including health insurance, long-term care, and
prescription drugs;
• the budgets and programs of the state departments with health care
responsibilities; and
• programs. budgets, and services for different population groups, including
the elderly, women and children, and the disabled.
In addition, tables illustrating income eligibility levels for health care programs and the
current federal poverty levels are provided. An index appears at the back of the book to
assist the reader in finding specific information.
00 I, NZ,
a� 2002-2030
Health Care
Resource Book
2002
A Gulde tc (Major Colorado Health
Care Issues andPrograms
Resource Book Compiled by
Legislative Council Staff:
Jeanette Chapman, 303-866-6136
Whitney Gustin, 303-866-4789
Jim Hill, 303-866-4790
— INTRODUCTION
This resource book is intended to serve as a
reference guide for information on the most common
health care issues in Colorado. The book is divided
into three sections to make it easier for the reader to
access information. The first section covers major
issues such as the cost of health insurance, long-term
care, prescription drug costs, and the uninsured
population. The second section reviews the health
care programs of executive branch departments that
are of legislative interest. The final section provides
detailed information about specific programs, their
cost, and the services they provide by population
group. In addition, the reader may find information
based on a particular area of interest. An index has
been included to assist in finding that information.
Page 3
TABLE OF CONTENTS
—
MAJOR HEALTH CARE ISSUES 5
Health Insurance 6
— Long-Term Care 7
Prescription Drugs 8
Uninsured Population 9
— Small Group Market and Rural Health Care 9
STATE DEPARTMENT FUNCTIONS 11
Department of Health Care Policy and Financing 11
Department of Public Health and Environment 12
—
Department of Human Services 13
Department of Regulatory Agencies 13
Division of Insurance 13
— Division of Registrations 14
MAJOR HEALTH CARE PROGRAMS AND SERVICES 17
Elderly 17
— Medicaid 17
Older Americans Act Programs 18
Old Age Pension Health and Medical Care Fund 19
— Health Facilities Division 20
Women and Children 21
Medicaid 21
Children's Basic Health Plan 22
— Women, Infants, and Children 23
Family Planning Program 24
Mentally III and Substance Abusers 26
— Community Mental Health Services 26
Medicaid Mental Health Services 26
Non-Medicaid Mental Health Services 27
Alcohol and Drug Abuse Division 28
Disabled 29
Medicaid 29
Developmental Disabilities Services 30
_. Uninsured 31
Colorado Indigent Care Program 31
CoverColorado 33
— TABLES
I Sources of Payment for Health Care 5
II State-Subsidized Insurance Coverage and Services 12
III State Departments and Programs 15
_
IV Federal Poverty Levels 35
INDEX 36
Page 5
MAJOR
HEALTH CARE ISSUES
Health insurance costs are rising at double-digit percentages.
Growth in the elderly population has exceeded the national
average in the last ten years, increasing the demand for quality
long-term care and affordable prescription drugs. Approximately
15 percent of the state's population does not have health
_ insurance. In addition, rural areas are disproportionately faced
with fewer options in health care providers as well as higher costs
for the coverage rural residents do receive. Table I provides a
breakdown of how health care costs are paid across the state.
Private insurance and out-of-pocket payments account for nearly
60 percent of the spending for health care coverage.
Table I
Sources of Payment for Personal Health Care, 1998
PUBLIC
Medicaid
Medic are
Other Public 11.0%
16.1%
1/4 m`
Other Private
+extittin
Out-of-
' Pocket
Private Insurance
PRIVATE
"source: 2001 Colorado Health Data Book,Colorado Coalition for the Medically Underserved
Page 6
Health Insurance
Costs for health insurance have increased dramatically since
1998. The increase for small group health insurance premiums in —
Colorado illustrates this trend. For example, in 2000, the average
monthly small group insurance premium with a health
maintenance organization (HMO) for a family of four in Denver —
increased by 14 percent from the previous year to $497.
Likewise, the premiums for preferred provider organizations
(PPOs) and standard indemnity plans increased by 20 percent and
19 percent, respectively. In addition, premium costs vary
between rural and urban areas of the state. In Grand Junction, for
example, HMO premiums were 15 percent higher than those in —Denver; however, premium costs in Grand Junction for PPOs and
indemnity plans were between five and nine percent less than
those for Denver. While the Division of Insurance does not keep —
data on large group (those with 51 or more employees) insurance
premiums, national data indicates that large group premiums
reflect the increases of small group insurance premiums. —'
Six Colorado insurers account for half the market, and the
three companies with the largest market share are health —
maintenance organizations (Pacificare of Colorado, Kaiser
Permanente Health Plan, and HMO Colorado). Although HMOs —
account for approximately three percent of health insurers in the
state, with a total of 18 companies, they account for nearly 60
percent of the market share.
Colorado regulates group health insurance policies by
requiring coverage for: pregnancy and childbirth, newborn _
children, child immunizations, therapies for congenital defects
and birth abnormalities of children up to five years of age, low-
dose mammography, treatment for mental illness, diabetes, _
prosthetic devices and prostate cancer screening. Colorado
further regulates HMOs by requiring them to maintain a sufficient
network of providers; allow direct access to OB/GYNs; provide
standing referrals to specialists, requiring only a one-time referral
Page 7
for medically necessary treatment; permit emergency room access
24 hours a day, seven days a week; and provide for an
independent and external review of patient grievances. In
addition, Colorado bans gag clauses that restrict doctors'
communication with enrollees. Colorado law does not cover self-
insured plans.
Long-Term Care
Long-term care involves a wide variety of services for people
with a prolonged physical illness, disability, or cognitive disorder.
Services are aimed at helping people with chronic conditions who
are limited in their ability to function independently. As the
_ country's population ages, the costs of these services are of
increasing concern to patients and their families, as well as to the
government. Long-term care continues to be one of the largest
_ health care expenses in the country and in Colorado. Basic
nursing home costs in Colorado typically range from $95 to $144
per day, with higher costs in the Denver metropolitan area.
Personal care services at home cost between $13 and $16 per
hour, with most older clients typically needing two or three hours
of service, three or four days per week.
Medicare, the federal health insurance program for the elderly
and disabled, covers only short-term nursing home stays, as well
- as hospitalization and physician services. Medicaid, the health
program for the very poor, is the primary payer of publicly
funded long-term care. For fiscal year 2001-02, approximately 41
- percent of Colorado's entire Medicaid budget will go toward
long-term health care costs. Nursing home utilization remains
steady, but high demand for other long-term care services, such as
home- and community-based services, has led to waiting lists and
higher occupancy rates for alternative care.
Long-term care insurance is designed to pay the cost of
medical and personal care for individuals. The policies pay a
certain daily maximum dollar amount for a specific time period.
Page 8
Consumers pay the balance. Colorado requires that long-term --
care insurers offer two packages: the Basic Nursing Home Long-
Term Care Insurance and Standard Nursing Home/Home Care
Long-Term Care Insurance. The Basic program provides —
catastrophic coverage while the Standard plan is more
comprehensive. Although Colorado offers a tax incentive to
purchase long-term care insurance, it is currently an underutilized —
coverage option.
Prescription Drugs
In 1998 and 1999, spending on prescription drugs increased —
over 18 percent per year, bringing national spending on
prescription drugs to more than $94 billion. In 2000, the cost of
prescribed medications was expected to jump another 11 percent. —
At the same time, the number of patients accessing prescription
drugs continues to increase, as does the number of prescriptions
used by each patient. The pricing of prescription drugs is itself a —.
difficult issue. Different institutional customers receive different
discounts. A recent study estimated that large HMOs buy drugs
for 30 to 39 percent less than the retail price, approximately twice —
the discount most state Medicaid programs receive.
The elderly are the largest consumer group of prescription --
medications. While seniors make up just 13 percent of the state's
population, they consume about 30 percent of prescribed _
medications. Rising drug prices therefore disproportionately
impact the elderly. Although all individuals over 65 are covered
by Medicare, the program does not provide prescription drug —
coverage except in a few cases. Some senior citizens have access
to discounted prescription drugs through employer retiree health
insurance; some purchase supplemental "Medigap" insurance;
and some low-income seniors qualify for Medicaid. Drug
companies also provide some low-cost medications to lower-
income consumers. However, approximately one-third of all
Medicare recipients have no access to discounted prescription
drugs.
Page 9
Uninsured Population
_ The number of uninsured in Colorado has increased in the last
decade from 517,000 in 1990 to 700,000 in 2000. While the
number of uninsured continues to grow, the percentage of the
_ state's population without insurance has remained relatively
stable at around 15 percent.
Three quarters of uninsured Coloradans live in families with
at least one full-time worker. The highest percentages of
uninsured reside in Alamosa, Conejos, Costilla, Mineral, Rio
Grande, and Saguache counties. Young adults between 18 and
24 years of age are least likely to have insurance. Working adults
between ages 18 and 64 make up a disproportionate share of the
_ uninsured. While individuals in this age group make up
approximately 65 percent of the state's population, they account
for nearly 75 percent of the uninsured. In contrast, the elderly,
_ because of the availability of Medicare, are more likely to be
insured than any other age group.
_ Uninsured status is correlated with poverty; those with the
lowest incomes make up a disproportionate share of the
uninsured. Although Coloradans with incomes below 200 percent
of the federal poverty level make up approximately 30 percent of
the population, these individuals account for nearly 60 percent of
the uninsured.
Small Group Market and Rural Health Care
Colorado's small group market includes employers with 50 or
fewer employees and business groups of one, which are usually
self-employed individuals. State law requires carriers in the small
group market to offer insurance products to groups of one to 50
employees, regardless of the health status of the group. Under
state law, all carriers in the small group market are required to
offer basic and standard health care plans. Only four percent of
Page 10
carriers offer traditional indemnity plans. Preferred provider _
plans and health maintenance organizations make up 37 percent
and 59 percent of the small group market, respectively.
Rural areas typically face higher-than-average health care
costs. There are several factors that influence the cost differential
including a lower volume of customers which tends to yield higher-than-average costs per visit, a higher percentage of
Medicaid and Medicare recipients that leads to cost shifting, and
fewer providers which makes health plan contracting less —
appealing to providers. As there are generally fewer HMOs that
serve rural areas, customers are disproportionately reliant on
traditionally more expensive indemnity plans. In recent years, —
many carriers have elected to discontinue coverage to rural areas.
There are approximately 33 small group carriers listed with the
Division of Insurance and several of those offer plans only in —
metropolitan areas.
Page 11
STATE
DEPARTMENT FUNCTIONS
The state departments that focus much of their work on
health-related issues are Health Care Policy and Financing, Public
— Health and Environment, Human Services, and Regulatory
Agencies. Each, department administers several programs to
address Coloradans' various health care needs. County
— departments of social services are the primary source for
determining eligibility. Eligibility for programs often depends
largely on an individual's income level. Table II on page 12
— shows the income eligibility requirements for the main state
medical coverage programs. All of these programs are
administered by the Department of Health Care Policy and
— Financing. Table III on page 15 shows the different programs
described in this book and the departments that administer them.
Department of Health Care Policy and Financing
�- The Department of Health Care Policy and Financing
(HCPF) is the federally recognized single state agency for
administering the Colorado Medicaid Program. The Department
— also develops and provides policy, program, and financial
oversight for the Children's Basic Health Plan, the Colorado
Indigent Care program, and several other statewide health
programs. The entire budget of the Department of Health Care
Policy and Financing is used for health-related programs.
Approximately half of its funding comes from federal money and
— the remaining half from state funds.
Department of Health Care Policy and Financing
— Fiscal Year 2001-02 Budget
Ninfanin giiIPODDOISMIi!POORECash Funds :federal :t
Appropriation Funds Funds Exempt Funds
fmillio[ts) Amiss) ! fm{iJianslmmosohow gymilliehom
$2,449 $1,093 $11 $139 $1,207
100% 45% 0% 6% 49%
Page 12
Table II
State-Subsidized Insurance Coverage and Health Care Services
Family Income
as%of FPL
222%
Medicaid
200% NO SUBSIDY FOR CARE OR COVERAGE if LTC
eligible
155%
CICP CICP
Only CHP+and CICP Only
133%
100% Medicaid Medicaid
74%
Medicaid
39%
0% Pregnant 0 through 5 6 through 15' 19+ Persons with
Women (Adults) Disabilities
' Children born after September 30, 1983,who ere over age 5 and In in families with incomes at 100 percent of
poverty are covered. -'-
Department of Public Health and Environment
The Department of Public Health and Environment (CDPHE)
provides public health and environmental protection services. _
Health program areas include disease control, local health
services, inspection of hospitals and nursing homes, emergency
medical services, and preventive medical services for children. _
County departments of health, nursing home facilities, and
community health clinics provide these services. Approximately
65 percent of the Department's budget goes toward health-related
programs. A majority of the budget is made up of federal funds.
Department of Public Health and Environment
Fiscal Year 2001-02 Budget
Total General Cash Cash Funds Federal
Appropriation Fund Fund Exempt Funds
(minions) (millions) (millions) (minions) (maims)
$263 $35 $24 $54 $150
100% 13% 9% 21% 57%
Page 13
_ Department of Human Services
_ The Department of Human Services (DHS) provides health
and non-health-related services through county departments of
social services, state mental health institutes, youth corrections
_ facilities, nursing homes, vocational rehabilitation offices,
regional centers for persons with developmental disabilities, and
numerous community-based public and private providers.
_ Health-related services include those administered by the Alcohol
and Drug Abuse Division, Developmental Disabled Services,
Division of Aging and Adult Services, Mental Health Services,
_ and the Old Age Pension Health and Medical Care Fund.
Because some programs incorporate both health and non-health
related aspects, it is difficult to specify exactly how much of the
_ budget goes toward health-related services. A large portion of the
budget is funded through cash funds exempt due to transfers of
Medicaid dollars from the Department of Health Care Policy and
Financing.
Department of Human Services
Fiscal Year 2001-02 Budget
Total Cseneral Cash Cash Funds Fedetal
AFpropnafron Funds Funds. Exempt Funds
— (mtntons} (millions) (nuuoas)- (mtntons) (millions)
$1,815 $519 $66 $730 $500
100% 29% 4% 40% 28%
Department of Regulatory Agencies
The Department of Regulatory Agencies (DORA) addresses
the health care needs of the state through the Division of
— Insurance and the Division of Registrations. Approximately 30
percent of the Department's $68 million budget is allocated to
these two divisions. The Division of Insurance works to promote
— a competitive insurance marketplace, which allows for affordable
insurance and adequate consumer choice. The Division regulates
Page 14
insurance companies, non-profit hospitals and health service —
corporations, health maintenance organizations, and workers'
compensation self-insurance pools through financial
examinations, inspections, and enforcement of regulations. The —
Division also acts as a consumer advocate, responding to and
investigating complaints from consumers. The Division of
Insurance is funded almost entirely through tax assessments on —
insurers and license fees paid by regulated entities.
Division of Insurance —
Fiscal Year 2001-02 Budget
Total General £ash ' Cash Funds Federal
ApproAnation fund Funds Exempt Funds ..' —
$7 million $0 $6.8 million $72,225 $192,215
100% 0% 96% 1% 3%
The Division of Registrations works to protect health care
consumers through licensure of qualified medical practitioners, —
facilities, programs, and equipment. Its occupational boards and
licensing programs have been created by the General Assembly to
ensure a minimum level of competency among licensees and to —
protect the public welfare. The Division conducts inspections,
investigates complaints, and restricts or revokes licenses when
standards of practice have not been met. The budget is primarily —
funded through fees paid for licensure or registration by those
professions regulated by the Division.
Division of Registrations
Fiscal Year 2001-02 Budget
Total ! General Gash Cash funds Federal > —
Appropriation . Fund Funds Exempt Funds
(millions) (millions) (millions) (nnliions) (millions)
$13 $0 $11 $2 $0 -
100% 0% 83% 17% 0%
Page 15
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Elderly...Page 17
MAJOR HEALTH CARE
PROGRAMS AND SERVICES
Colorado provides health care-related programs and services
for low-income citizens of all ages with various care needs.
— These programs serve the elderly, women, children, the mentally
ill, substance abusers, the disabled, and the uninsured. This
section is organized by these population groups and provides the
- costs and eligibility requirements for each program as well as the
services provided.
ELDERLY
Many state government programs in Colorado provide health
care assistance to the elderly. The programs that are most
commonly discussed by the General Assembly are highlighted
here. Colorado will spend approximately $678 million on
programs for the elderly that are administered by the Department
of Health Care Policy and Financing, the Department of Human
Services, and the Department of Public Health and Environment.
Approximately $323 million of the total appropriation comes
- from the General Fund.
Medicaid
Medicaid is the state and federal health care coverage
program for poor individuals of all ages. Elderly individuals
typically qualify for Medicaid by first qualifying for the
Supplemental Security Income (SSI) or Old Age Pension (OAP)
programs. Qualifying for OAP is based on income and resources,
while SSI requires a disability diagnosis and contains income and
resource limitations.
Page 18...Elderly
Medicaid for the Elderly ^
Fiscal Year 2001-02 Budget
Total: G nerai Gast► Cash l ands Federal
Appropriation fund funds Exempt Funds : —
(mittions} (milkons) (milbons) (minions) (an&ons)
$642 $321 $0 $0 $321
100% 50% 0% 0% 50%
Budget: Colorado receives an approximately one-to-one federal-
to-state dollar match for Medicaid.
Number of enrollees: FY 01-02 is estimated at 49,603.
Cost per enrollee: FY 01-02 is estimated at $12,951. —
Services: Clients may access services that include nursing
facilities, community long-term care, HMO physician care, home
health, pharmaceuticals, Title XVIII Medicare coinsurance and
deductibles, Program for All-Inclusive Care for the Elderly _
(PACE), inpatient and outpatient hospital, hospice care, as well as
nursing care and durable medical equipment.
Eligibility: There are several categories of eligibility for
Medicaid benefits. Individuals who qualify for the federal
Supplemental Security Income program for people age 65 and _
older are also eligible for Medicaid. Individuals who are below
the age of 65 and are disabled may also qualify for Medicaid.
Older Americans Act Programs
The Aging Services programs of the Department of Human
Services provide health- and non-health-related services for
disabled or vulnerable adults who require some level of assistance _
to maintain their independence. The major medical program
areas are Older Americans Act programs and Old Age Pension
Health and Medical Care. The Older Americans Act programs
are available to individuals who are aged 60 or older and have
difficulty with some aspects of daily living.
Elderly...Page 19
— Older Americans Act Programs
Fiscal Year 2001-02 Budget
Total eneral Cash Cash Funds federal
— Appropriation 'Fund Funds:: Exempt funds
(milions) (millions} (millions) (milions) {m lions}
$18 $2 $3 $3 $10
100% 11% 17% 17% 57%
Budget: The cash fund source comes from state sales and use
taxes transferred to the Older Coloradans Fund, and the cash
funds exempt dollars come from local sources. Federal finding is
from the Older Americans Act.
Number of persons served: FY 01-02 is estimated at 64,114.
Cost per person served: FY 01-02 is estimated at$281.
Services: Services include employment programs, nutrition
programs, transportation and information services, and
ombudsman services.
Eligibility: Anyone over age 60 is eligible for services. There is
no means test.
Old Aqe Pension Health and Medical Care
This fund is for those low-income persons aged 60 and older
receiving Old Age Pension payments who are not eligible for
Medicaid.
Old Age Pension Health and Medical Care Fund
Fiscal Year 2001-02 Budget
total '-Genera[; Gash Cash Funds :;;Federal ;!
APPropnatton Fund infoiddp
(millions) (!pillions},.... fmillions) (millions) fmilions):,::j'
$9.8 $0 $0 $9.8 $0
100% 0% 0% 100% 0%
Page 20...Elderly
Budget: Money for the Old Age Pension Health and Medical
Care Fund is taken out of state dollars before they reach the
General Fund. The Health and Medical Care Fund is capped at
$10 million.
Number of enrollees: FY 01-02 is estimated at 3,395.
Cost per enrollee: FY 01-02 is estimated at $2,902.
Services: Services available to this population are the same as
Medicaid, except that recipients cannot access inpatient
psychiatric care, nursing home care, or home- and community- _
based services (i.e., alternatives to nursing home). Beneficiaries
of Old Age Pension may also be eligible for the medically
correctable program, burial, and home care allowance.
Eligibility: The income eligibility test for this program is
constitutionally established and adjusted for cost of living. In
2001, the income amount was $582 per month.
Health Facilities Division
The Health Facilities Division within the Department of —
Public Health and Environment establishes and enforces
standards for the operation of health care facilities throughout the
state, ensuring that elderly patients and residents receive quality —
care from health care facilities and programs.
Health Facilities Division —
Fiscal Year 2001-02 Budget
7atal General Cash Cash Funds federat
Appropriation Fund Funds Exempt :,' 1 ands —
$7.6 million $231,000 $470,000 $4 million $3 million
100% 3% 6% 48% 43/0 u
Elderly...Page 21
Budget: Funding for the Division comes primarily from Medicaid
moneys transferred from the Department of Health Care Policy
and Financing (cash funds exempt) and federal finds.
Number of persons served: The Division oversees 231 nursing
homes with approximately 17,285 residents. Seven of these
— nursing facilities are private; the remaining 224 are eligible for
state and federal funds and serve approximately 16,990 residents.
Cost per facility: FY 01-02 estimated cost per facility inspection
is $33,976.
Services: Services include licensure of hospitals and other health
care facilities, HMOs, and personal care boarding homes;
certification of nursing homes; and training for individuals to
administer medications in residential care facilities and adult day
care programs.
Eligibility: The Division primarily oversees facilities that accept
Medicare and Medicaid enrollees.
•WOMEN fink)CHiLDREl+t
Four major programs provide health care services to women
and children. The Department of Health Care Policy and
_ Financing and the Department of Public Health and Environment
administer these programs. In Fiscal Year 2001-2002, the state of
Colorado will spend approximately $476 million on the programs
_ discussed here; $197 million of that total comes from the General
Fund.
Medicaid
Low-income women and children who are categorically
eligible for programs such as Temporary Assistance to Needy
Page 22...Women and Children
Families (TANF) or other programs targeted to this population —
such as Baby Care Kids Care may receive health care coverage
through Medicaid.
Medicaid for Women and Children
Fiscal Year 2001-02 Budget
Total t'aenerat Cash 'Cash Funds t ederai _
Appr4priatOri Fund Funds Exempt Fuiids .
!. {millions)` {millions) `(millions) (millions) {millions)
$372 $186 $0 $0 $186
100% 50% 0% 0% 50%
Budget: Colorado receives an approximately one-to-one federal-
to-state dollar match for Medicaid. —
Number of enrollees: FY 01-02 is estimated at 183,723.
Cost per enrollee: FY 01-02 is estimated at $2,025.
Services: Enrollees are provided physician and clinic services, —
hospital care, prescriptions, home health care, and mental health
services. Children may receive additional coverage including
early and periodic screening, diagnosis and treatment (EPSDT),
dental and vision services, and immunizations.
Eligibility: Individuals qualify for Medicaid through TANF or by
meeting specific income requirements that vary based upon the
age and health status of the applicant. In Colorado, the eligibility _
threshold for pregnant women and infants is 133 percent of the
federal poverty level.
Children's Basic Health Plan
The Children's Basic Health Plan (CHP+) provides health
insurance to uninsured children from families at or below 185
percent of the federal poverty level. Families pay an annual —
enrollment fee of$35 and make co-payments of$1 to $5 for most
services.
Women and Children...Page 23
Children's Basic Health Plan
Fiscal Year 2001-02 Budget
TotalmiGeneratmi Cash:;; Cash!Funds :: :Federal'o
Appropnatlori Fund Funds Exempt Funds
$47 million $9 million $250,000 $10 million $28 million
100% 18% 5% 21% 60%
Budget: Colorado receives a two-to-one federal-to-state dollar
match. The cash funds exempt is an annual amount from the
tobacco settlement, and the cash funds come from family
enrollment fees.
Number of enrollees: FY 01-02 is estimated at 40,688.
Cost per enrollee: FY 01-02 is estimated at $1,157 per year.
Services: Services include insurance coverage for medical care
including inpatient and outpatient hospital services, physician
services, prescription drugs, and mental health services.
Beginning in February 2002, a dental benefit will be part of the
medical care package available to children enrolled in the
program.
Eligibility: Children under the age of 19 whose families are at or
below 185 percent of the federal poverty level and who are not
eligible for Medicaid are eligible for the program.
Women, Infants, and Children
The Special Supplemental Food Program for Women, Infants,
and Children (WIC) is a federal nutrition program for pregnant
_ women and children up to age five. The goal of the program is to
decrease the incidence of anemia, height/weight deviations, and
low birth weight through maximizing nutrition services to high-
risk populations. In Colorado, WIC is administered by the
Department of Public Health and Environment.
Page 24...Women and Children
Women, Infants,and Children
Fiscal Year 2001-02 Budget
MingTOWERWMPOnOtt !Cashia;ii:gowrOgnig.pooton
A} propriatlon Fund Funds .Exempt Funds —
(mi!ltonsl (minions} (inimans} ,. (miliion5} (rriiS.nsJ ,€
$53 $0 $0 $0 $53
100% 0% 0% 0% 100% -
Budget: The WIC program is fully funded by the U.S.
Department of Agriculture. Funding is provided on month-to- —
month basis.
Number of enrollees: The Colorado WIC program currently —
serves approximately 75,000 persons. Of those participants,
approximately 19,000 are women, 20,000 are infants, and 35,500
are children between the ages of one and five.
Cost per enrollee: For FY 00-01, the average monthly food
benefit to participants was $48. —
Services: The program provides nutrition education, referrals,
and nutritious food to supplement the regular diet of pregnant and
breast-feeding women, infants, and children under the age of five.
There are approximately 125 clinics throughout the state that
provide WIC services.
Eligibility: Enrollees must have incomes under 185 percent of the
federal poverty level and qualify as "nutritionally at risk," which —
is determined by a county health department during a WIC visit.
Family Planning Program
The program provides family planning services to women and
men through county health departments, county nursing services,
and non-profit organizations. The program's services emphasize _
prevention through clinical exams and patient education.
Women and Children...Page 25
Family Planning Program
Fiscal Year 2001-02 Budget
Total t eneral ? gash Cash;Funds :Federal:
—
Approprtaftdn SFOrtcWwExempt Funds `i
1t111111CFt$) ..Ilr tltt4nsi (rnfltipnSJn:VilifteOnig Nyijiadarp
$4 $1 $0 $0 $3
100% 31% 0% 0% 69%
Budget: The program receives some funding through state
— General Fund dollars and Title X, a federal grant that makes
family planning services available to low-income individuals.
Clinics receive approximately $6 million in additional funding
— from local sources and from donations and patient fees.
Number of persons served: There are 65 sites throughout the state
- that provide services to over 55,000 women and men. Seventy-
seven percent of patients served have incomes at or below 150
percent of poverty.
Cost per person served: FY 01-02 is estimated at $71 per patient.
— However, this estimate does not include funds from other sources.
When community sources, donations, and fees are included, the
estimated cost for providing a year's worth of services is $181 per
patient.
Services: Program services include gynecological and male
_ exams, cervical, breast, and testicular cancer screening,
contraceptive information and supplies, sexually transmitted
disease testing and treatment, health education and counseling,
_ and referrals. The program does not pay for abortion services.
Eligibility: Anyone is eligible to receive services. Patient fees
are determined by the patient's income level.
Page 26...Mentally Ill and Substance Abusers
`MENFA tx Ii t AND 5tl8STA►+tC ABUSERS
There are several means by which Colorado state government —
provides assistance with mental health and substance abuse
services. The majority of these programs are implemented
through the Alcohol and Drug Abuse Division (ADAD) and —
Mental Health Services (MHS). Colorado will spend
approximately $233 million in FY 2001-2002 to administer the
programs highlighted here; approximately $116 million of that
total comes from the General Fund.
Community Mental Health Services
The Colorado Mental Health Services program, within the —
Department of Human Services, provides mental health treatment
to the community for Medicaid eligible and non-Medicaid
eligible patients. The program supports community-based mental —
health treatment by purchasing services from 17 community
mental health centers, three specialty clinics, and seven Mental _
Health Assessment and Service Agencies (MHASAs). The
Department of Health Care Policy and Financing contracts with
Mental Health Services to provide mental health care to the
Medicaid population by purchasing services from the MHASAs.
The MHASAs are responsible for implementing Medicaid mental
health capitation and case management programs.
Medicaid Mental Health Services
Medicaid Mental Health Services
Fiscal Year 2001-02 Budget
• Total General Cash Gash Funds Federal
Appropriation Fund Funds Exempt . Funds
(minions)i Cmthons} (millions) {millions) fmlltions)
$155 $78 $0 $0 _ $78
100% 50% 0% 0%
50%
Mentally Ill and Substance Abusers...Page 27
Budget: Colorado receives approximately one dollar from the
federal government for each dollar it spends on Medicaid.
Number of Persons Served: FY 01-02 is estimated at 36,787
children and adults.
Cost Per Person Served: FY 01-02 is estimated at $4,220 per
person, including anti-psychotic pharmaceuticals.
Services: A wide range of services, including hospitalizations
and pharmaceuticals, are provided by the MHASAs, which
_ determine the appropriate level of service.
Eligibility: Eligibility is determined by Medicaid eligibility rules.
Non-Medicaid Mental Health Services
Non-Medicaid Mental Health Services
Fiscal Year 2001-02 Budget
FY 07 1$ General r t Cash Cash Funds Mf#1006
Total Fund Funds Exem}3imania
IrtritGorrs} (rnt7Gons} (nutGuns}- (mflhonsl . . (rmffrons)
$45 $29 $0 $11 $5
100% 64% 0% 25% 11%
Budget: Community mental health agencies receive additional
— funds from many sources. Most of these funds are not reflected
in the state budget because they are not state dollars. Of the
General Fund dollars listed, $9.2 million is provided to the 1,600
— members of the Goebel lawsuit settlement class.
Number of persons served: FY 01-02 is estimated at 38,629.
Cost per person served: FY 01-02 is estimated at $962, however,
this estimate does not include funds from other sources. When
— community sources are included, the estimated cost per person is
$2,162.
Page 28...Mentally Ill and Substance Abusers
Services: Services provided include a range of inpatient and
outpatient mental health services. Inpatient services are provided
through referrals to the state's two mental health institutes.
Eligibility: Anyone may take advantage of services at a
community mental health agency, however, to qualify for public
assistance to help pay for those services, individuals' incomes are —
evaluated according to a sliding scale.
Alcohol and Drug Abuse Division
This Division (ADAD), within the Department of Human
Services, develops, supports, and advocates for comprehensive
prevention, intervention, and treatment services to reduce alcohol, _
tobacco, and drug abuse. Treatment, prevention and
detoxification services are provided primarily through four
managed care organizations in six different geographic areas of
the state. —
Alcohol and Drug Abuse Division
Fiscal Year 2001-02 Budget _
FY0102. General Cash Gash Funds Federal
Total ` Funds Funds Exempt Funds
$33 million $9 million $2 million 760,000 $22 million —
100% 27% 6% 2% 65%
Budget: The majority of funds come from a federal Substance
Abuse Block Grant and other federal grants.
Number of persons served: FY 01-02 is estimated at 27,000
shelter/detoxification admissions and 17,000 substance abuse
treatment admissions.
Cost per person served: Cost varies according to services
provided, ranging from approximately $300 for detoxification to
$3,000 for a residential treatment program.
Mentally III and Substance Abusers...Page 29
Services: Prevention services include information dissemination,
education, alternative activities, problem identification and
— referral. The division also approves, monitors, and investigates
treatment programs and sets standards for alcohol and drug abuse
counselors.
Eligibility: Anyone needing the services of the Division is
eligible to participate.
There are two state programs that address the needs of the
physically and developmentally disabled population in Colorado.
— The Department of Health Care Policy and Financing and the
Department of Human Services administer these programs.
Colorado spends approximately $784 million on the programs
— described here, of which $269 million is from the General Fund.
— Medicaid
Individuals who receive Medicaid disabled assistance have
— been deemed permanently and totally disabled by the Disability
Determination Service and are eligible for federal Supplemental
Social Security.
Medicaid for the Disabled
Fiscal Year 2001-02 Budget
Total General Cash ' Cash Funds Federal ;'
g4100000011!;,$ Fund Funds Exempt Funds
Ittt8lion) fmirr(ons) (mr7t ans) trnruions) {rrrtrttons)
$486 $243 $0 $0 $243
100% 50% 0% 0% 50%
Budget: Colorado receives an approximately one-to-one federal-
to-state dollar match for Medicaid.
Page 30...Disabled
Number of persons served: FY 01-02 is estimated at 49,797.
Cost per person served: FY 01-02 is estimated at$9,752.
Services: Services include managed health care through HMOs,
inpatient hospital visits, pharmaceuticals, access to nursing
facilities, home- and community-based services for the elderly, —
blind, and disabled, home health care, and Medicare coinsurance
and deductibles.
Eligibility: Those individuals who qualify for either Aid to the
Needy Disabled, Supplemental Security Income or Aid to the
Blind qualify for Medicaid Disabled benefits.
Developmental Disabilities Services
The Office of Rehabilitation and Disabilities Service, which _
includes Developmental Disabilities Services (DDS), is within the
Department of Human Services and is responsible for managing
the provision of state and Medicaid-funded services and supports _
for adults with developmental disabilities. Services to children
with developmental disabilities are managed by Children's Health
and Rehabilitation Services, also within DHS.
Developmentally Disabilities Services
Fiscal Year 2001-02 Budget
FY 01 02. Generat cash •casts funds Federal
• Total Fund Funds exempt Funds
{rnlnronsl. (rnr'llions) (millions) {rnd/evrfsJ (millions) _
$298 $26 $2 $271 $0
100% 9% .01% 91% 0%
Budget: Approximately 91 percent of the total budget for
Developmental Disabilities Services comes from transfers of state
and federal Medicaid funds from the Department of Health Care
Policy and Financing to the Department of Human Services.
Disabled...Page 31
— Most of the remaining 10 percent of the total budget is from the
General Fund.
— Number of persons served: As of July 2001, there were
approximately 12,019 adults and children in community-based
services and approximately 400 in institutional services.
Cost per person served: Cost varies among programs, spending
up to $73,000 for comprehensive services down to $5,345 for
— family support services.
Services: Services include case management and ancillary
services, day and residential services, and supported living
services. Services to children include family support and early
childhood services, as well as case management.
Eligibility: Eligibility is determined by Medicaid eligibility rules
and a diagnosis of developmental disability.
hanNSAIRtganteMENEMEENOMMENKIMENERESEngi
There are two state programs that provide medical care
coverage for those who are unable to get private insurance and do
not qualify for Medicaid or another program. Colorado spends
approximately $292 million for these programs that are
administered by the Department of Health Care Policy and
Financing and CoverColorado. Approximately $26 million of the
total appropriation comes from General Fund.
Colorado Indigent Care Program
The Colorado Indigent Care Program (CICP) provides a
reimbursement to participating hospitals and clinics that serve
uninsured or under-insured Coloradans who are not eligible for
Medicaid. Participating hospitals and clinics determine an
Page 32...Uninsured
individual's program eligibility and co-payment on site. —
Providers are reimbursed approximately 30 cents on the dollar by
CICP for part of the cost of the treatment.
Colorado Indigent Care Program
Fiscal Year 2001-02 Budget
Total General mm Cash Cash Funds F decal
Appropriation Fund Funds Exempt Furtda
$288 million $26 million $250,000 $127 million $135 million
100% 9% 0% 44% 47% —
Budget: Approximately half of the budget for CICP comes from
federal funds and less than ten percent of spending comes from —
the General Fund.
Number of persons served: For FY 99-00, CICP estimated there —
were 156,000 individuals served, approximately 10,000 for
inpatient care and 146,000 for outpatient care.
Cost per person served: Costs vary greatly according to services
provided.
Services: CICP services are prioritized and delivered on site
according to the following guidelines:
• At a minimum, providers must give emergency and urgent
care to persons presenting themselves to a facility.
• Additional medical care may include prenatal care, lab, x-
ray, on-site pharmacy, and transportation. —
• Providers may give any other additional medical care to
the extent of their resources. _
Eligibility: Individuals must have income or assets equal to or
less than 185 percent of the federal poverty level and must not _
qualify for Medicaid.
_ Uninsured...Page 33
CoverColorado
_ CoverColorado (formerly Colorado Uninsurable Health
Insurance Plan, or CUHIP) provides major medical health
insurance to Colorado residents who have been denied access to
health insurance because of pre-existing medical conditions.
CoverColorado
Fiscal Year 2001-02 Budget
;.!!!!!R:MiligWattfEEMP00DTgriii iiegORtg4Mtga gift1DMER
gON.P.0090t2i!!!!iPFund Funds: Exempt Funds
rmilliors) lm+�kons7 {rrrfllrortsl {rrrrurCnsl... . .....{mlUionsl...:%
$4.4 $0 $0 $4.4 $0
_ Budget: CoverColorado is funded by interest earned from the
Business Associations' Unclaimed Moneys Fund that includes
money orders, paychecks, and life insurance policies that have
_ never been cashed. In addition, HB 01-1319 allows
CoverColorado to meet any additional expenses by collecting the
balance from insurance companies. Enrollee premiums also help
_ to cover the program's costs.
Number of enrollees: There were 2,881 enrollees as of February
— 1, 2002.
Cost per enrollee: In 2000, the average annual medical expenses
— per enrollee were $4,210. The average premium paid by
enrollees was.$218 per month.
— Services: Services include inpatient and outpatient hospital care,
skilled nursing facilities, transplants, home health care,
prescription drugs, preventive care, mental health and substance
— abuse treatment, and hospice care.
Eligibility: To participate in the CoverColorado program, an
— individual must have been a resident of Colorado for at least six
months and meet one of these conditions:
Page 34...Uninsured
• applied for health insurance, but the application was
rejected because of a medical condition, the premium was
too high, or treatment of pre-existing health conditions has been excluded for more than six months under the
application;
• had insurance coverage involuntarily terminated by an
insurer for reasons other than nonpayment of premiums;
• have a pre-qualifying medical condition, such as AIDS or
HIV, metastatic cancer, cystic fibrosis, etc.; or
• be eligible for the Health Insurance Portability and
Accountability Act (HIPAA) of 1996.
Page 35
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Page 36
INDEX -
Aging and Adult Services 13, 15
Alcohol and Drug Abuse Division (ADAD) 13, 15, 26, 28-29 —
children 6, 11-12, 15, 17, 21-24, 27, 30-31
Children's Basic Health Plan (CHP+) 11, 12, 15, 22-23
Medicaid 12, 15, 21
Women, Infants, and Children (WIC) 15, 23-24
Children's Basic Health Plan (CHP+) 11-12, 15, 22-23
Colorado Indigent Care Program (CICP) 11, 12, 15, 31-32
CoverColorado 31, 33-34 —
Department of Human Services (DHS) 13, 15, 17-18, 26, 28-30
Aging and Adult Services 13, 15
Alcohol and Drug Abuse Division (ADAD) 13, 15, 26, 28-29 _
Developmental Disabilities Services (DDS) 15, 30
Mental Health Services (MHS) 13, 15, 26-28
Old Age Pension Health and Medical Care Fund 13, 15, 19-20
Older Americans Act Programs 18-19 —
Department of Health Care Policy and Financing (HCPF) 11, 13, 15,
17, 21, 26, 29-31
Children's Basic Health Plan (CHP+)' 11-12, 15, 22-23 _
Colorado Indigent Care Program (CICP) 11-12, 15, 31-32
Medicaid 7-8, 10-12, 13, 15, 17-23, 26-27, 29-32
Department of Public Health and Environment (CDPHE) 12, 15, 17, 20-
21, 23 —
Family Planning Program 15, 24-25
Health Facilities Division 15, 20-21
Women, Infants and Children (WIC) 15, 23-24
Department of Regulatory Agencies (DORA) 13-15
Division of Insurance (DOI) 6, 13-15
Division of Registrations 13-14
disabled population 7, 12-13, 15, 17-18, 29-31 —
Medicaid 12, 15, 29-31
Developmental Disabilities Services (DDS) 15, 30-31
Division of Insurance (DOI) 6, 13-15
Division of Registrations 13-14 —
elderly population 5, 7, 9, 15, 17-21, 30
Aging and Adult Services 13, 15
Health Facilities Division 15, 20-21 —
long-term care 5, 7-8, 12, 18
Medicaid 15, 17-21
Old Age Pension Health and Medical Care Fund 13, 15,19-20
prescription drugs 5, 8 —
Family Planning Program 15, 24-25
Page 37
— federal poverty levels 35
Health Facilities Division 15, 20-21
health insurance 5-7, 33-34
Division of Insurance (DOI) 6,.13-15
rural health care 9-10
small group health insurance market 6, 9-10
long-term care 5, 7-8, 12, 18, 29-31
— Medicaid 7-8, 10-11, 13, 15, 17-23, 26-27, 29-32
children 12, 15, 21
disabled 12, 15, 29-31
elderly 15, 17-21
mentally ill 15, 26-29
women 12, 15, 21-25
Medicare 7-10, 18, 21, 30
— mentally ill 13, 15, 17, 26-28
Medicaid 15, 26-27
non-Medicaid 27-28
Old Age Pension Health and Medical Care Fund 13, 15, 19-20
prescription drugs 5, 8,
Program for All-Inclusive Care for the Elderly (PACE) 18
rural health care 9-10
— senior citizens (see elderly population)
small group health insurance market 6, 9-10
substance abusers 15, 17, 26, 28-29
Alcohol and Drug Abuse Division (ADAD) 13, 15, 26, 28-29
uninsured population 9, 15, 17, 31-34
Colorado Indigent Care Program (CICP) 11, 15, 31-32
CoverColorado 31, 33-34
— women 15, 17, 21-25
Family Planning Program 15, 24-25
Medicaid 12, 15, 21-22
Women, Infants, and Children (WIC) 15, 23-24
Women, Infants, and Children (WIC) 15, 23-24
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