HomeMy WebLinkAbout20001501.tiff COLORADO GENERAL ASSEMBLY
EXECUTIVE COMMITTEE COMMITTEE
Sen. Ray Powers,Chairman Sen. Ken Chlouber
•
Rep. Russell'George,Vice Chairman • C' p Sen. Gigi Dennis
Sen.Tom Blickensderfer Sen. Rob Hernandez
Sen.Michael Feeley F: Sen. Doug Lamborn
Rep. Doug Dean rn O Sen. Pat Pascoe
Rep. Ken Gordon * * Sen. Bill Thiebaut
t rM Rep. Bob Bacon
STAFF {` Ia T• • Rep. Dorothy Gotlieb
Charles S. Brown,Director . . -" Rep.Steve Johnson
Daniel Chapman,Assistant Director, LEGISLATIVE COIJNCIL Rep.Shawn Mitchell
Administration Rep.Lola Spradley
Deborah Godshall,Assistant Director, ROOM 029 STATE CAPITOL Rep.Abel Tapia
Research
DENVER, COLORADO 80203-1784
E-mail: Ics.ga@state.co.us
303-866-3521 FAX: 303-866-3855 TDD: 303-866-3472
June 6, 2000
Ms. Jackie Brown
Prowers County Public Health Nursing Service
1001 South Main Street
Lamar, Colorado 81052-3838
Dear Ms. Brown:
Enclosed is a copy of the Colorado Health Care Task Force 2000 Resource Book. The
Task Force is a ten-member legislative committee which met for the first time in 1999 to study
health-related issues. The Resource Book is a product of the Task Force and provides
information about some of the most pressing health care issues in Colorado. In addition, the
book gives an overview of the major health care programs within the state departments of
Human Services,Health Care Policy and Financing, and Public Health and Environment. This
is the book's first publishing, and the goal is to upd.ate it annually until the Task Force is
repealed in 2004. Members of the General Assembly are the book's primary readership, but it
has also been distributed to local officials and advocacy groups.
Task Force meetings are open to the public, and meeting information is available
through the General Assembly web site(www.state.co.us/gov_dir/stateleg.html). Once on the
web site, select Interim Information. You can access past or current Task Force materials by
selecting either 1999 or 2000. Available information includes meeting dates, meeting
summaries, proposed legislation, and the Resource Book. If you prefer, meeting notices can
be mailed, faxed, or e-mailed to you. Please submit your contact information to Marie
Mayorga (303-866-4749 or marie.mayorga@state.co.us) if you wish to be included on the
interested persons list.
I hope you find the Resource Book informative. Please feel free to share it with other
interested persons or direct them to our web site.
Very truly yours,
417,6140 /2/D IT/'5 akt--,0
Representative Marcy Morrison
e/ 1999 Health Care Task Force Chairman
/
11
Ie
2000-1501
COLORADO HEALTH CARE
TASK FORCE
RESOURCE BOOK
2000
A Guide to Major Colorado Health Care Issues
and Programs
-• The Health Care Task Force is a ten-member legislative
committee charged with studying health-related issues.
The Task Force will meet from 1999 to 2004.
Representative Marcy Morrison, 1999 Chairman
Senator Mary Ellen Epps, 1999 Vice Chairman
Resource Book Compiled by:
•
Stanley Weinberger,Legislative Council Staff Intern
Whitney Gustin, Legislative Council Staff, 303-866-4789
Jim Hill, Legislative Council Staff, 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 covers major issues such as the cost of health insurance,
the uninsured population and long-term care. The book also
reviews the health care programs of executive branch departments
which are of legislative interest.
This health resource guide is an ongoing project. The goal is
to update it on a yearly basis.
Table of Contents
MAJOR HEALTH CARE ISSUES
Health Insurance
Long-Tenn Care in Colorado 6
Uninsured Population . . . . . . . . . . . . . . . . . . 7
Under-Insured Population
MAJOR HEALTH CARE PROGRAMS AND STATE
DEPARTMENT FUNCTIONS 9
Department of Health Care Policy and Financing(HCPF) 9
Medicaid IC
Children's Basic Health Phan/Child Health Plan Plus (CBHP/CHP1-) _ 13
Colorado Indigent Care Program (CICP) 13
Department of Human Services 14
Alcohol and Drug Abuse Division (ADAD) I S
Developmentally Disabled Services 16
Division of Aging and Adult Services 16
Mental Health Services(MHS) 17
Old Age Pension Health and Medical Care Fund 18
Department of Public Health and Environment 1$
Disease Control & Environmental Epidemiology Division (DCEED) _ 19
Emergency Medical Services and Prevention Division 19
Family and Community Health Services Division I9
Early and Periodic Screening. Diagnosis, and Treatment 19
Family Planning Program 20
Women, Infants, and Children (WIC) 20
Health Facilities Division 21
Trauma Program - . 2I
Department of Regulatory Agencies (DORA)
Division of Insurance 22
Colorado Uninsurable Health Insurance Plan (CUHII') 22
Table of Charts and Graphs
I. Sources of Pas ment for Health Care in Colorado 6
II. Coloradans' Insurance Status by Income
III. Coloradans' Insurance Status by Age 8
IV. Projected Colorado Medicaid Enrollees and
Relevant Expenditures, 1999 I I
V. State-Subsidized Insurance(overage and Ileatlh Care Services _ 12
VI_ United Stales Department of Health and I Inman
Services Poverty Guidelines, 2000 24
MAJOR HEALTH CARE ISSUES
Colorado faces a number of major health care issues. Some of the most
pressing issues arc health insurance, long-term care, the uninsured, and the
under-insured. Health insurance costs arc rising and making it more difficult
to afford. As the population continues to age, the demand for long-term care
is growing. A large portion of the population does not have health insurance
and others lack sufficient coverage.
Health Insurance
cost of Private Health insurance. While growth in health insurance
premiums has been slow, ranging from 0.2 to 3.5 percent between 1493 and
1998, recently premiums have begun to rise faster. Between 1998 and 1999,
premiums rose on average 5 2 percent nationside. In Colorado, the increase
for small group health insurance premiums was much more pronounced.
Between 1997 and 1998, Colorado HMO premiums rose at an average annual
rate of 7.5 percent,while PPO and indemnity plan premiums rose at an annual
average rate of 22 to 23 percent. In 1998, in Colorado, average family
premiums for the standard health benefit plans ranged from$400 per month
for HMOs to $800 per month with some indemnity insurers.' These costs
make up close to 15 percent of the annual expenses for a family of four with
an income of$32,900 (200 percent of the Federal Poverty Level).'
Approximately 64 percent of the state's non-elderly population(under 65)
has reduced these costs by purchasing employer-based health insurance
Rising insurance expenses however arc forcing employers to seek alternatives,
including covering a smaller proportion of premium costs After adjusting for
inflation, the average employee contributions between 1988 and 1996 cor
employee-only coverage increased 189 percent The average employee
contribution for family coverage increased 85 percent during the same period
A/undated 1lealfh Coverage and('on.cwner Protections. Under Colorado
law,all group and individual health insurance policies must provide coc,rage
for newborn children, pregnancy and childbirth. child immunizations.
therapies for congenital defects and birth abnormalities of children up to twc
years of age, low-dose mammography. hospice care, treatment for iv 'm.a
illness, alcoholism and diabetes, and prostate cancer screening.
Other consumer protections include: a'law requiring health ntaintemmcc
organizations to maintain a sufficient network of providers, a ban on gag
clauses which restrict communication with an enrollee, direct a.CC to
OB/GYN; standing referrals to specialists, requiring only a one-time referral
S —
for medically necessary treatment; emergency room access 24 hours a day, 7
days a week; and an independent and external review of grievances.
Colorado's Health Insurance Market. The six largest Colorado health
insurers(Pacificare of Colorado; Kaiser Foundation Health Plan of Colorado;
Blue Cross/Blue Shield of Colorado;Rocky Mountain HMO; HMO Colorado;
and Employers Health Insurance Company)cover over half the market. Four
of these six insurers are health maintenance organizations. While only 3.5
percent of Colorado insurers are HMO's,they account for over half of the total
premium value of Colorado's private health insurance market.'The rest of the
market is covered by indemnity, sickness and accident insurers, non-profit
corporations and other managed care plans. Table I illustrates the amount of
all health care paid for by insurance in comparison to various government
programs and through out-of-pocket expenses.
Table I
Sources of Payment for Health Care
In Colorado, '1994
Other Government(6.30°.
Medicare(18 90% act of Pocket(25 40%j
Medicaid(13 30%
idly Insured(24 00%)
Self Insured(12 10%
Long-Term Care(LTC)
('ost and Utilization of Long-Term Care. Long-tern care is one of the
largest health care expenses and is expected to grow as the population ages.
National long-term care expenditures reached$115 billion or 12 percent of all
health spending in 1997. The cost of these services is of great concern to
seniors and the government; Medicaid pays 57 percent of all long-term care
costs in Colorado° Basic nursing home costs in Colorado typically range from
$95 to$144 per day,with higher costs in the Denver metro area. Personal care
services at home cost around $15 per hour, with most older clients typically
needing two or three hours of service, three or four days per week.
There arc 234 nursing homes in Colorado with close to 18,000 residents.
An additional 535 assisted living/personal care boarding homes provide less
intense care than in nursing homes. There are also approximately 145
—6—
certified home health agencies and 128 personal care/homemaker agencies
providing skilled and non-skilled home nursing care.'
Medicare and Medicaid Coverage. Medicare,the federal health 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. In 1998,
57 percent of all long-term care costs were paid for be Medicaid. Thirty
percent of Colorado's Medicaid dollar is spent on nursing homes
(approximately $590 million) and an additional 11 percent is spent on home
health and other long-term care(approximately $215 million)."
Long-Term Care Insurance Long-term care insurance is a relatively new
product designed to pay the cost of personal care for individuals. These
policies agree to pay a certain daily dollar maximum for a certain time period.
Consumers pay the balance. Colorado requires that long-term care insurers
offer two packages. the Basic Nursing Home Long-Term Care Insurance and
the Standard Nursing Home/Home Care Long-Term Care Insurance. The
basic policy is designed as a lower cost product, covering only care in a
nursing home. The standard policy has these benefits:
Care settings: nursing home and home care
Dollar amount of coverage: $100/day nursing home, $50/day home care
Inflation protection: five percent compound unless rejected by the
consumer
Length of coverage: $125,000 at issue
Deductible period: 60 days
Prices for the standard policy can range from $750 to$1,900 per year at age
60,and prices increase rapidly based on age for older consumers. Consumers
have many choices in buying a policy,but all of the options selected impact the
price of coverage. Consumers arc encouraged to buy inflation protection to
guard against increases in the cost of care.
Uninsured Population
There is considerable research showing that lack of health insurance
negatively affects health status. For example,the uninsured have a higher risk
of death when they go into the hospital9 and are more likely to be hospitalvad
for a condition which could have been managed with good primary care 10
In Colorado, more than 580,000 people, or 15.2 percent of the state's
population,do not have health insurance. The number of uninsured continues
to grow, although the percentage has remained at approximately IS percent
— 7
Approximately 60 percent of uninsured Coloradans live in families where the
head of the household works. Many of these families(43 percent)have a head
of the household who works full-time.' Asked why they did not have health
insurance,only seven percent of uninsured adults reported they were uninsured
by choice or because they did not believe in insurance. Uninsured status is
correlated with poverty, as Table II shows.12'Table III shows that 18-24 year-
olds are most likely to be uninsured.
Table II
Coloradan's Insurance Status by Income
1995-1997 Average
35%
v30%
ai
:9,25%
-[20% -_
p`10°/a
a)
0- 5%
0%-- < 1xFPL 1-2xFPL 2-3xFPL >3xFPL
Income Level
Table III
Coloradan's Insurance Status by Age
1995-1997 Average
35%
30%
25%
; 20%
ro
15%
10%
RUM-
5%
Under 6 Yrs 6-.17 Yrs 18-24 Yrs 25-54 Yrs 55-64 Yrs 65+Yrs
Age
—8 —
Under-Insured Population
While health insurance shields people from the full cost of health care.
many person's health insurance is insufficient in the case of catastrophic
illness. The under-insured are individuals who arc younger than 65 Nears of
age with private health insurance coverage that. in the case of unusually
expensive catastrophic illness.would requite the insured to pay over 10 percent
of their annual fancily income in out-of-pocket health expenditures. Close to
20 percent of Americans with health insurance coverage fell into this
under-insured category in 1994 The likelihood of under-insurance increases
with poverty."
MAJOR HEALTH CARE PROGRAMS AND STATE
DEPARTMENT FUNCTIONS
The slate departments which focus much of their work on health-related
issues are Health Care Policy and Financing, Human Services, and Public
Health and Environment. Each department administers several programs to
address Coloradans'various health care needs. The programs which arc most
commonly discussed by the General Assembly are highlighted here.
Department of Health Care Policy and Financing(HCPF)
The Department of Health Care Policy and Financing is the federally
recognised single state agency for administering the Colorado Medicaid
program. HCPF also develops and provides policy, program and financial
administration oversight for the Children's Basic Health Plan (CHID), the
Colorado Indigent Care Program (CICP).and several other statewide health
programs The department's budget covers only health-related programs.
Department of Health Care Policy and Financing
Fiscal Year 97-98 Bud et _
Total Actual General Cash Cash funds ledcinl
Iiudf.ct f ands Funds I xcmpl 1unit,
FY 97-98 (millions) (mullion;) (millions) (million,)
$1,963,901,674 $9101 SIP $77 SI/72
16% =1'%.. d°4 49
_ 9 -
Medicaid
Medicaid is a state administered program that provides health care
coverage to very poor Coloradans of all ages. Table IV lists the different
Medicaid enrollee groups and the expenditures for each (page 11). Table V
illustrates the income, age, and health status eligibility requirements for
HCPF's programs, including Medicaid(page 12). Federal poverty guidelines
appear in Table VI on page 24.
Total budget: The Department of Health Care Policy and Financing's total
projected Medicaid budget was $1.2 billion in fiscal year 1999. This
represents 62 percent of the HCPF's total budget. Colorado receives an
approximately one-to-one federal to state dollar match. Medicaid expenditures
increased from 10.5 percent of the state General Fund in 1990 to 17.9 percent
in 1999.
Eligibility Persons qualify for Medicaid through various programs such
as Temporary Aid to Needy Families(TANF), Supplemental Social Security
Income(SSI),and Old Age Pension(OAP). Individuals may also qualify by
meeting specific income requirements which vary based upon the age and
health status of the applicant. County departments of social services determine
if persons qualify for Medicaid.
Services/Benefits: Enrollees are provided physician and clinic services,
hospital care, prescriptions, home health care, and mental health services.
Additional coverage for children includes early and periodic screening
diagnosis and treatment (EPSDT), dental and vision services, and
immunizations. Additional services to meet the needs of elderly and disabled
persons are transportation to medical appointments, services for
technologically dependent and homebound patients, and long-term care
services.
Medicaid Managed ('are: State law requires 75 percent of Medicaid
clients be enrolled in a managed care plan by July I,2000. Approximately 70
percent of Medicaid clients were enrolled in managed care as of January 2000.
flame and Community Based Services Medicaid Waivers (l/CBS):
Colorado has ten different HCBS waivers providing Medicaid funded,
specialized services to disabled children, the mentally ill, the blind and
disabled,and those living with AIDS. Services to those individuals eligible for
these programs are delivered in the home or by other community providers.
-- 10_
Projected Colorado Medicaid Enrollees and Relevant Expenditures, 1999
Percent of Percent
Medicaid Total Medicaid of Total Average Per Capita
Group Enrollees Enrollees Expenditures Expenditures Papinents
Children(0-17 I rsi 121,125 45.60% $176 Million 14.80% 51.452
adults(18-591'rs'I 35.401 13.30% 5115 Million 9.700/c 53254
Elderly(61N S n) I 47.720 18.00% 553', Million 45.30% $11260
Disabled 54,780 20.60% 5341 Million 28.80% 56.231
i
Other 6,559 2.50% 516 Million 1.40% $2.5"1
Total 265.585 100% 51.2 Billion 100% $4,468
(average)
r untrg Sur. _ i.. ''-I ?ads, ..e- - deal en m,. ....
T__he remainder comes i rcm the state's General Fond
State-Subsidized Insurance Coverage and Health Care Services
Family
Income
as%of FPL
219%
NO SUBSIDY FOR CARE OR COVERAGE
200%
185% CICP Medicaid
Only CHP+ and CICP CICP if LTC -
Only eligible
1330/
100% 1
73%
Medicaid Medicaid
Medicaid
39%
Pregnant 0 to 5 6 to 12 15 to 17 18 + Persons with
Women (Adults) Disabilities
AGE
Children's Basic Health Plan/Child Health Plan Plus (CBIIP/CIIP+)
The Children's Basic Health Plan subsidizes health insurance coverage for
low-income families with children who do not qualify. for Medicaid
Toml budget Colorado receives a two-to-one federal to state dollar match
The total budget for FY 99-00 is$30 6 million. Of this, $10 7 million is front
the state through a Children's Basic I Icalth Plan Trust funded by the General
Fund and Cash Funds Exempt. The matching federal gran( is$19.9 million.
Number of enrollees: Enrollment as of November 1999 was 22,800
children. Approximately 72,000 children in Colorado are eligible for the plan.
(.'usi per enrollee. The average cost for health care services per child per
month is$67.86.
Eligibility: Eligible children arc under 19 years of age. live in a family
earning less than 185 percent of the federal poserty level($31,543 for a family.
of four), and are not eligible for Medicaid Families earning more than PM
percent of the federal poverty level pay a state-subsidized monthly premium for
covered benefits.
Services Benefits: Benefits include inpatient and outpatient hospital
services. physician services, prescription drugs, mental health and other
medical services which may be necessary for the health of enrollees Dental
services are excluded.
Providers: Depending on the geographic area in which the child lives,
services arc provided either by an HMO or by a fee-for-service network, in
which providers arc reimbursed directly far services provided. As of
November 1999, 63 percent of enrollees were in HMO enrollment and the
remaining 37 percent were in fee-for-service enrollment.
Colorado Indigent Care Program (CICP)
The Colorado Indigent Care Program serves uninsured Coloradans not
• eligible for Medicaid Participating hospitals and clinics determine
individuals' program eligibility and their co-payment on site. CICP then
reimburses those providers for part of the cost of treatment
Tura/ budget The total budget for FY 99-00 is approximately $163
million.
- 13 -
Funding sources: CICP payments are funded through the General Fund
and federal dollars in an approximately one-to-one ratio.
Number of enrollees: In FY 97-98,about 160,117 CICP clients accounted
for over 13,000 inpatient admissions and over 512,176 outpatient visits.
Eligibility:Eligible persons have income and assets lower than 185 percent
of the federal poverty level and are ineligible for assistance from the Medicaid
program.
Providers: In FY 97-98,there were 64 participating hospitals and clinics,
providing care in 114 facilities across the state.
Services/Benefits: CICP services arc prioritized on site according to the
following guidelines:
• At a minimum,providers must give emergency and urgent
care to persons presenting themselves to the 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.
Department of Human Services"
The Department of Human Services (DHS) provides health-related
services through the 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. Through various
programs the department tries to ensure that employment is obtained,
self-sufficiency is maintained, and that people live in environments that arc
safe and stable. Because of the nature of this department,different programs
may incorporate both health and non-health related aspects. For this reason
it is difficult to specify exactly how much of the budget goes towards health-
related services.
•
-- 14 —
Department of Human Services, Fiscal Year 97-98 Bud ,et
'total Actual General Cash Cash Funds Federal
Budget Funds funds Fxempt Fwids
FY 97-98 (millions) (millions) (millions) (mullions)
$1,245.998,011(7 $123 563 $745 5315
31% 5% 36% 25%
Alcohol and Drug Abuse Division (ADAD)
This division develops. supports, and advocates for comprehensive
prevention and treatment services to reduce alcohol,tobacco,and drug abuse.
Total budget The total budget for FY 99-00 is approximately$34 million.
Funding sources. Approximately 73 percent of the budget comes from the
federal Substance Abuse Block Grant out of the federal Department of Health
and Human Services and other federal grants. Twenty-three percent of the
budget is from the General Fund,and the remaining four percent is from Cash
Funds
.Number o/'enrollees: In FY 98-99, there were 63.375 admissions. Of
these, almost 27,000 were for DUI programs.
Cost per enrollee: the average cost per enrollee figures are broken down
into four categories:
• Detoxification: $298/enrollee
• Outpatient Treatment: $873/enrollee
• Intensive Outpatient Treatment: $I,I I3/enrollee
• Residential Treatment: $2,759/enrollee
For outpatient, intensive outpatient and residential treatment, ADAD
reimburses on average 49 percent of the cost of treatment to providers.
l'Ji,g>ibilire Ainone needing ADAD's services is eligible to participate.
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.
Providers: Prevention sen ices are provided through both statewide and
local community agency contracts. ADAD contracts with four managed care
service organizations for the deliver)of treatment services
15 —
Developmental Disabled Services
Developmental Disabilities Services is responsible for managing the
provision of stale and Medicaid-funded services and supports for persons with
developmental disabilities.
Total budges: The total budget in FY 99-00 is$224 9 million.
!Funding sources. Approximately 90 percent of the total budget comes
from Cash Funds Exempt(primarily transfers of federal Medicaid funds from
the Department of Health Care Policy and Financing)- The remaining 10
percent of the total budget is from the General Fund.
Number of enrollees: The Developmental Disabilities Services operates
many different programs which vary greatly in cost and intensity.
Services: Services include family and child support services, case
management and ancillary services, day and residential services, and
supported living services.
Eligibility: Eligibility is determined by Medicaid eligibility rules and a
diagnosis of developmental disability.
Providers: Services are provided through 21)community centered boards
and 230 service providers.
Division of Aging and Adult Services
This Division serves disabled or ulnerable adults who require some level
of assistance to maintain their independence. The five major program areas
include Adult Income and Medical Support, Adult Protection, Older
Americans Act, Supportive Housing and Homeless Programs. and a
computerized information and referral program.
Total budget: The total budget for FY 99-00 is $14.2 million
Funding sources: Eighty percent of the funds for the Aid to the Needy
Disabled and Adult Protection programs conies from the General Fund with
the remaining 20 percent from Con lily Funds Exempt. The Old Age Pension
programs arc funded entirely from Cash Funds. The ombudsman programs
arc 100 percent federally funded
Service" Services include cash grants to low-income elderly.blind. and
disabled persons. employment programs. nutrition programs. transportation
- 16 -
and information services, affordable housing programs, and ombudsman
services.
Eligibility: Eligibility is determined on a program basis.
Providers: The division administers. programs through the county
departments of social services, area agencies on aging, and other
community-based contract agencies.
Mental Health Services (MHS)
The Colorado MI IS supports community-based mental health treatment
by purchasing services from 17 community mental health centers and from
five specialty clinics. In FY 1997-98,there were 68,616 individuals served in
community programs.
Tnta! budget: The total budget for FY 99-00 is approximately $175
million.
In June 1998, the Medicaid Mental Health Capitation Program became
operational statewide. The Department of Health Care Policy and Financing
contracts with MHS to provide mental health care to the Medicaid population
To do this, MHS purchases services from seven Mental Health Assessment
and Services Agencies (MHASAs), who are responsible for implementing
Medicaid mental health capitation and case management programs.
Thin!budget: The total capitation budget for Medicaid Mental Health is
about $125 million.
Number of enrollees. There arc about 240,000 Medicaid clients eligible
for Medicaid Mental Health services There are approximately 31,000
Medicaid clients receiving mental health services
Cost per enrollee: The capitated rate for a Medicaid Mental Health
enrollee varies greatly depending on the eligibility category as well as the
geographic location. The capitation rate for persons eligible through
AFDC/TANF, for example, is about $15-20 per member per month The
capitation rate for foster children is about $400 per number per month
Services: A wide range of services, including hospitalizations. arc
provided by the MHASAs, who determine the appropriate level of service
provision.
_ 17_
Eligibility: Eligibility is determined by Medicaid eligibility rules. Certain
groups are excluded by state law.such as undocumented aliens and state-only
Aid to Needy Disabled(AND)enrollees.
Old Age Pension Health and Medical Care Fund
This fund is for those low-income persons aged 60 and older receiving Old
Age Pension payments who arc not eligible for Medicaid.
Tula/ budget: The total budget for FY 99-00 is approximately $9.9
million.
Funding sources: The Old Age Pension Fund and Health and Medical
Care Fund is taken out of tax dollars before they reach the General Fund. The
Health and Medical Care Fund has been capped at$10 million.
Number of enrollees: In FY 99-00, there were 3,3(x)service recipients.
Cost per enrollee: The projected annual cost per client for FY 98-99 is
$2,986.
Services: Recipients receive the same level of services as do Medicaid
recipients with nursing home and psychiatric cart excluded.
Eligibility: Program eligibility decisions arc made by county departments
of social services.
Department of Public Health and Environment Is
The Department of Public Health and Environment provides public hcali Ii and
environmental protection services for the entire state. Approximately 65
percent of the department's budget goes toward health-related programs.
Department of Public Health& Environment, Fiscal Year 97-98 Budget
Total Actual General Cash ('ash Exempt
Budget Fund Fund fund I"edetal Funds
FY 97-98 (millions) (millions) r (Millions) (millions)
$207,197,790 $21 $16 $30 '6140
I0% 8% 1..1% 68%
- l8
Disease Control & Environmental Epidemiology Division (DCEED)
The mission of the DCEED is to collect data on infectious diseases,birth
defects and environmental/chronic conditions; to prevent and control the
spread of infectious diseases; and to evaluate the health risk of toxic
substances and environmentally-related disease.
Total budget: The total budget for FY 99-00 is $28,472,837.
Emergency. Medical Services and Prevention Division
The division works to prevent and control disease and injury and to create
emergency response for those individuals affected by sudden illness or injury.
Total budget: The total budget for FY 99-00 is$13,112,882.
Providers: The division works in partnership with public and private
organizations to provide emergency response.
Family and Community Health Services Division
The Family and Community Health Services Division includes programs
which oversee fancily planning and maternal and child health services The
division supports and provides funding for school-based health centers,
abstinence education efforts, and healthy child care. This division also
provides funds for the Medicaid Early and Periodic Screening,Diagnosis and
Treatment (EPSDT) program The division works closely with the
CBHP/CHP+ program, helping to promote enrollment. The division also
workswith local county health departments,local county nursing services,and
other agencies to provide limited direct personal health care services
Early and Periodic Screening, Diagnosis, and Treatment (ERSD7): The
EPSDT program attempts to improve the health status of Medicaid-eligible
pregnant women and children.
Tonal budget: The total budget for FY 99-00 is$3,104.900 The program
is funded by the Department of Health Care Policy and Financing through
Medicaid.
Number al-enrollees: In FY 98-99, 143,753 clients were served.
('ost per enrollee: The average cost per client was $20.74.
-- 19-
Services Services include non-medical outreach and case management to
those requesting/requiring assistance in accessing health care delivery
systems.
h:/iKihili r: Eligibility for EPSDT is determined through Medicaid rules.
Providers EPSDT services are provided hrough subcontracts with health
agencies. county health services, and organized health departments.
Family Planning Program: The program's services emphasize prevention
through clinical exams and patient education.
Total budget: The Family Planning Program is funded through state
General Fund dollars,local support,patient fees,and Title X,the federal grant
which makes family planning services available to low-income individuals.
The total budget for FY 99-00 is almost $3.7 million. This amount includes
approximately$1.6 million from state funds and $2 million front the Title X
grant.
Services: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. No abortion services are paid for by the program
Eligibility Patient fees are determined by the patient's income level.
Eighty-six percent of the patients served have incomes at or below 1511 percent
of poverty.
Number of enrollees. Over 52,1100 \Sonata and men teethe services
annually
('ost per enrollee' 'T'he average cost for a year's worth of sen ices is$168.
Patient fees are determined by patient income leads
Prin./Miry There are 6i non-profit and county health department clinics
throughout Colorado receiving federal and/or state family planning fnding.
Women, Infants, and Children (WJ('li 'Ilie Special Supplemental Food
Program for Women. Infants_and Children is a federal nutrition program for
pregnant women and children lip to age five The goal of the WIC program
is to decrease the incidence ol'Imenria, hciglit/wcighi deviations and tow birth
weight through maximizing nutrition sen ices to high-risk populations.
—20 -.
Total budget. The WIC program is funded by the United Stales
Department of Agriculture. The total budget for Colorado for FY 99-00 is
$52.6 million.
Nunther of enrollees: The monthly caseload is approximately 74,200,and
the program annually serves approximately 120,000 Coloradans.'
Cost per enrollee: The average cost per enrollee is$58 per month. The
food benefit varies,but averages$45. The average cost for administration and
nutrition education is$13.
Services: The program provides nutrition education, referrals, and
nutritious food to supplement the regular diet of pregnant and breast-feeding
women, and infants and children under the age of five.
Eligibility: Enrollees must have income under 185 percent of the Federal
Poverty Level and qualify as "nutritionally at risk," which is determined
during a WIC visit.
Providers: WIC is provided through local health departments and county
nursing services. There are approximately 125 clinics throughout the state
that provide WIC services.
Health Facilities Division
The Health Facilities Division assures that patients and residents receive
quality care from health facilities and programs.
Total budget: The total budget for FY 99-00 is $7,075,997.
Approximately 50 percent of this is a pass-through from the Department of
Health Care Policy'and Financing.
Services: Services include state licensure and federal certification of
health facilities and programs through on-site inspections and complaint
investigations. Facilities under the division's purview include: ambulatory
surgical centers;community clinics;community mental health centers;home
health agencies;hospices,personal care boarding homes;and nursing homes.
Trauma Program
The program provides services related to the development of the
infrastructure of the state's trauma system to reduce morbidity and mortality
of injured patients.
_ 21 _
7uta1 budget: The total budget for FY 99-00 is $1.157.219 Funding
sources include the emergency medical services within the Ifighway User'fax
Fund and fees for designation of trauma centers.
Services: Services include designating trauma centers in the slate.
providing technical assistance to local agencies, and defining the role of
facilities contributing to the trauma registry.
Department of Regulatory Agencies
Division of Insurance
The Division of Insurance works to promote a competitive insurance
marketplace, which allows for affordable insurance and adequate consumer
choice, and to provide prompt and effective service to Colorado consumers.
It does this by licensing and regulating health insurance companies. The
Division of Insurance also acts as a consumer advocate, responding to and
investigating complaints brought forth by consumers.
Colorado Uninsurable Health Insurance Plan (CUHIP)
CUHIP provides individual,major medical health insurance to Colorado
residents who have been denied access to affordable health insurance because
of pre-existing medical conditions
lb/al budget: $2,106,991 in FY 1997-98'7
Funding sources: CUHIP is funded primarily by the Business
Associations Unclaimed Moneys Fund(Cash Funds Exempt)which includes
money orders,pay checks, and life insurance policies which have never been
cashed. The state appropriated$4.8 million to CUIIIP during 1999. Enrollee
premiums also help to cover the program's costs.
Number of enrollees: There were 9'1I enrollees as of January. 2001).
Cost per enrollee. In I'r99, the average annual medical expenses per
enrollee were $5.960_ The average pennon] paid by enrollees is $254 per
month.
Benefits.Services. Services include hospital, both inpatient ;md
outpatient care. skilled nursing lacihtr-.s_ transplants, home health care,
prescription drugs, preventive care, mental health and substance abuse
treatment, and hospice care.
— 22 —
Eligibility. To take part in the CUHIP program,an individual must have
been a resident of Colorado for at least six months and meet one of these
conditions:
• Applied for health insurance but the application has been 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 health 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.
—23 —
Appendix
Table VI
Eligibility for many assistance programs is based on poverty guidelines issued by
the U.S.Department of!learnt and I uman Sc,vices_
Annual Incomes and Percent of Poverty Level
Household
Size 39% 73% 100% 133% 185% 220%
1 $3,257 $6,096 $8,350 $11,106 $15,448 $18,370
2 $4,388 $8,213 $11,250 $14,963 $20,813 $24,750
3 $5,519 $10,330 $14,150 $18,820 $26,178 $31,130
4 $6,650 $12.447 $17,050 $22,677 $31,543 $37,510
Source 2000 United States Department of Health & Human Services
Poverty Guidelines
24 _
Sources
1. September 1998 Small Group Health Insurance Premiums fbr Colorado.
Division of Insurance. September 1998.
2. Department of Health Care Policy and Financing,Annual Report, 1995,
1998.
3. Fronstcin_ ERRI .Notes, No. II. Employee Benefit Research Institute.
1997
4. AFL-CIO and the Lewin Group, Inc. Exploring the Determinants of
Employer Health Insurance (overage. January 20, 1998.
5. Colorado Division of Insurance /996 Annual Reports.
6. HCPF. 1999-2000 Reference Alanual Director James T. Rizzuto.
7. Health Facilities Division Colorado Department of Public
Health& Environment.fisrer tory Listings. 1999.
8 HCPF. 1999-2000 Reference Manual. Director James T. Rizzuto.
9. Rowland, Feder, and Keenan. "Profile of the Uninsured in America."
The future of U.S. Healthcare System: Who Will Care for the Poor
and Uninsured?ed. Altman, Reinhardt, and Shields.
Chicago: Health Administration Press, 1998.
10. Department of Health Care Policy and Financing. Colorado Medicaid's
Primary Care Physician and Ambulatory('are Sensitive
Hospitalizations General Report.
II. 1995-97 Current Population Survey and Colorado State Demographer
12. Rowland, Feder, and Keenan. "Profile of the Uninsured in America."
The Future of I.'-S. Healthcare System. Who II'WI('are for the Poor
and Uninsured? ed. Altman, Reinhardt, and Shields.
Chicago. Health Administration Press, 98
13. Short and Banthin. "New Estimates of the Under Insured Younger
than 65 Years."Journal of the American Medical Association.
274:1302-1306, 1995.
14 Colorado Department of Human Services.Annual Report, 1998.
— 25 -
15. Colorado Department of Public Health and Environment.
Director Jane E. Norton
website. wuw cdphe state co us/cdphehom.asp. 12/9;99
lb. Discussion with Bill Leade, Director of WIC program
17. Discussion with Bill Leade, Director of WIC program
Appropriations Report, Fiscal Year 1999-00.
Hello