There are several factors contributing to the uncertain status of the CDC Eviction Moratorium, which has protected thousands of renters nationwide from eviction during the pandemic. The moratorium is currently set to expire at the end of June; in March, it was extended for another three months less than a week before its expiration date. The moratorium is also being challenged in federal courts.
On top of that, states, jurisdictions, and judges are all interpreting the moratorium differently because it is an unusual use of CDC authority. Denver is applying CDC guidelines to bar landlords from filing evictions for nonpayment of rent. Meanwhile, in Jefferson County, sheriffs are actively evicting people who are behind on rent. Landlords also use other strategies to evict tenants, including lease violations, because the moratorium only prevents evictions for nonpayment of rent.
Governor Polis allowed the State of Colorado’s eviction moratorium to expire, so as soon as the federal moratorium is lifted, renters will be expected to pay the sum of what they owe in rent. Colorado Legal Services and other housing advocates are expecting a significant spike in evictions and bankruptcies as a result. Check out this CPR article for a list of resources available to Colorado renters and answers to commonly asked questions about the moratorium.
Denverites will also have access to legal representation during eviction proceedings in September after the City Council recently passed an eviction legal defense fund. Previously, tenants were represented in less than 1% of eviction cases. The Colorado Legislature also passed a bill that grants tenants additional eviction protections this session, SB21-173.
Emerging from the Pandemic Starts with Small Steps
Mental Health Center of Denver recently posted on their blog about post-pandemic anxiety and strategies to manage the unease many people feel about being in close proximity with others as things begin to re-open. Jen Jackson, a licensed clinical social worker and assistant program manager with MHCD, recommends that rather than avoiding social activities, “repetition and easing back into things may solve some discomfort”.
Project ECHO Colorado is also launching a new 6-week ECHO series for healthcare workers titled “Past the Pandemic: Mental Well-Being for You and Your Patients”. The series aims to provide concrete strategies to navigate pandemic-related stress, prevent burnout, and promote mindfulness. It will occur weekly on Tuesdays from 12:00-1:00 beginning on June 29th.
Takeaways from the Access to Specialty Care Engagement Network (ASCENT) Cohort
The purpose of this three-year grant program funded by Kaiser Permanente Colorado was to improve access to specialty care for uninsured or Medicaid-insured adults in Colorado. The 5-organization cohort sought to tackle this pervasive barrier to care by connecting specialty care safety net programs in Colorado, coordinating patient referrals to specialty care practices, and offering e-consults. MHHA and other ASCENT cohort members are reflecting back on the progress achieved and identifying major takeaways from the cohort’s work, which began in 2018.
The Colorado Health Institute recently published several materials summarizing the ASCENT Cohort’s work:
Ensuring Access to Monoclonal Antibody Treatment for COVID-19
Mile High Health Alliance is working on a statewide initiative led by CU Anschutz with the goal of ensuring that people in Colorado who test positive for COVID-19 and are eligible have access to monoclonal antibody (mAb) treatments. MAb Colorado is working to reach both providers and patients about the availability of mAb treatment, which has FDA approval under Emergency Use Authorization to treat mild-to-moderate COVID-19. Research has demonstrated that mAb treatment is a highly effective method of preventing severe COVID-19 symptoms in individuals who have recently contracted COVID-19, and it is available to people who are deemed high risk for severe COVID-19 symptoms and meet eligibility criteria.
We want to learn more about awareness of monoclonal antibodies (mAbs) as a treatment for COVID-19 among people in Colorado, and are collecting feedback via a 10-minute community survey. Participants will receive a $25 gift card.
MHHA Hosts Active Bystander Training to Stop AAPI Hate
In response to the widely documented rise in anti-Asian hate incidents occurring in our communities and throughout the United States, MHHA teamed up with Defend Yourself, an anti-violence program based in Washington, D.C., to learn and practice effective bystander intervention and de-escalation tactics. Thanks to our member and partner organizations who joined us for the training. We look forward to working together to build a future where people of all identities can thrive, and where hate is not tolerated.
This Week Marks One Year of Working Remotely for MHHA Staff
The COVID-19 pandemic has left an indelible and unique mark upon each of us. This has been a difficult year, and there is more to understand and act on as we move forward. Despite these challenges, spring is around the corner and the delivery of vaccines gives us optimism.
As our work spaces changed, so did the substance of our work, our ways of life, and the world around us. While working from home has presented its fair share of challenges, it has also had some bright spots. We met colleagues’ kids and pets during Zoom meetings and enjoyed the sunshine during conference calls.
As our work continues here at MHHA, we are committed to building a future that is healthier and more equitable for everyone.
MHHA Named a Recipient of COPIC Medical Foundation Grant
A recent grant from COPIC Medical Foundation will support the continuation of our Orange Flag Project, a pilot which will use historic, predictive, and real-time data to inform emergency department personnel of a patient’s high utilization of emergency services to aid in care coordination.
During the 2021 funding cycle, COPIC Medical Foundation granted a total of $775,000 to five organizations with initiatives designed to reduce fragmentation across care settings. A top concern in patient safety, breakdowns in coordinated care can lead to readmissions, missed diagnoses, delayed treatment, duplicative testing, and reduction in quality of care leading to general patient and provider dissatisfaction. The COPIC Medical Foundation is a nonprofit organization affiliated with COPIC, a leading medical liability insurance provider.
What Happens When the Public Health Emergency Ends?
As Chiquita Brooks-LaSure awaits confirmation as the head of Centers for Medicare and Medicaid Services (CMS) under the Biden Administration, MHHA is planning for and working on the future of Medicaid at the state and local level. Since Secretary Azar’s declaration of a federal Public Health Emergency (PHE) in response to the novel coronavirus on January 31st, 2020, the Department of Healthcare Policy and Financing (HCPF) has submitted a host of waivers allowing for increased flexibilities and temporary regulations that are in effect for the duration of the COVID-19 PHE.
The MHHA team is documenting how these CMS-approved Colorado-specific state actions to address COVID-19 have affected Colorado’s Medicaid and CHP+ members and providers. These efforts will inform advocacy with HCPF regarding which temporary rules and flexibilities Colorado should seek to adapt or make permanent, a process we are planning alongside providers, stakeholders, and organizational partners.
There are a few changes of particular interest to us. For one, the Maintenance of Eligibility requirement mandates continuous enrollment for Medicaid members, suspending Medicaid’s regular eligibility renewal and redetermination process. While this protects Colorado’s Medicaid population with continuous coverage until the end of the PHE, we are concentrating on what efforts will be necessary to ensure that the massive re-determination effort slated to occur at the end of the PHE is successful. Another notable change is the expansion of funding for wraparound services and supports, which aligns with efforts to support interventions related to social and economic barriers to health.
The healthcare sector has also adapted to the pandemic with increased flexibilities around telehealth use, which was initially ushered in by temporary waivers approved by CMS. Telehealth is now reimbursed at the same rate as in-person visits and includes both audio-only and chat correspondence, which made telehealth a viable option for Coloradans without broadband access or the technology required for video visits. These telehealth-related temporary flexibilities were made permanent via the passage of SB20-212 during the last legislative session. In the current legislative session, HCPF is proposing a telehealth bill to adjust the parity requirement included in this statute, giving them more flexibility to address the differences in how telehealth is delivered via various providers and platforms.
We would appreciate hearing any additional insights you may have about how Medicaid and CHP+ have changed in response to the pandemic for either providers or individuals insured through these programs. Please email firstname.lastname@example.org to connect with us.
MHHA Signs On to Denver Flavor Ban
Denver is considering a ban on all flavored tobacco products in an effort to counteract the frightening rise in youth tobacco use. According to Flavors Hook Kids Denver, the coalition leading the push for a flavor ban in the city, one in four high school students has used an e-cigarette in the past month. Additional data points to flavored products as a primary cause of the rise in young people using tobacco in the past few years: 97% of youth e-cigarette users reported trying a flavored product within the past 30 days.
Recent polling data also suggests that a majority of Denver voters are in favor of banning the sale of all flavored tobacco products. A survey of nearly 700 Denverites conducted by Campaign for Tobacco-Free Kids, American Heart Association and Kaiser Permanente found that 65% were in favor of a flavor ban ordinance. The Mile High Health Alliance is one of many organizations that have signed on in support of the flavor ban to create a healthier environment for our youth. Check out this fact sheet for more information about the campaign and the list of organizational partners. We will continue to provide updates on this initiative as it is introduced and progresses through the legislative process.
What Are Colorado Legislators and the Biden-Harris Administration Doing to Advance Equity?
Continuation of Necessary Document Program: Extends funding for a program that was slated to end in 2021. The Necessary Document Program helps low income Coloradans acquire documentation of their identity, immigration, or citizenship status, which is essential for accessing healthcare, public benefits, and other important services.
“Fix 2006”: A bill passed in 2006 barred people without legal documentation (or who lived with people unable to legally verify their presence) from obtaining professional and commercial licenses. This initiative aims to repeal the 2006 bill, which will allow undocumented individuals to hold occupational and commercial licenses in Colorado and and provide them with access to basic state and local public support services (fact sheet).
Reproductive Health Care Program: This program would allow people who are undocumented to access contraceptives and counseling services. There is evidence from other states that increasing access to contraceptives results in considerable cost savings, in addition to providing an important healthcare benefit.
Residential Tenancy Procedures: Extends protections for tenants, including several actions related to eviction and court proceedings. For one, the bill requires that landlords give 14 days’ notice prior to starting eviction proceedings rather than 10. The bill also includes regulation regarding landlords’ ability to increase rent.
Multilingual Ballot Access For Voters: This bill ensures that voters have access to the ballot in their primary language. It creates a multilingual ballot hotline to provide access to qualified translators or interpreters in all of the languages in which the most recent Census was offered.
Advancing Racial Equity and Support for Underserved Communities Through the Federal Government: Revokes President Trump’s EO that limited federal agencies’ ability to offer EDI training and directs all agencies to review the equity implications of their practices and policies and deliver a report within 200 days.
Ensuring an Equitable Pandemic Response and Recovery: Among other things, this EO established the COVID-19 Health Equity Task Force, headed by Dr. Marcella Nunez-Smith. The Task Force is charged with providing recommendations to the President for mitigating the health inequities caused or exacerbated by the COVID-19 pandemic and for preventing such inequities in the future.
Restoring Faith in our Legal Immigration Systems & Strengthening Integration and Inclusion Efforts for New Americans: Directs an immediate review of public charge regulations implemented during the Trump Administration.
Supporting the Reopening and Continuing Operation of Schools and Early Childhood Education Providers: Includes a requirement that the Secretary of Education collect data disaggregated by race, disability, English-language-learner status, and free or reduced lunch status to assess the impact of the COVID-19 pandemic on students and educators.
Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation: Affirms anti-discrimination laws and the recent Supreme Court decision upholding that Title VII of the Civil Rights Act of 1964 prohibits discrimination on the basis of sexual orientation or gender identity.
By leveraging and activating existing community partners in high need and under-resourced communities in Southwest Denver, Montbello, and Northeast Denver, we successfully distributed over 20,000 pieces of collateral during our Census outreach work this year.
We used various strategies to reach Denver’s hard-to-count populations, including hosting community COVID-19 testing events, partnering with food distribution sites, training Promotores and trusted community leaders, commissioning chalk artists to promote the Census in three hard to count neighborhoods, aerial messaging, social media posts and ads, phone banking, and extensive literature distribution by more than 40 community partners. One of our Facebook ads directed towards Spanish-speaking families and those with young children in Denver reached nearly 13,000 individuals and produced over 2,000 clicks to 2020census.gov.
As a result of our collaborative outreach efforts, we educated an estimated 87,000 people about the importance of the Census and how to complete it. By the time we reached the October 15th deadline, Denver had a 69.3% self-response rate, on par with the 70.0% statewide average self-response rate.
Medicaid Enrollment Reverses Course in 2020
Medicaid Enrollment Reverses Course in 2020
We have all experienced innumerable things that have made this year unprecedented. Medicaid enrollment trends are no exception. Between 2017 and 2019, Colorado saw around 25,000 people disenroll from Medicaid, a 12% decline. By contrast, in 2020, statewide Medicaid enrollment numbers increased by more than 75,000 between March and October.
In the spring, the Department of Health Care Policy and Financing (HCPF) estimated that half a million Coloradans would enroll in Medicaid by the end of the year due to rising unemployment and their requirement to refrain from disenrolling anyone for the duration of the federal public health emergency.
While we aren’t seeing new enrollee totals approaching the 500,000 mark anticipated by HCPF, a steady upward trend in enrollment is occurring in Denver County and statewide. In fact, we are seeing similar upticks throughout the nation.
Perhaps the lower-than-expected enrollment increase we are seeing so far is because many eligible Coloradans are unaware that they qualify. The lower totals may also indicate people’s hesitation to enroll in Medicaid or other public benefits due to public charge fears or the stigma associated with safety net programs.
In order to combat this stigma and reach all uninsured Coloradans, we have been working alongside HCPF and other organizations across the state on outreach and enrollment efforts. The current open enrollment period ends on January 15th.
HCPF’s new landing page, We’re Here for YOU, Colorado! has information for people and providers. MHHA also participated in a nation-wide coordinated enrollment push on December 10th. Partner organizations have been asked to take the lead on different parts of the campaign; HCPF is investigating whether there might be resources to support this effort.
Here is a quick breakdown of Medicaid income eligibility limits: a qualifying household’s income must not exceed 133% of the federal poverty level, which equates to about $1,415 per month for a single individual and $2,904 per month for a family of four. In addition, individuals making up to $4,253 per month and families of four with an annual household income up to $8,733 can still qualify for financial help to cover their monthly premiums through the insurance marketplace.
Connect for Health Colorado offers free assistance from their certified enrollment experts to individuals and families seeking insurance coverage. Please direct people to their website to ensure they are covered in 2021.
Vaccine Hesitancy Is Widespread: How Do We Combat It?
A poll of 1,008 Coloradans by Healthier Colorado in late November found that 40% of respondents did not intend to receive the COVID-19 vaccine. They reported that 39% of white respondents, 44% of Latinx respondents, 48% of Black respondents, 34% of people with a college degree, and 69% of people with a high school education or less were not willing to receive the COVID-19 vaccine.
Pew Research Center data indicate that willingness to receive the COVID-19 vaccine has plummeted across racial and ethnic groups nationwide since the spring, making it clear that vaccine hesitancy is a problem everywhere.
Healthcare workers are not exempt from this uncertainty. A national survey of nearly 13,000 nurses in October found that 36% would not voluntarily receive the COVID-19 vaccine, and 31% were unsure. Reasons for increased vaccine skepticism include concerns about politics influencing the development and approval process, the “warp speed” timeline, and the lack of diversity in clinical trials.
Vaccine hesitancy also has historic roots for the African American population. Deidre Johnson, the executive director of the Center for African American Health, was recently interviewed for a 9News article about racial and ethnic disparities in flu vaccination rates. She stated that, “All of these disparities, whether it’s flu vaccine or the COVID issues, they’re all deeply rooted in systemic racism… Our system is creating exactly what it was designed to do.”
We are facing rising mistrust and misinformation about the COVID-19 vaccine as initial doses are arriving in Colorado. In order to create an equitable pandemic response and achieve herd immunity, we need tailored community-specific messaging to combat misinformation, earn trust, and spread the message about the importance of getting vaccinated.
Collaboration . . . is about the ideas that never existeduntil after everyone enters the room.
Message from the Executive Director
Achievingbetter health through collaboration says as much or more about how the Mile High Health Alliance pursues its priorities as it does about the purpose of our programs and activities. Our work is simultaneously broad and narrow – understanding the big picture in order to implement iterative changes that result in tangible impact.
In the health sector there are often confounding variables that lead to improved individual, family, and community outcomes. As a result, evaluation of collaborative activities is frequently rooted in contribution analysis: understanding the relative role that each organization, activity, and program contributes to the success of an effort. No one organization can claim sole credit for achieving the goal, but each organization can identify how, but for their participation, the achievement would not have been possible.
Please enjoy this quarterly newsletter, which highlights some of the ways through which MHHA is fostering and engaging in collaborative efforts to improve the health of Denver residents.
MHHA Collaboration Efforts
Health and Wellness, COVID / Census Events
Over the past several months, Stephanie has partnered with the Denver Indian Center, the mobile health van operated by Servicios de La Raza, Martinez Dental Services, and promotoras in Montebello to host two COVID19 health and wellness events. Among the two events, the community and partners provided services and COVID-19 tests to over 200 individuals, including A1C screenings sponsored by the Barten Institute and screenings Oral health screenings. They also provided 250 pieces of Census outreach material and information in the form of Swag Bags. Each Swag Bag contained information about the Census, Immigrant service information, fabric masks, school supplies, pens, notebooks, hand sanitizer, and more. Necessary resources are provided by the community, organizations, and the generosity of individuals looking to better their community.
If you are looking to collaborate, provide resources, or be involved with the next COVID19 health and wellness event, save the date for Saturday, September 19, 2020. There, we will be providing resource Swag Bags, cardiovascular and diabetes screening (A1C), COVID19 testing, and more. For more information, contact Stephanie Salazar Rodriguez @ email@example.com.
Aurora/Mile High Health Alliance e-Consult Webinar Series
Since the beginning of the pandemic, telehealth and virtual encounters have become a significant topic. However, e-Consult is rarely included. I bet you’re wondering…..aren’t they the same thing? Actually, the two are quite different. The Mile High Health Alliance and the Aurora Health Alliance were both working on addressing the access to specialty care problem, but never together. Through these discussions, we decided to collaborate and create three webinars focusing on e-Consult. Each e-Consult webinar focused on three unique areas: Statewide Perspective, Colorado Perspective, and Next Steps for Health Alliances
First off, what is the difference between Telehealth and an e-Consult? Telehealth is a technology platform where physicians can deliver health care, health education, and health information services and communicate remotely between their patients. An e-Consult is not the communication between physicians and patients but the consulting between two physicians. The importance of using e-Consult is the elimination of a potential visit or online conversation with the specialist. Eureka!!! One positive solution to minimizing the gap to specialty care access.
So why have a webinar series? The short answer is to bring like-minded people who understand the need for specialty care access and to find feasible solutions where any health alliances can implement these strategies. We presented the challenges currently being faced, best practices, current work being done throughout the states, and patient experiences. At the end of our webinar series, we developed concrete solutions in which Alliance throughout Colorado can implement.
PowerPoint information for the three webinar series can be accessed by clicking the links below.
The Orange Flag Project proposes to address the lack of a proactive, coordinated, multi-sector framework to reduce excessive Emergency Department and hospital use in the Denver metro area. Despite the availability of a health information exchange through CORHIO, ED personnel still cannot easily access the data they need to identify high utilizer patients, have insufficient standardized response protocols, and limited connections to available cross-sector community resources.
Here is an overview of the goals for each phase of the project:
1. Identify a target population– In alignment with Regional Accountable Entity (RAE) Key Performance Indicators (KPI), Hospital Transformation Program quality measures, and Governor Polis’s Wildly Important Goals, the target population will consist of high health system users who have potentially manageable factors that if addressed could mitigate future ED and hospital use.
2.Protocols- The first set of protocols will address actions ED providers take when receiving the Orange Flag push notification in the patient’s emergency health record (EHR). The second set addresses the notification of the care team, providing alternative intervention to the ED.
3.Technology- Create an interoperable algorithm to identify at-risk patients and alert the ED staff in real-time.
4.Evaluation- Establish process measures to track patients who received the intervention and evaluate the project’s effectiveness as a whole.
So far, preliminary meetings have been conducted with stakeholders in various positions of the healthcare industry. Interest has been identified from health systems (Denver Health, Kaiser Permanente, St. Josephs, and UC Health), public health organizations (Denver Public Health), government networks (the Department of Health Care Policy and Financing, Region 5 Regional Accountable Entity-CO Access), as well as community-based health centers (Stout St. Health Center from CCH).
This past May, MHHA was selected as a host organization for the 2020 Regional Complex Care Convenings. In addition to receiving a grant to progress this work, the contract with the National Center for Complex Health and Social Needs provides technical support and convening expertise. The Orange Flag project was chosen along with 5 other projects across the country, all with parallel goals of increasing collaboration within the health sector (link).
MHHA and the National Center will convene stakeholders before the end of Q2 in 2021 to solidify the relationships needed to develop and implement a plan for the pilot Orange Flag project. Through the convening, the group will work to form a shared understanding of the approach and project components, identify data available to support the project’s efforts, and form an action plan. Meetings with the other regional host sites will also occur quarterly to share successes and discuss how to overcome barriers.
The project is currently in the first phase of development; meetings are taking place with representatives from HCPF and CO Access. The aim is to incorporate Orange Flag into various previously identified priorities of these governing bodies. Alignment is vital to the success and sustainability of the project.
One of the convening goals is to create an environment that fosters collaboration between organizations in the Metro Denver Area, which will ultimately lead to better health for our entire community. The effort to identify and recruit other key stakeholders with interest and influence in the issue areas the project proposes to address is ongoing.
Things You Don’t Want To Miss
Are You Ready For Your Flu Shot?
Health experts are warning about the possibility of a “twindemic” of COVID-19 and flu this fall and winter. Hospitals could be overwhelmed by a flood of patients sick with the flu, which presents another barrier to caring for individuals infected with COVID-19. It is more important than ever to get this year’s flu shot, in addition to consistently wearing masks, physically distancing, and practicing regular handwashing. Two vaccines have been licensed for the use during the 2020-21 flu season and will be available soon in Denver doctor’s offices and clinics, including from several drive-thru flu shot clinics opening across the Front Range. Use VaccineFinder to find out where to get vaccinated near you.
TRUA: Denver’s New Housing Assistance Program
You may already be familiar with the Temporary Rental and Utility Assistance program, but if you are not aware of it, here’s some information you don’t want to miss. The TRUA program assists residents of the City & County of Denver who are facing a housing crisis or hardship due to circumstances beyond their control. The financial assistance given is a grant that helps mitigate displacement and or eviction to help residents stabilize their housing conditions. Individuals can qualify for TRUA regardless of legal status, but they must be Denver residents and meet an income limit. MHHA plans to broaden our outreach and navigation services to our existing community engagement activities, as well as develop specific outreach to our members and partners who are not familiar with available programs and services.
Nominations Open for KUSA Award
The Kathy Underhill Scholarship Award was created in honor of the founding CEO of Hunger Free Colorado. It recognizes a community leader who works to eliminate hunger in Colorado using a health equity lens. Visit the page linked in the next section to submit a nomination before the October 5th deadline.
COVID-19 Update:At the PIAC call on March 18, HCPF Director Kim Bimestefer and Medicaid Director Tracy Johnson spoke about actions the Department is taking to respond to COVID-19. A section 1115 waiver was submitted on Friday, March 13th to CMS including approval for a variety of temporary measures. The 14-page waiver application included 11 amendments to Appendix K, Home and Community Based Services. Changes include:
Paying telehealth/telemedicine (computer, phone, text, eConsult) at the same rate as for a regular encounter.
Getting people enrolled in Medicaid quickly; as people lose their jobs they are first filing for unemployment and then Medicaid enrollment.
Getting providers credentialed including those waiting, graduating, and retired.
CMS has approved a 6.2% FMAP bump over the current 50% rate; HCPF had requested 100% and is still working on it.
With the economic impact of COVID-19, the state revenue forecast will be significantly affected. There is the concern that if we get approval from CMS to make changes, will the state be able to afford it.
There are so many pieces in motion with Medicaid right now that it’s hard to keep up with everything. The issues most on my mind these days are declining enrollment, Payment Error Rate Measurement, the proposed Medicaid Fiscal Accountability Rule, and uncertainty about the Community Health Center Fund.
Through the Medicaid expansion under the Affordable Care Act, along with the “welcome mat” effect, over 100,000 new Medicaid holders were enrolled in Denver, which helped cut our uninsured rate by half. These newly-enrolled have had the opportunity to access regular healthcare, as well as the additional care coordination services provided through Colorado Access, Denver’s Regional Accountable Entity.
As a result of ACA implementation and Medicaid expansion, safety-net providers in Colorado made substantial improvements, increasing services, programs, and even locations to better serve residents who face some of the greatest barriers to gaining coverage and accessing care. However, changes to policy and regulation at the federal level now threaten to undermine Medicaid and destabilize the safety-net in Colorado.
Below is a very brief summary of each of the above topics and, for those of you who want to go deeper, some additional links to further reading. The most important take-away: if we fail to act, the healthcare safety-net could experience a significant contraction, jeopardizing operations at critical facilities and leaving many Coloradans without coverage or care.
Decline in Medicaid Enrollment: MHHA has been focused on understanding in more detail the factors contributing to the decline in Medicaid enrollment and rising uninsured rate among our members, with the goal of developing strategies to mitigate the erosion of the payer mix. As the ratio of uninsured to insured patients increases, these facilities have fewer resources to meet the needs of the people they provide care for.
The Colorado Center on Law and Policy released a report in December about the Medicaid decline, outlining several potential factors for decreased enrollment, including a stronger economy, the “chilling effect” of Public Charge, and operational changes made by HCPF in response to pressure from CMS.
MMHA contributed to helping Colorado Health Institute develop a research agenda on declining Medicaid enrollment, and CHI has received funding to proceed with the development of two related reports. The first is due out in April.
What you can do: Let MHHA
know if you have experienced declining Medicaid enrollment and how it has
affected operations and the people you serve.
Medicaid Payment Error Rate Measurement: “PERM” measures “improper” payments in Medicaid based on audits of whether a state is implementing its program in accordance with federal and state policies. The Center for Medicaid/Medicare Services has interpreted PERM differently, equating the errors with fraud, and indicating that they may claw back funding from states whose audits reveal an error rate greater than 3%.
At the February meeting of the Program Improvement Advisory
Committee for the RAEs, Medicaid Director Tracy Johnson shared that Colorado’s
PERM is 28%, putting $30-$60 million or more of Medicaid funding at risk. As a
result, HCPF is “implementing several
work streams in partnership with county partners to improve eligibility
practices.” For now, the claw back
remains theoretical, but clearly is driving a number of HCPF’s operational
What you can do: Work with the counties to ensure people keep their information with HCPF up to date and complete the income verification requirements promptly.
Fiscal Accountability Rule (MFAR): While intensely wonky, this proposed rule by
CMS could have a significant impact on financing mechanisms for Medicaid, such
as the Hospital Provider Fee. We don’t know what the exact impact of MFAR would
be in Colorado, but the Colorado Hospital Association in their comment letter
estimated a $3 billion loss in Medicaid funding as a result. To learn more,
read Cindy Mann’s excellent blog post.
What you can do: The
comment period has closed, so the best course is to contact CMS and ask the
rule be withdrawn.
Community Health Center Fund: Funding for Federally-Qualified Health Centers has been caught up in the federal budget chaos since last summer. Support for the CHCF has been maintained through a series of “Continuing Resolutions,” which is what happens when Congress doesn’t reach an agreement on a new budget by the October 1st start date. CHCF support was extended for 60 days, then 30 days, and then until May 22, 2020. But there is still uncertainty about when and if the federal budget will be passed, and how much will be earmarked for the CHCF.
What you can do: Contact members of Congress to urge full funding of the CHCF.
Be Counted – Census 2020
COVID-19 Update:Mandatory and requested restrictions on gatherings and close contact will have a significant impact on our Census outreach, education, and enrollment efforts. MHHA is developing new strategies, such as phone and direct mail, to substitute for our original outreach plans. If you have ideas about how we can effectively reach hard-to-count populations in these challenging times – or how we could partner with your organization – please email Census2020@milehighhealthalliance.org.
The Mile High Alliance (MHHA) has received three time-limited Census 2020 grants to provided education and outreach for “hard to count” populations in Denver. The funding is designed to offer staff and community education presentations and provide collateral material for MHHA members and community organizations, as requested. The collateral materials are available in English/Spanish and various other languages. Additionally, MHHA will collaborate with various community partners to coordinate five community Census/health events in Southwest Denver and Montbello.
MHHA’s model for Census outreach and education includes the
Providing collateral materials for partner organizations that can reach hard-to-count communities in Denver
Providing Census training for your staff
Post-training technical assistance if your staff have questions
Help with the development of a work or action plan for Census plans for your organization
To date, we have facilitated two community presentations/training and have additional presentations scheduled in the upcoming months. We welcome the opportunity to provide additional information and assistance to your organization. Please feel free to contact us at firstname.lastname@example.org
MHHA invited to join MLP Safe and Healthy Housing Cohort
invited to participate in the MLP Safe and Healthy Housing Cohort. By convening
this cohort, the Network for Public Health Law (NPHL) and the National Center
for Medical-Legal Partnership (NCMLP) aim to support MLPs working at the intersection
of individual patient/client needs and population health. The conveners will
facilitate opportunities for peer discussion and will provide legal technical
assistance to support MLP efforts to improve health through housing.
The NPHL and NCMLP commit to working with the cohort on
developing a legal strategy to improve access to safe and healthy housing. The
conveners will partner on legal strategy implementation by providing up to 20
hours of legal technical assistance, connecting MLP leadership with state and
local health departments, and facilitating three virtual meetings of the
cohort. Cohort members will periodically check in with point persons. These
meetings will serve as an opportunity to adjust the legal strategy, brainstorm
solutions to obstacles, identify new contacts, and celebrate accomplishments to
In addition to participating in the cohort, members will
attend and engage in three virtual meetings and participate in the 2020 Public
Health Law Conference in Baltimore, MD, where the cohort will convene in
Medicaid and the Coronavirus
Here is an important discussion of the connection between the current COVID-19 pandemic and Medicaid by Sara Rosenbaum from George Washington University:
“In their recent editorial on the burgeoning public health crisis brought on by the fast-spreading coronavirus, David Blumenthal, M.D., and Sara Collins point out Medicaid’s long-standing role as the nation’s single largest health care first responder. ” [Read more]
“Long-awaited interoperability rules finalized by Trump admin”
“Trump administration healthcare officials on Monday (March 9th) finalized two highly anticipated rules prohibiting the practice of information blocking and giving patients more agency over their medical data. The rules had been held up amid controversy and a fierce industry discussion about patient access versus privacy and security.” [Read more]
(Almost) Welcome Our New VISTA – Tim Morton
We were hoping to onboard our new VISTA on April 13th. However, in response to COVID-19, the Corporation for National Service has delayed all new positions until May.
Tim graduated from CU Boulder last spring with a degree in Integrative Physiology and a minor in Spanish:
“I’ve been aspiring to improve the health of our society since high school and am looking for the best way to make the biggest impact. Working for underserved populations with MHHA is a great way for me to combine my interests in science and research with my passion for community service. Outside of work, I try my best to live an active lifestyle. My hobbies include skiing, ice hockey, and helping my mom train guide dogs.”
ReFUND Colorado – An Easy Way to Support MHHA
If you get a state income tax refund in 2020, you will have a new opportunity to donate some or all of it to support our ongoing work in the community. Since Mile High Health Alliance is a project of the Colorado Nonprofit Development Center (CNDC), all donations will be made using their name and tax ID number.
The new program described by the ReFUND CO
initiative puts you in charge of where your donation goes. It’s as simple as
Decide how much of your refund to donate.
2. Enter Colorado Nonprofit Development Center and their registration number 20023005384 in the Donate to a Colorado Nonprofit Fund line on your state income tax return or tax software. NB: In order for these funds to be allocated to Mile High Health Alliance, please use this link to provide information about your donation.
3. Smile knowing you’ve helped a cause that matters to you!
As always, we’re grateful
for your past support and hope you’ll consider donating again through this new
program to maintain our mission.
Quote: “It’s no longer sufficient to segment the population into those individuals who are most likely to have high costs; we need to segment by those whom we can help in partnership with other sectors, and build those partnerships to ensure their long-term recovery.“
David Labby, MD, MPH, Health Strategy Advisor and former Chief Medical Officer at Health Share of Oregon. [Read more]
In the two years between August 2017 and August 2019, Medicaid enrollment in Denver dropped by almost 12%, or about 25,000 people. The decline in Medicaid-insured residents wasn’t steady – there were some peaks and valleys during this period – but the overall downward trend is very concerning for MHHA members and the safety net in general.
Medicaid expansion under the Affordable Care Act, along with the “welcome mat”
effect, over 100,000 new Medicaid holders enrolled in Denver, which helped cut
our uninsured rate by half. These newly-enrolled now had the opportunity to
access regular healthcare, as well as the additional care coordination services
provided through the Colorado Access, Denver’s Regional Accountable Entity.
providers, fewer uninsured patients meant stronger revenues. With increased
resources, safety-net providers expanded capacity, programs, and services in
order to deliver better care to their patient populations. These advances are
at risk as Medicaid enrollment continues to fall. Furthermore, if the people
dropping off Medicaid rolls are eligible-but-not-enrolled, HCPF is likely to
end up paying for expensive care at emergency departments instead of at primary
Center on Law and Policy recently released an in-depth analysis of HCPF data,
noting that the “rate of decline in enrollment in Medicaid and CHIP in
Colorado is more than threefold the national average.” What’s
Causing Colorado’s Decline in Medicaid and CHIP Enrollment? suggests that operational and process factors
contributing to the decrease include:
Functioning of redetermination
County management of validation
Obstacles to real-time eligibility
Impact of the returned mail policy
There’s no time to waste; further erosion of Medicaid enrollment
could affect the stability of the safety net, which serves many of the
communities that face the greatest social and economic barriers to healthcare. Have
you noticed an increase in uninsured patients? We’d like to hear from you about
how it’s affecting your organization.
Medical-Legal Partnership Convening
This past October, MHHA hosted MLPs: Past, Present, and Future. The event itself focused on bringing together stakeholders who work with, have worked with, or are interested in working with Medical-Legal Partnerships (MLPs). The goal was to create/launch a learning community about MLPs and explore alignment on issues such as data, screening tools, sustainability, etc.
The first part of the convening featured speakers from the Health Equity Advocacy Cohort, 9to5, and a keynote speaker, Kirby Mitchell, who gave great insight into pulling together different stakeholders from South Carolina to create an MLP. The afternoon consisted of a panel with partners who are invested in MLP efforts in Denver. After the panel, attendees split into working groups. These groups discussed opportunities, challenges, and next steps for screenings tools, policy, and data/evaluation.
The convening was a resounding success. Many people remarked
that they found the day useful and inspiring. It is our hope to continue this energy
and conversation around MLPs with interested parties. In the new year, we are
planning to bring this group back together for further discussions around
working as a collaborative to sustain metro Denver’s MLPs.
Enhancing Vision for Older Montbello Residents
According to the Latino Community Foundation, the Colorado Latino Age Wave (LAW) “is an initiative that supports the well-being of a rapidly growing Latino older adult population in Metro Denver through innovative services and programs.” Through a limited grant, the LAW awarded funding to MHHA to coordinate a vision testing and eyeglasses initiative for adults 65+, who reside in the Montbello neighborhood. As a result, MHHA is collaborating with the LAW Connectoras (Spanish-speaking connectors), to identify and refer eligible (un-insured) individuals to MHHA. The alliance monitors the initiative and is responsible for ensuring direct payment is made to the vendor, America’s Best. To date, the initiative has provided services to 20 individuals and anticipates serving additional residents, prior to the conclusion of the grant in 2020.
Specialty Care Update
After careful consideration, we have decided to revamp our Mile High Specialty Care SPAN working group. As we look towards the new year, we want to bring a diverse set of health experts as well as feasible action steps to address specialty care access. We are looking to relaunch at the beginning of January of next year. If you are interested or know of someone who is addressing specialty care access and would like to participate in the conversation, please reach out to Vicente Cardona @email@example.com.
Department of Local Affairs Census Grant: The Mile High Health Alliance recently support for our 2020 Census outreach efforts through the funding appropriated by HB19-1239. Our workplan is already coming together, as we will need to move quickly in order to reach hard-to-count communities in Denver. Keep an eye out for an email from MHHA staff inquiring about how we can support our members and partner in their Census work. We have the capacity to provide collateral materials, training, education, and technical support.
Together We Count Mini-Grant: The Mile High Health Alliance received additional funding through a mini-grant from Together We Count. This money will join the DOLA funding in the census support pool to help us reach our program goals.
Support Mile High Health Alliance This Colorado Gives Day!
Regional Health Connector (RHC) Funding: The University of Colorado Department of Family Medicine has received approval to fund comprehensive practice transformation, including financial support to the RHC program. Each RHC region will be eligible to receive up to $30,000 for one year starting November 1, 2019, with the possibility of two additional years of funding.
The Mile High Health Alliance is a coalition of organizations committed to achieving better health through collaboration, working together to increase access to healthcare for the uninsured, underinsured, and Medicaid-insured residents of Denver. Donations through Colorado Gives Day will support our Medical-Legal Partnership, which connects patients who access care at safety-net clinics with legal services that can help address issues of housing safety and stability for individuals and families in our communities.
Access Monitoring Review Plan Comments Due October 4th
On September 5th, the Department of Health Care Policy and Financing released a draft of the 2019 Access Monitoring Review Plan, triggering a 30-day comment period. The AMRP reports on whether access to care is sufficient for Medicaid-holders in five categories:
Behavioral Health Fee-For-Service
Home Health Services
Pre-Natal including Labor and Delivery
The Centers for Medicaid/Medicare Services requires every state Medicaid office to submit the AMRP every three years. “Sufficient” for Medicaid-holders is defined by CMS as equivalent to access by people with commercial insurance. For many rural geographies, as well as urban and suburban areas, this means that access to care is sufficient even though no one can get the care they need.
The 2016 AMRP and the 2019 draft AMRP both conclude that access to care is sufficient for Medicaid-holders in all categories. These findings by HCFP are incongruent with a report released in June by the Colorado Health Institute, which estimates that Medicaid patients forgo 486,000 specialty care appointments every year. That’s roughly 87 appointments annually for each specialty care physician in Colorado.
Comments on the AMRP are due on Friday, October 4th. Please, if you can, provide feedback regarding your experiences and challenges with access to care for Medicaid holders – qualitative or quantitative – to firstname.lastname@example.org.
Thanks so much.
Director of Community Engagement/Regional Health Connector is honored at the Public Health in the Rockies Conference
On August 27, 2019, Stephanie Salazar-Rodríguez received a prestigious “General Recognition” award at the annual Public Health in the Rockies (PHiR) conference. The award recognized her contributions to public health through her commitment to improving overall health outcomes for residents in Denver.
Community Engagement Work
On June 30, 2019, Stephanie Salazar-Rodríguez’s primary role as the Regional Health Connector (RHC) concluded, as the State Innovation Model (SIM) funding sunsetted. In the final RHC Social Network Analysis for Region 20, 55 survey respondents reported that the “new and strengthened relationships, facilitated by the RHCs were more valuable than pre-existing relationships in terms of the time commitment, resources contribution, and influence offered by new or strengthened partnerships. They also reported higher levels of trust among the new and strengthened relationships,” while 100% of survey respondents stated they believe that the role of an RHC is imperative to a stronger community health system in Denver.
Stephanie’s work continues as the Director of Community Engagement/RHC. The most recent priorities of the Director of Community Engagement are working with the Latino Age Wage in Montbello, Phase III of the Immigrant Drop-Off the Medical/Legal Partnership and promoting the importance of a complete count in the 2020 Census.
Stephanie’s community engagement work in Southwest Denver remains a priority. On August 6, 2019, Stephanie and Karen attended the Southwest Denver National Night Out event. They hosted a resources table where they provided information on the healthcare focus for the Census 2020. The MHHA staff, conducted an informal poll that revealed nearly everyone who participated in the poll, plan to respond to the upcoming Census. Denver’s Mayor, Michael Hancock stopped by the MHHA table to congratulate us on our commitment to the Census work.
Additionally, as part of the work in Montbello, on August 17, 2019, MHHA (Karen Trautman and Vicente Cardona) participated in a Wellness Fair held at the Montbello Recreation Center. There were approximately 200 individuals in attendance, including 40 people from the Latino Age Wave, who received health screening services through the CREA Results Mobile Health Van and the distribution of 10 home monitoring blood pressure cuffs.
All Things Census
Ignite at Public Health in the Rockies
Earlier this month, Dede de Percin, our executive director, presented an Ignite Talk at Public Health in the Rockies. Her five-minute presentation featured 20 slides highlighting the importance of the census for Coloradans, as well as why folks in the room should pay attention and take action. We should mention, she did this all while sporting fashion-forward “Star-Spangled Leggings.”
Department of Local Affairs
The Mile High Health Alliance recently submitted a proposal to support 2020 Census outreach, education, and promotion to the Department of Local Affairs for state funding appropriated by HB16-1239. We will be notified by November 1st whether we are successful.
Together We Count
Together We Count has opened an RFP for additional census outreach funding. MHHA plans to submit a proposal for this grant as well – every little bit helps! Click here for more information.
What the Census Tells Us: Health Insurance Coverage Edition
The Census recently released an extensive report on health insurance coverage. The percentage of insured individuals in Colorado held steady, despite the national downward trend. The number of individuals enrolled collectively, in both public and private insurance, remains equivalent to previous years.
Interestingly, Colorado’s Medicaid-insured numbers are down, consistent with the national trend reported in Census data. Theories about the reason for the decline include the impact of the “chilling effect” of Public Charge and other federal policies. Colorado has apparently been able to maintain our percentage of insured because of an uptick in commercial insurance enrollment. Click here for more information.
Mile High Specialty Care Network
The Mile High Specialty Care Network has been active in its new role within the Kaiser Cohort. Mile High Health Alliance is leading the conversation about our system change goals and focusing our efforts by utilizing various levers to ensure impactful change towards better access to specialty care.
During our cohort meetings, there have been discussions around system change and how the cohort can make a significant impact within Colorado. Mile High Health Alliance has taken the lead to focus on four system change goals that can make a considerable impact in accessing specialty care. The goals that we will be focusing on are: tracking current policy opportunities, UC Health participation with Health First Colorado, Health First Colorado provider enrollment, and e-consult reimbursement. Though the tasks are ambitious, we feel we are up to the challenge.
For those who might not be aware, Mile High Health Alliance has been focusing on Track II of its Specialty Care Network. Track II looks at finding specialists within Denver who are accepting new Medicaid patients. We then reach out to clinics or referralists seeking assistance and provide information most suitable to their patients. If you need information about Medicaid accepting specialists in your area, please contact us at Vicente@milehighhealthalliance.org.
Within the past several months, Mile High Health Alliance has had the privilege to participate as judges for the 2019 Prime Health Challenge. We have used our knowledge and resources from our network to ensure that each company concept embodied innovation, community, and was equitable for all. As the Prime Challenge comes to an end, only seven companies remain. To learn more about the dates and the seven finalists click here.
On October 23, at the Asterisk Event Center in Denver, Prime Health will be hosting a live “Shark Tank” style event. Seven finalists will pitch their product for an opportunity to win a portion of $150,000 provided by the Colorado Health Foundation. The seven companies that will be participating will be Babyscripts, Manatee, Meru Health, phas3, Moving Analytics, Care Cognitics, and STREAMD. If you haven’t already registered, click here to get your tickets to the main event.
New Initiative: Budtenders Program
We have a very exciting update on a new strategic initiative that MHHA has been working hard on – Budtenders Program. This project came out of a male mental health crisis. In Denver, suicides disproportionately affect men, which has a ripple effect throughout the whole community. There have been many efforts to address mental health and specifically male mental health in Denver, but MHHA’s strategy is a bit different. We’re interested in meeting people where they are with information, messaging, and resources to improve health. In this case, we’re interested in meeting people at cannabis retailers. Similar models have been used at gun ranges and gun stores to provide education and resources on suicide prevention.
In collaboration with Native Roots Dispensary and Mental Health Center of Denver, MHHA has put Colorado Crisis materials on the counters of dispensaries throughout the metro area. Although some teams were apprehensive at first to engage their guests with these materials, they soon warmed up to the idea once it was clarified that they should only engage if they feel comfortable and feel that the situation called for it. In one month, 57 cards and 14 flyers were handed out. We’re keeping track of the numbers over the next few months to see if the number of cards and flyers taken stays steady or increases as the teams become more comfortable with the materials.
Home Equity Report
A new analysis of housing trends in Colorado reveals that the health of Coloradans is closely tied to access to affordable, stable, accessible and quality housing. Residents across the state have been harmed by the rapid increase in housing costs, and that pinch has been acute for seven distinct demographic groups, the report found.
The report details how housing instability has a direct negative effect on the health and well-being of people of color, Coloradans with low incomes, families with children, people in rural areas, people with disabilities, immigrants without documentation and Coloradans experiencing homelessness. The report, “Home Equity: A Vision of Housing Security, Health and Opportunity” was produced by the Colorado Health Institute in partnership with a cohort of 18 Colorado nonprofit organizations. The average Colorado home price increased 77 percent in the past decade, researchers found, yet the state’s median income increased just 4.5 percent.
To improve housing opportunities throughout the state, the report outlines 11 promising policy ideas created in partnership with affected communities that state and local policymakers should consider. They range from local to state-level solutions and include ways to correct historic and current policies that have created today’s inequitable systems.
One of the policy ideas promoted in this report on page 32, is “Promote Medical-Legal Partnerships.” MHHA belongs to a Medical-Legal Partnership (MLP) partnership. Starting with two Denver Health Clinics, Intensive Outpatient and Westside Pediatrics, 186 patients were screened for legal needs such as housing and utilities, education, benefits, and safety and stability. Patients were then referred to one of our three legal partners; Colorado Legal Services, Colorado Poverty Law Project, and DU Sturm College of Law. We have since received funding to expand the MLP to two additional clinics, focused on aging adults 50+.