by Adela Flores-Brennan, Executive Director

Time after time, we are reminded that advocacy is, more often than not, a long game. I recently read an article about the convergence of several major policy gains within the space of a couple of weeks. The author of that article reminds us that those gains didn’t just happen, there were years of advocacy and building blocks being put in place–opportunities taken at just the right time to get us to the point where victories could be recognized and celebrated. It was a reminder that realizing change takes time, patience, a steady drumbeat, and a catalyst.

At the beginning of last month we marked the implementation of an important policy change that removes a significant barrier for lawfully-residing immigrant children and pregnant women to access affordable health care.  The new policy, which removes a five-year mandatory waiting period before becoming eligible for Medicaid and CHP+, took six years to realize. Now implemented, lawfully-residing immigrant children and pregnant women, who are otherwise eligible for Medicaid or CHP+, are immediately able to enroll. This is a huge step forward for health care in Colorado. Children and pregnant moms simply shouldn’t have to delay or forego health care.

This story of success in policy and advocacy dates even further back than six years ago with the first efforts to reauthorize the State Children’s Health Insurance Program, which was set to expire in 2007. Despite bipartisan support, then-President Bush vetoed both efforts to reauthorize the legislation. A temporary reauthorization was subsequently put into place.  Then, in 2009, the Children’s Health Insurance Program Reauthorization Act (CHIPRA) in 2009 was one of the first pieces of legislation Congress passed and President Obama signed. Kaiser Family Foundation published a brief but detailed history of the reauthorization efforts. CHIPRA included a provision called the Immigrant Children’s Health Improvement Act (ICHIA), which gave states the ability to eliminate the five-year waiting period for lawfully-residing immigrant children and pregnant women to become eligible for Medicaid and CHIP.

Later that same year, championed by a coalition of children and health care advocacy organizations and Governor Ritter’s office, the Colorado legislature passed HB09-1353 (Miklosi/Foster) giving the Department of Health Care Policy and Financing the authority to eliminate the five-year waiting period. However, due to the state budget situation at the time, the bill did not include a budget appropriation to finance the change.  It took five more years for the conditions to be right to pass a budget appropriation. During the 2014 legislative session the legislature made an appropriation and set a July 2014 timeline for HCPF to implement. However, it took yet another year for the necessary rule and computer changes to go into place allowing the benefit to finally be delivered to lawfully-residing immigrant children and women.

We celebrated each incremental victory as they passed – from CHIPRA to budget appropriation to rulemaking. Key advocates kept their eyes open for the right opportunities and maintained the health coverage drumbeat to ensure we would get to each subsequent milestone. Now, we can look forward to celebrating pregnant women and children being able to access regular health care because they have a source of affordable coverage. But as advocates, we should also look ahead in anticipation of the next change. Perhaps we consider removal of the five-year waiting period for all lawfully residing immigrants. Perhaps we extend coverage to all children, irrespective of immigrant status.  Change is possible. After all, the building blocks are in place, we just need to identify the catalyst and the opportunity.

To learn more about the five-year bar and coverage for lawfully-residing immigrant children and pregnant women, visit Colorado Covering Kids and Families or the Colorado Department of Health Care Policy and Financing. If you or your child needs to get health care coverage, click here.

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