C.R.S.
Section 25.5-5-101
Mandatory provisions
- eligible groups
- rules
- repeal
(1)
In order to participate in the medicaid program, the federal government requires the state to provide medical assistance to certain eligible groups. Pursuant to federal law and except as provided in subsection (2) of this section, any person who is eligible for medical assistance under the mandated groups specified in this section must receive both the mandatory services that are specified in sections 25.5-5-102 and 25.5-5-103 and the optional services that are specified in sections 25.5-5-202 and 25.5-5-203. Subject to the availability of federal financial participation, the following are the individuals or groups that are mandated under federal law to receive benefits under this article 5 and articles 4 and 6 of this title 25.5:(a)
Repealed.(b)
Parents and caretaker relatives living with a dependent child who meet the eligibility criteria pursuant to section 1902 (a)(10)(A) of the federal “Social Security Act”, including those who subsequently would have become ineligible under such eligibility criteria because of increased earnings or increased hours of employment whose eligibility is specified for a period of time by the federal government;(c)
Pregnant women whose family income does not exceed one hundred thirty-three percent of the federal poverty line, adjusted for family size, who meet the requirements pursuant to section 1902 (a)(10)(A) of the federal “Social Security Act”. Once initial eligibility has been established, the pregnant woman is continuously eligible throughout the pregnancy and for the sixty days following the pregnancy, even if the woman’s eligibility would otherwise terminate during such period due to an increase in income.(d)
A newborn child born of a woman who is categorically needy. Such child is deemed medicaid-eligible on the date of birth and remains eligible for one year.(e)
Children for whom adoption assistance or foster care maintenance payments are made under Title IV-E of the federal “Social Security Act”, as amended, including foster care children, pursuant to section 1902 (a)(10)(A)(i)(IX) of the federal “Social Security Act”, who are under twenty-six years of age, who were in foster care under the responsibility of the state or a tribe, and who were enrolled in medicaid under the state medicaid plan when they turned eighteen years of age;(f)
Individuals receiving supplemental security income;(g)
Individuals receiving mandatory state supplement, including but not limited to individuals receiving old age pensions;(h)
Institutionalized individuals who were eligible for medical assistance in December 1973;(i)
Individuals who would be eligible except for the increase in old-age, survivors, and disability insurance under Pub.L. 92-336;(j)
Individuals who become ineligible for cash assistance as a result of old-age, survivors, and disability insurance cost-of-living increases after April 1977;(k)
Disabled widows or widowers fifty through sixty years of age who have become ineligible for federal supplemental security income or state supplementation as a result of becoming eligible for federal social security survivor’s benefits, in accordance with the social security act, 42 U.S.C. sec. 1383c;(l)
Individuals with income and resources at a level which qualifies them as medicare-eligible under section 301 of Title III of the federal “Medicare Catastrophic Coverage Act”;(m)
Children under the age of nineteen who meet the eligibility criteria pursuant to section 1902 (a)(10)(A) of the federal “Social Security Act”.(2)
Intentionally left blank —Ed.(a)
A qualified alien who entered the United States before August 22, 1996, who meets the exceptions described in the federal “Personal Responsibility and Work Opportunity Reconciliation Act of 1996”, Public Law 104-193, as amended, shall receive benefits under this article and articles 4 and 6 of this title.(b)
Intentionally left blank —Ed.(I)
A qualified alien who entered the United States on or after August 22, 1996, shall not be eligible for benefits under this article or article 4 or 6 of this title, except as provided in section 25.5-5-103 (3), for five years after the date of entry into the United States unless he or she meets the exceptions described in the federal “Personal Responsibility and Work Opportunity Reconciliation Act of 1996”, Public Law 104-193, as amended.(II)
Notwithstanding the five-year waiting period established in subparagraph (I) of this paragraph (b), but subject to the availability of sufficient appropriations and the receipt of federal financial participation, the state department may provide benefits under this article and articles 4 and 6 of this title to a pregnant woman who is a qualified alien and a child under nineteen years of age who is a qualified alien so long as such woman or child meets eligibility criteria other than citizenship.(3)
Repealed.(4)
An asset test shall not be applied as a condition of eligibility for individuals or families described in paragraphs (b), (c), (d), and (e) of subsection (1) of this section.(5)
The county departments responsible for administering benefits programs under the department of health care policy and financing and the department of human services shall identify and review all current county guidance materials, including forms, training materials, websites, and any other materials that reference a prohibition on sponsorship as a condition of eligibility for benefits and shall remove all such references from verbal and digital communications and from all physical materials currently provided to applicants or beneficiaries.(6)
Intentionally left blank —Ed.(a)
To ensure that the state department maintains access to state and federal funding provided by the federal “Families First Coronavirus Response Act”, Pub.L. 116-127, and the federal “Consolidated Appropriations Act, 2023”, the following subsections of this section are suspended until June 1, 2024:(I)
Subsection (1)(c) of this section requiring the state department to disenroll a woman receiving medical assistance sixty days following the woman’s pregnancy;(II)
Subsection (1)(d) of this section requiring the state department to disenroll a child at one year of age who was eligible to receive medical assistance at birth;(III)
Subsection (1)(e) of this section requiring the state department to disenroll former foster care children; and(IV)
Any other provision of this section that requires the state department to disenroll an individual receiving medical assistance prior to the state department processing the individual’s next annual renewal for eligibility following the end of the continuous enrollment requirements implemented pursuant to the federal “Families First Coronavirus Response Act”, Pub.L. 116-127, and the federal “Consolidated Appropriations Act, 2023”.(b)
The state board may adopt rules to implement this subsection (6) to ensure that the state department can resume routine operations by June 1, 2024, that follow guidance issued by the federal centers for medicare and medicaid services, including terminations of eligibility, the processing of eligibility renewals, and the transition between medical assistance and children’s basic health plan eligibility categories.(c)
This subsection (6) is repealed, effective June 1, 2024.
Source:
Section 25.5-5-101 — Mandatory provisions - eligible groups - rules - repeal, https://leg.colorado.gov/sites/default/files/images/olls/crs2023-title-25.5.pdf (accessed Oct. 20, 2023).
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