C.R.S. Section 25.5-5-204
Presumptive eligibility

pregnant person
children
long-term care
state plan

(1)

For purposes of this section, “presumptive eligibility” means the self-declaration of income, assets, and status in order to promptly receive medical assistance services prior to the verification of income, assets, and status.

(2)

Intentionally left blank —Ed.

(a)

A pregnant person is presumptively eligible for the medical assistance program and shall receive services specified by federal law only if the person declares all pertinent information relating to the criteria of income, assets, and, only if necessary to administer reimbursement for services, status.

(b)(Deleted by amendment, L. 2022.)(2.5) A child less than nineteen years of age is presumptively eligible for the medical assistance program and shall receive services specified by federal law only if a parent or legal guardian of the child declares all pertinent information relating to the criteria of income, assets, and, only if necessary to administer reimbursement for services, status of the child’s family.

(2.7)

Intentionally left blank —Ed.

(a)

[Editor’s note:

This version of subsection (2.7)(a) is effective until July 1, 2024.]

The state department is authorized to seek federal authorization to allow a person who is in need of long-term care, as defined in section 25.5-6-104, to be presumptively eligible for the medical assistance program pursuant to this article and articles 4 and 6 of this title.

(2.7)

Intentionally left blank —Ed.

(a)

[Editor’s note:

This version of subsection (2.7)(a) is effective July 1, 2024.]

The state department is authorized to seek federal authorization to allow a person who is in need of long-term services and supports, as defined in section 25.5-6-1702 (10), to be presumptively eligible for the medical assistance program pursuant to this article 5 and articles 4 and 6 of this title 25.5.

(b)

[Editor’s note:

This version of subsection (2.7)(b) is effective until July 1, 2024.]

If the state department receives federal authorization pursuant to paragraph (a) of this subsection (2.7) and sufficient spending authority, a person in need of long-term care shall be presumptively eligible for the medical assistance program if the person or the person’s legal representative declares all pertinent information relating to the criteria of income, assets, and immigration status. Such person shall be assessed for the appropriate level of care pursuant to section 25.5-6-104. If required due to limitations of federal authorization or spending authority, the state department may implement this paragraph (b) as a pilot program rather than statewide.

(b)

[Editor’s note:

This version of subsection (2.7)(b) is effective July 1, 2024.]

If the state department receives federal authorization pursuant to subsection (2.7)(a) of this section and sufficient spending authority, a person in need of long-term services and supports shall be presumptively eligible for the medical assistance program if the person or the person’s legal representative declares all pertinent information relating to the criteria of income, assets, and immigration status. The person shall be assessed for the appropriate level of care pursuant to section 25.5-6-1704. If required due to limitations of federal authorization or spending authority, the state department may implement this subsection (2.7)(b) as a pilot program rather than statewide.

(c)

The state department shall make any necessary changes to the state plan and waivers for home- and community-based service programs authorized pursuant to this article and articles 4 and 6 of this title to comply with this subsection (2.7).

(d)

If it is determined that a recipient was not eligible for medical benefits after the recipient had been determined to be eligible based upon presumptive eligibility, the state department shall not pursue recovery from a county department for the cost of medical services provided to the recipient, and the county department shall not be responsible for any federal error rate sanctions resulting from such determination.

(3)

The state department shall make any necessary changes to the state plan to comply with this section.

Source: Section 25.5-5-204 — Presumptive eligibility - pregnant person - children - long-term care - state plan, https://leg.colorado.gov/sites/default/files/images/olls/crs2023-title-25.5.pdf (accessed Oct. 20, 2023).

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C.R.S. Section 25.5-5-204 Presumptive eligibility

(1)

(2)

(a)

(2.7)

(a)

(2.7)

(a)

(b)

(b)

(c)

(d)

(3)

C.R.S. Section 25.5-5-204
Presumptive eligibility