C.R.S.
Section 25.5-8-109
Eligibility
- children
- pregnant women
- rules
- repeal
(1)
To be eligible for a subsidy, a child must not be insured by a comparable health plan through an employer.(2)
If one child from a family is enrolled in the plan, all children must be enrolled, unless the other children have alternative health insurance coverage.(3)
The department may establish procedures such that children with family incomes that exceed the percent of the federal poverty guidelines specified in section 25.5-8-103 (4)(a) may enroll in the plan, but are not eligible for subsidies from the department.(4)
A child whose family income does not exceed the applicable level specified in section 25.5-8-103 (4)(a) shall be presumptively eligible for the plan. Children who are determined to be eligible for the plan shall remain eligible for twelve months subsequent to the last day of the month in which they were enrolled; except that a child shall no longer be eligible for the plan and shall be disenrolled from the plan if the department becomes aware of or is notified that any of the following has occurred:(a)
The child has moved out of the state; or(b)
Repealed.(c)
The child has been enrolled in a commercial health insurance plan during the twelve-month period following enrollment in the plan under this article.(II)
The department shall annually verify the recipient’s income eligibility at reenrollment through federally approved electronic data sources. If a recipient meets all eligibility requirements, a recipient remains enrolled in the plan. The department shall also allow a recipient to provide income information more recent than the records of federally approved electronic data sources.(III)
If the state department determines that a recipient was not eligible for medical benefits solely based upon the recipient’s income after the recipient had been determined to be eligible based upon information verified through federally approved electronic data sources, 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 is not responsible for any federal error rate sanctions resulting from such determination.(IV)
Notwithstanding any other provision in this paragraph (a), for applications that contain self-employment income, the state department shall not implement this paragraph (a) until it can verify self-employment income through federally approved electronic data sources as authorized by rules of the state department and federal law.(V)
The county department, state department, or other entity designated by the state department to make the eligibility determination shall automatically transfer to the state insurance marketplace through a system interface the application data and verifications of a child or pregnant woman who is determined ineligible for medical assistance benefits pursuant to this section.(b)
Repealed.(c)
Subject to the provisions and requirements of section 25.5-4-205 (3)(e), the department shall establish a process so that an enrollee or the parent or guardian of an enrollee may apply for reenrollment either over the telephone or through the internet.(II)
Repealed.(b)
Intentionally left blank —Ed.(I)
Under the plan, prenatal and postpartum primary health-care providers shall implement policies regarding the integration of evidence-based tobacco use treatments into the regular health-care delivery system, including, but not limited to:(A)
Assessment of tobacco use and exposure to second-hand smoke;(B)
Education on the dangers of tobacco use during pregnancy and postpartum;(C)
Referrals to appropriate cessation services.(II)
Health-care providers may coordinate the implementation of such policies with the tobacco education, prevention, and cessation programs established in section 25-3.5-804, C.R.S.(c)
The addition of coverage under the plan for pregnant women shall only be implemented if the department obtains a waiver from the federal department of health and human services.(d)
Enrollment of a pregnant woman in the plan shall be limited based upon annual appropriations made out of the trust by the general assembly as described in section 25.5-8-105 and any grants and donations. The general assembly shall annually establish maximum enrollment figures for pregnant women in the plan. The department shall not exceed the enrollment caps regardless of whether the funding comes from annual appropriations or grants and donations.(5.5)
Intentionally left blank —Ed.(a)
Subject to the receipt of federal financial participation, to the maximum extent allowed under federal law, a person who was eligible for the plan while pregnant and who remains eligible for the plan for the sixty days following the pregnancy remains continuously eligible for all services under the plan for the twelve-month postpartum period.(b)
The department shall seek any plan amendment necessary to implement a twelve-month postpartum benefit pursuant to this subsection (5.5) and shall implement the benefit only upon receipt of federal authorization and financial participation, and no later than July 1, 2022.(c)
If permissible under federal law, an eligible individual within the postpartum period may resume coverage under the plan upon implementation of this section.(6)
Intentionally left blank —Ed.(a)
Notwithstanding any other provision of law, but subject to the receipt of federal financial participation, the department shall provide benefits pursuant to this article 8 to a pregnant person who is lawfully residing, as defined in section 25.5-4-103 (10), and a child less than nineteen years of age, who is lawfully residing, so long as such pregnant person or child meets eligibility criteria other than those related to citizenship or immigration status.(7)
Intentionally left blank —Ed.(a)
Beginning no later than January 1, 2025, notwithstanding any other provision of law, the department shall provide benefits pursuant to this article 8 to a pregnant person who is not a citizen and is not eligible pursuant to subsection (6) of this section, so long as the pregnant person meets the eligibility criteria other than those related to citizenship or immigration status. Eligibility pursuant to this section extends continuously through the twelve-month postpartum period, so long as eligibility remains in effect pursuant to subsection (5.5)(a) of this section.(b)
The department shall seek any necessary federal approvals to maximize any available federal financial participation in implementing this subsection (7).(c)
Intentionally left blank —Ed.(I)
During its 2024 presentation to the joint budget committee of the general assembly and in its presentation to the health and human services committee of the senate and the health and insurance committee of the house of representatives, or any successor committees, at the hearing held pursuant to section 2-7-203 (2)(a) of the “State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act”, the state department shall report on its plans and progress in implementing the coverage expansion created pursuant to this subsection (7).(II)
Beginning January 1, 2026, and continuing every January thereafter, the state department, in its presentation to the joint budget committee of the general assembly and in its presentation to the health and human services committee of the senate and the health and insurance committee of the house of representatives, or any successor committees, at the hearing held pursuant to section 2-7-203 (2)(a) of the “State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act”, shall report on the cost savings and health improvements associated with the coverage expansion created pursuant to this subsection (7).(d)
This subsection (7) constitutes state authority within the meaning of 8 U.S.C. sec. 1621 (d), as that law existed on January 1, 2022.(8)
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”, subsections (4) and (4.5)(a)(II) of this section requiring the state department to disenroll an individual enrolled in the children’s basic health plan due to the annual verification of income, as authorized by the centers for medicare and medicaid services, are suspended until June 1, 2024.(b)
The state board may adopt rules to implement this subsection (8) 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 (8) is repealed, effective June 1, 2024.
Source:
Section 25.5-8-109 — Eligibility - children - pregnant women - rules - repeal, https://leg.colorado.gov/sites/default/files/images/olls/crs2023-title-25.5.pdf (accessed Oct. 20, 2023).
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