House Bill 25b-1013 Introduced

A Bill for an Act

• Page 1, Line 101Concerning narrowing eligibility for subsidies allocated by

• Page 1, Line 102the health insurance affordability enterprise.

Bill Summary

(Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.)

The health insurance affordability enterprise (enterprise) is required to allocate a portion of the enterprise's revenue for subsidies to state-subsidized individual health coverage plans purchased by qualified individuals. The bill narrows the current definition of "qualified individual" by excluding individuals who do not have lawful immigration status in the United States and individuals who are ineligible for certain federal health benefits.

• Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:

• Page 2, Line 2SECTION 1.  Legislative declaration. (1)  The general assembly finds and declares that:

• Page 2, Line 3(a)  Colorado is facing a declared fiscal emergency for the current

• Page 2, Line 4state fiscal year, with the office of state planning and budgeting projecting a deficit of $783 million;

• Page 2, Line 5(b)  The state's financial condition requires immediate and

• Page 2, Line 6responsible action to preserve core services such as education, public safety, transportation, and health care for documented Colorado citizens;

• Page 2, Line 7(c)  In times of fiscal crisis, it is necessary and prudent to prioritize

• Page 2, Line 8the needs of Colorado citizens and lawfully present residents first,

• Page 2, Line 9ensuring that scarce state resources are directed to those who are eligible

• Page 2, Line 10for federal cost sharing or otherwise entitled to benefits under state and federal law;

• Page 2, Line 11(d)  Current statutes governing the health insurance affordability

• Page 2, Line 12enterprise and certain state-only, medicaid-equivalent benefits extend

• Page 2, Line 13subsidized health coverage to individuals who are not lawfully present in

• Page 2, Line 14the United States, including those who are ineligible for federal medicaid benefits and federal premium tax credits;

• Page 2, Line 15(e)  Continuing to provide such subsidies during a budget shortfall

• Page 2, Line 16not only diverts tens of millions of dollars annually from legal residents

• Page 2, Line 17but also risks policy conflicts that could further endanger federal grant revenues upon which the state relies for essential programs;

• Page 2, Line 18(f)  Clarifying statutory eligibility to exclude individuals who are

• Page 2, Line 19not lawfully present in the United States will free up significant health

• Page 3, Line 1insurance affordability cash fund and general fund dollars, which can then be directed to:

• Page 3, Line 2(I)  Reduce or prevent premium increases for eligible Coloradans in the individual health insurance market;

• Page 3, Line 3(II)  Maintain coverage for lawfully present residents who are at risk of losing insurance due to 2026 rate increases; and

• Page 3, Line 4(III)  Preserve core state services threatened by the current fiscal shortfall; and

• Page 3, Line 5(g)  Section III.B.2. of executive order D 2025 009 calls for

• Page 3, Line 6"adjustments to the Health Insurance Affordability Enterprise (HIAE) to

• Page 3, Line 7facilitate a reduction in premium increases and avoid health insurance

• Page 3, Line 8coverage loss for those in the individual market and those unable to

• Page 3, Line 9purchase through Connect for Health Colorado", and the changes in this

• Page 3, Line 10act are directly responsive to this call by making targeted statutory

• Page 3, Line 11adjustments to health insurance affordability enterprise revenue

• Page 3, Line 12allocations and by ensuring that resources are focused on eligible

• Page 3, Line 13Coloradans in compliance with both the scope of the executive order

• Page 3, Line 14calling for an extraordinary session of the general assembly and the state's fiscal priorities.

• Page 3, Line 15(2)  The general assembly therefore declares that this act is

• Page 3, Line 16necessary to maintain fiscal stability, ensure fairness in the allocation of

• Page 3, Line 17scarce public resources, protect the state's federal funding streams, and

• Page 3, Line 18prioritize the needs of Colorado citizens and lawfully present residents during an extraordinary budget crisis.

• Page 3, Line 19SECTION 2.  Legislative intent. (1)  It is the intent of the general assembly that:

• Page 3, Line 20(a)  All state-administered health coverage subsidy programs

• Page 4, Line 1funded in whole or in part by the health insurance affordability enterprise,

• Page 4, Line 2including the SilverEnhanced savings program under OmniSalud, limit

• Page 4, Line 3eligibility to individuals who are lawfully present in the United States, as defined by applicable immigration law and state law;

• Page 4, Line 4(b)  All state-administered health coverage programs that are

• Page 4, Line 5designed to mirror medicaid benefits but are funded solely from

• Page 4, Line 6state-revenue sources, including coverage for children and pregnant

• Page 4, Line 7individuals not eligible for medicaid matching funds, limit eligibility to

• Page 4, Line 8individuals who meet federal medicaid eligibility requirements, unless otherwise expressly authorized by federal law or federal regulations;

• Page 4, Line 9(c)  The phrase "qualified individual", as used in sections

• Page 4, Line 1010-16-1203 and 10-16-1205, Colorado Revised Statutes, be interpreted

• Page 4, Line 11and applied to exclude individuals who are not lawfully present in the

• Page 4, Line 12United States and individuals who are ineligible for federal medicaid or

• Page 4, Line 13federal premium tax credits, regardless of prior program rules or administrative practices;

• Page 4, Line 14(d)  The savings realized from the exclusion of ineligible

• Page 4, Line 15individuals from programs funded by the health insurance affordability

• Page 4, Line 16enterprise and from state-only health coverage programs be prioritized for:

• Page 4, Line 17(I)  Stabilizing premiums and reducing coverage losses in the

• Page 4, Line 18individual market for individuals who are lawfully present in the United States;

• Page 4, Line 19(II)  Maintaining coverage for eligible Coloradans during the projected premium increases for plan year 2026 and beyond; and

• Page 4, Line 20(III)  Supporting other essential state services that are necessary to

• Page 4, Line 21protect the health, safety, and welfare of the people of Colorado;

• Page 5, Line 1(e)  Nothing in this act diminishes or restricts health-care services to individuals if such services are:

• Page 5, Line 2(I)  Mandated by federal law regardless of immigration status; or

• Page 5, Line 3(II)  Provided through private charitable or philanthropic funding independent of state-administered programs;

• Page 5, Line 4(f)  State agencies administering health coverage programs take all

• Page 5, Line 5necessary steps to ensure program compliance with these eligibility

• Page 5, Line 6standards beginning on the effective date of this act, including updating

• Page 5, Line 7application processes, eligibility verification systems, program guidance, and public communications; and

• Page 5, Line 8(g)  Agencies implement these changes in a manner that minimizes

• Page 5, Line 9disruption for lawfully present enrollees and ensures that communications

• Page 5, Line 10regarding eligibility determinations are clear, accurate, and accessible to affected individuals.

• Page 5, Line 11(2)  It is further the intent of the general assembly that this act be

• Page 5, Line 12construed broadly to achieve the fiscal, coverage, and policy goals

• Page 5, Line 13described in the legislative declaration and that any ambiguity in

• Page 5, Line 14interpretation be resolved in favor of preserving state resources for

• Page 5, Line 15citizens and individuals who are lawfully present in the United States during the current fiscal crisis.

• Page 5, Line 16SECTION 3.  In Colorado Revised Statutes, 10-16-1203, amend (12) as follows:

• Page 5, Line 1710-16-1203.  Definitions. As used in this part 12, unless the context otherwise requires:

• Page 5, Line 18(12) (a)  "Qualified individual" means an individual regardless of immigration status, who:

• Page 5, Line 19(a)  (I)  Is a Colorado resident;

• Page 6, Line 1(b)  (II)  Has a household income of not more than three hundred percent of the federal poverty line; and

• Page 6, Line 2(c)  (III)  Is not eligible for Meets federal eligibility

• Page 6, Line 3requirements for the premium tax credit, medicaid, medicare, or the

• Page 6, Line 4children's basic health plan. except for individuals eligible pursuant to section 25.5-5-201 (6) or section 25.5-8-109 (7).

• Page 6, Line 5(b)  "Qualified individual" does not include an individual

• Page 6, Line 6who does not have lawful immigration status in the United States.

• Page 6, Line 7SECTION 4.  Safety clause. The general assembly finds,

• Page 6, Line 8determines, and declares that this act is necessary for the immediate

• Page 6, Line 9preservation of the public peace, health, or safety or for appropriations for

• Page 6, Line 10the support and maintenance of the departments of the state and state institutions.