Senate Bill 25b-007 Introduced

A Bill for an Act

• Page 1, Line 101Concerning limiting certain health-care coverage that

• Page 1, Line 102relies on public funds, and, in connection therewith,

• Page 1, Line 103limiting eligibility for certain state-subsidized

• Page 1, Line 104individual health-care coverage and prohibiting state

• Page 1, Line 105reimbursement for medical services provided to

• Page 1, Line 106individuals who are not lawfully residing.

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.)

Current law extends health insurance coverage to various people, including low-income pregnant and postpartum people and children in low-income families, whose immigration status would otherwise make them ineligible for coverage under state-federal programs or would limit the coverage's scope or duration. Other expansions make state-subsidized individual health insurance coverage available for certain people, regardless of immigration status. The bill modifies several provisions related to these coverage expansions by:

• Prohibiting the department of health care policy and financing (HCPF) from reimbursing a health-care provider, entity, or facility for providing medical services to a person who is not a lawful resident;
• Eliminating full health insurance coverage for pregnant and postpartum people who would be eligible for medicaid or the children's basic health plan if not for their immigration status;
• Eliminating full health insurance coverage for children who would be eligible for medicaid or the children's basic health plan if not for their immigration status;
• Repealing the state reproductive health-care program, the medical assistance program, and the state children's basic health plan (state-funded programs) that were established to provide expanded coverage;
• Halting outreach to and enrollment of eligible groups into new coverage options;
• Removing HCPF's potential to spend in excess of an authorized amount for the state-funded programs; and
• Excluding immigrants who are not lawfully residing in the state from state-subsidized individual health insurance coverage available through the health insurance affordability enterprise.

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

• Page 2, Line 2 SECTION 1.  In Colorado Revised Statutes, 10-16-1203, amend (12) as follows:

• Page 2, Line 310-16-1203.  Definitions. As used in this part 12, unless the context otherwise requires:

• Page 2, Line 4(12) (a)  "Qualified individual" means an individual regardless of immigration status, who:

• Page 2, Line 5(a)  (I)  Is a Colorado resident;

• Page 3, Line 1(b)  (II)  Has a household income of not more than three hundred percent of the federal poverty line; and

• Page 3, Line 2(c)  (III)  Is not eligible for the premium tax credit, medicaid,

• Page 3, Line 3medicare, or the children's basic health plan. except for individuals eligible pursuant to section 25.5-5-201 (6) or section 25.5-8-109 (7).

• Page 3, Line 4(b)  "Qualified individual" does not include a person who

• Page 3, Line 5is not a citizen or national of the United States or who is not lawfully residing as defined in section 25.5-4-103.

• Page 3, Line 6SECTION 2.  In Colorado Revised Statutes, 24-75-109, repeal (1)(a.7) and (1)(a.8) as follows:

• Page 3, Line 724-75-109.  Controller may allow expenditures in excess of

• Page 3, Line 8appropriations - limitations - appropriations for subsequent fiscal

• Page 3, Line 9year restricted - repeal. (1)  For the purpose of closing the state's books,

• Page 3, Line 10and subject to the provisions of this section, the controller may, on or

• Page 3, Line 11after May 1 of any fiscal year and before the forty-fifth day after the close

• Page 3, Line 12thereof, upon approval of the governor, allow any department, institution,

• Page 3, Line 13or agency of the state, including any institution of higher education, to

• Page 3, Line 14make an expenditure in excess of the amount authorized by an item of appropriation for such fiscal year if:

• Page 3, Line 15(a.7)  The overexpenditure is by the department of health care

• Page 3, Line 16policy and financing for the state medical assistance program, established pursuant to section 25.5-2-104; or

• Page 3, Line 17(a.8)  The overexpenditure is by the department of health care

• Page 3, Line 18policy and financing for the state children's basic health plan, established pursuant to section 25.5-2-105; or

• Page 3, Line 19SECTION 3.  In Colorado Revised Statutes, 25.5-1-201, repeal

• Page 3, Line 20(1)(f.5) as follows:

• Page 4, Line 125.5-1-201.  Programs to be administered by the department

• Page 4, Line 2of health care policy and financing. (1)  The state department shall administer the following programs and perform the following functions:

• Page 4, Line 3(f.5)  The reproductive health-care program that provides reproductive health-care services, as specified in section 25.5-2-103;

• Page 4, Line 4SECTION 4.  In Colorado Revised Statutes, repeal 25.5-2-103, 25.5-2-104, and 25.5-2-105.

• Page 4, Line 5SECTION 5.  In Colorado Revised Statutes, 25.5-4-201, amend (1) as follows:

• Page 4, Line 625.5-4-201.  Cash system of accounting - financial

• Page 4, Line 7administration of medical services premiums - medical programs

• Page 4, Line 8administered by department of human services - federal

• Page 4, Line 9contributions - rules. (1)  The state department shall utilize the cash

• Page 4, Line 10system of accounting, as enunciated by the governmental accounting

• Page 4, Line 11standards board, regardless of the source of revenues involved, for all

• Page 4, Line 12activities of the state department relating to the financial administration

• Page 4, Line 13of any nonadministrative expenditure that qualifies for federal financial

• Page 4, Line 14participation under Title XIX of the federal "Social Security Act", and for

• Page 4, Line 15the administration of the state-funded health and medical care program,

• Page 4, Line 16created pursuant to section 25.5-2-104, and for the state children's basic

• Page 4, Line 17health plan, created pursuant to section 25.5-2-105, except for

• Page 4, Line 18expenditures under the program for the medically indigent, article 3 of this title 25.5.

• Page 4, Line 19SECTION 6.  In Colorado Revised Statutes, 25.5-4-503, amend (2) as follows:

• Page 4, Line 2025.5-4-503.  Waiver applications - authorization. (2)  The state

• Page 4, Line 21department shall pursue and, if approved, implement a demonstration

• Page 5, Line 1waiver that authorizes the state to use federal medical assistance

• Page 5, Line 2payments authorized pursuant to section 1903(v) of the federal "Social

• Page 5, Line 3Security Act", as amended, in coordination with the division of insurance

• Page 5, Line 4to enhance or expand a state-subsidized individual health coverage plan

• Page 5, Line 5as defined in section 10-16-1203 (15). and, only if needed to maximize

• Page 5, Line 6federal financial participation, for Coloradans receiving state medical

• Page 5, Line 7assistance pursuant to section 25.5-2-104 or 25.5-5-201 (6). To the extent

• Page 5, Line 8such the federal funds are used to enhance or expand a state-subsidized

• Page 5, Line 9individual health coverage plan, as defined in section 10-16-1203 (15),

• Page 5, Line 10the health insurance affordability enterprise created pursuant to section

• Page 5, Line 1110-16-1204 must receive, deposit into the health insurance affordability

• Page 5, Line 12cash fund created in section 10-16-1206, and allocate the federal share of

• Page 5, Line 13the medical assistance payments pursuant to section 10-16-1205 (2), subject to any conditions set forth in the approval of the waiver.

• Page 5, Line 14SECTION 7.  In Colorado Revised Statutes, 25.5-5-103, amend (3)(a) as follows:

• Page 5, Line 1525.5-5-103.  Mandated programs with special state provisions

• Page 5, Line 16- rules. (3) (a)  Emergency medical assistance shall must be provided to

• Page 5, Line 17any person who is not a citizen of the United States, including

• Page 5, Line 18undocumented aliens, aliens who are not qualified aliens, and qualified

• Page 5, Line 19aliens who entered the United States on or after August 22, 1996, who has

• Page 5, Line 20a qualified alien with an emergency medical condition and meets one

• Page 5, Line 21of the categorical requirements set forth in section 25.5-5-101. except that

• Page 5, Line 22such persons shall not be required to meet any residency requirement other than that required by federal law.

• Page 5, Line 23SECTION 8.  In Colorado Revised Statutes, add 25.5-5-103.5 as

• Page 5, Line 24follows:

• Page 6, Line 125.5-5-103.5.  Prohibition on reimbursement for medical

• Page 6, Line 2services to a person who is not lawfully residing.Except as provided

• Page 6, Line 3in section 25.5-5-103 and notwithstanding any other law to the

• Page 6, Line 4contrary, the state department shall not reimburse a

• Page 6, Line 5health-care provider, entity, or facility for providing medical

• Page 6, Line 6services to a person unless the person is a citizen or national of

• Page 6, Line 7the United States or is lawfully residing as defined in section 25.5-4-103.

• Page 6, Line 8SECTION 9.  In Colorado Revised Statutes, 25.5-5-201, repeal (6) as follows:

• Page 6, Line 925.5-5-201.  Optional provisions - optional groups - rules.

• Page 6, Line 10(6) (a)  Beginning no later than January 1, 2025, a pregnant person who

• Page 6, Line 11is not a citizen and who is not eligible for medical assistance pursuant to

• Page 6, Line 12subsection (4) of this section is eligible to receive medical assistance

• Page 6, Line 13pursuant to this subsection (6)(a) if the individual meets the eligibility

• Page 6, Line 14requirements other than those related to citizenship and immigration status.

• Page 6, Line 15(b)  A pregnant person who is eligible for medical assistance

• Page 6, Line 16pursuant to this subsection (6) remains continuously eligible for all

• Page 6, Line 17medical services pursuant to the medical assistance program for the

• Page 6, Line 18twelve-month postpartum period, so long as eligibility remains in effect pursuant to subsection (4.5)(a) of this section.

• Page 6, Line 19(c)  The state department shall seek any necessary federal

• Page 6, Line 20approvals to maximize any available federal financial participation in

• Page 6, Line 21implementing this subsection (6). Benefits for services obtained pursuant

• Page 6, Line 22to this subsection (6) must be provided with only state funds if federal

• Page 6, Line 23financial participation is unavailable for such services.

• Page 7, Line 1(d) (I)  During its 2024 presentation to the joint budget committee

• Page 7, Line 2of the general assembly and in its presentation to the health and human

• Page 7, Line 3services committee of the senate and the health and insurance committee

• Page 7, Line 4of the house of representatives, or any successor committees, at the

• Page 7, Line 5hearing held pursuant to section 2-7-203 (2)(a) of the "State Measurement

• Page 7, Line 6for Accountable, Responsive, and Transparent (SMART) Government

• Page 7, Line 7Act", the state department shall report on its plans and progress in

• Page 7, Line 8implementing the coverage expansion created pursuant to this subsection (6).

• Page 7, Line 9(II)  Beginning January 1, 2026, and continuing every January

• Page 7, Line 10thereafter, the state department, in its presentation to the joint budget

• Page 7, Line 11committee of the general assembly and in its presentation to the health

• Page 7, Line 12and human services committee of the senate and the health and insurance

• Page 7, Line 13committee of the house of representatives, or any successor committees,

• Page 7, Line 14at the hearing held pursuant to section 2-7-203 (2)(a) of the "State

• Page 7, Line 15Measurement for Accountable, Responsive, and Transparent (SMART)

• Page 7, Line 16Government Act", shall report on the cost savings and health

• Page 7, Line 17improvements associated with the coverage expansion created pursuant to this subsection (6).

• Page 7, Line 18SECTION 10.  In Colorado Revised Statutes, 25.5-5-204, amend (2)(a) and (2.5) as follows:

• Page 7, Line 1925.5-5-204.  Presumptive eligibility - pregnant person -

• Page 7, Line 20children - long-term care - state plan. (2) (a)  A pregnant person is

• Page 7, Line 21presumptively eligible for the medical assistance program and shall

• Page 7, Line 22receive services specified by federal law only if the person declares all

• Page 7, Line 23pertinent information relating to the criteria of income, assets, and only

• Page 7, Line 24if necessary to administer reimbursement for services, status.

• Page 8, Line 1(2.5)  A child less than who is under nineteen years of age is

• Page 8, Line 2presumptively eligible for the medical assistance program and shall

• Page 8, Line 3receive services specified by federal law only if a parent or legal guardian

• Page 8, Line 4of the child declares all pertinent information relating to the criteria of

• Page 8, Line 5income, assets, and only if necessary to administer reimbursement for services, status of the child's family.

• Page 8, Line 6SECTION 11.  In Colorado Revised Statutes, 25.5-5-335, amend (2)(a), (2)(b), and (7)(b) as follows:

• Page 8, Line 725.5-5-335.  Continuous medical coverage for children and

• Page 8, Line 8adults feasibility study - federal authorization - rules - report -

• Page 8, Line 9definition. (2)  At a minimum, the feasibility study must consider the

• Page 8, Line 10costs; implementation factors, including county workload, training, and

• Page 8, Line 11administrative burdens on the counties, information technology systems,

• Page 8, Line 12upgrades, and associated costs; potential health benefits for individuals

• Page 8, Line 13and communities, including disadvantaged and marginalized groups;

• Page 8, Line 14impacts of increased use of preventive and high-value health services;

• Page 8, Line 15administrative savings, including, but not limited to, reducing or

• Page 8, Line 16eliminating eligibility processing for populations during the continuous

• Page 8, Line 17eligibility period; reductions in administrative turnover and coverage loss;

• Page 8, Line 18and, to the extent practicable, social and economic impacts with respect to the following:

• Page 8, Line 19(a)  Allowing an eligible child, as defined in this article 5 and

• Page 8, Line 20articles 2, 3, 6, and 8 of this title 25.5, including children eligible under

• Page 8, Line 21sections 25.5-2-104 and 25.5-2-105, to remain continuously eligible for

• Page 8, Line 22medical assistance and the children's basic health plan for twenty-four months after the last day of the month in which the child was enrolled;

• Page 8, Line 23(b)  Allowing an eligible child, as defined in this article 5 and

• Page 9, Line 1articles 2, 3, 6, and 8 of this title 25.5, including children eligible under

• Page 9, Line 2sections 25.5-2-104 and 25.5-2-105 who are less than who is under six

• Page 9, Line 3years of age, to remain continuously eligible for medical assistance or the

• Page 9, Line 4children's basic health plan without regard to a change in household income until the child reaches six years of age;

• Page 9, Line 5(7) (b)  For purposes of seeking federal authorization pursuant to

• Page 9, Line 6subsection (7)(a) of this section, an eligible child is as defined in this

• Page 9, Line 7article 5 and articles 2, 3, 6, and 8 of this title 25.5 including a child

• Page 9, Line 8eligible pursuant to sections 25.5-2-104 and 25.5-2-105, and must be

• Page 9, Line 9under three years of age. An eligible child shall remain continuously

• Page 9, Line 10eligible without regard to household income until the eligible child

• Page 9, Line 11reaches three years of age; except that a child is no longer eligible and

• Page 9, Line 12must be disenrolled from a medical assistance program if the state

• Page 9, Line 13department becomes aware that the child has moved out of the state, the

• Page 9, Line 14state department or county possesses facts indicating that the family has

• Page 9, Line 15requested the child's voluntary disenrollment, the state department determines eligibility was erroneously granted, or the child is deceased.

• Page 9, Line 16SECTION 12.  In Colorado Revised Statutes, 25.5-8-103, amend (4)(a)(I) and (4)(b)(I) as follows:

• Page 9, Line 1725.5-8-103.  Definitions - rules. As used in this article 8, unless the context otherwise requires:

• Page 9, Line 18(4)  "Eligible person" means:

• Page 9, Line 19(a) (I)  A person who is less than under nineteen years of age,

• Page 9, Line 20who is a citizen or meets the immigration status requirements set forth in

• Page 9, Line 21section 25.5-8-109 (6) or 25.5-8-109 (7), whose family income does not

• Page 9, Line 22exceed two hundred sixty percent of the federal poverty line, adjusted for

• Page 9, Line 23family size, and who is not eligible for medical assistance pursuant to articles 4, 5, and 6 of this title 25.5.

• Page 10, Line 1(b) (I)  A pregnant person who is a citizen or meets the

• Page 10, Line 2immigration status requirements set forth in section 25.5-8-109 (6) or

• Page 10, Line 325.5-8-109 (7), whose family income does not exceed two hundred sixty

• Page 10, Line 4percent of the federal poverty line, adjusted for family size, and who is

• Page 10, Line 5not eligible for medical assistance pursuant to articles 4, 5, and 6 of this title 25.5.

• Page 10, Line 6SECTION 13.  In Colorado Revised Statutes, 25.5-8-107, repeal (1)(i) as follows:

• Page 10, Line 725.5-8-107.  Duties of the department - schedule of services -

• Page 10, Line 8premiums - copayments - subsidies - purchase of childhood

• Page 10, Line 9immunizations. (1)  In addition to any other duties pursuant to this article 8, the department has the following duties:

• Page 10, Line 10(i) (I)  The department shall develop and implement an outreach

• Page 10, Line 11strategy for Coloradans who become eligible for health coverage pursuant

• Page 10, Line 12to section 25.5-2-104, 25.5-2-105, 25.5-5-201 (6), or 25.5-8-109 (7). The

• Page 10, Line 13state department shall work with stakeholders to develop an outreach strategy that includes:

• Page 10, Line 14(A)  Funding for community-based organizations to partner with the department on outreach;

• Page 10, Line 15(B)  A method for providing information related to eligibility and

• Page 10, Line 16enrollment that can be provided to nonprofit partners, school districts, and charter schools for outreach purposes; and

• Page 10, Line 17(C)  At a minimum, providing information related to eligibility and

• Page 10, Line 18coverage in English, Spanish, and in each language spoken by at least

• Page 10, Line 19two-and-one-half percent of the population of any county who speak

• Page 10, Line 20English less than very well, as defined by the United States bureau of the

• Page 11, Line 1census American community survey, and who speak the minority language at home;

• Page 11, Line 2(II)  Approximately twelve and twenty-four months after

• Page 11, Line 3implementation of the strategy required pursuant to subsection (1)(i)(I) of

• Page 11, Line 4this section, the department shall convene stakeholders, including directly

• Page 11, Line 5impacted individuals, service providers, and advocacy organizations that

• Page 11, Line 6are diverse with regard to race, ethnicity, immigration status, sexual

• Page 11, Line 7orientation, and gender identity and who are affected by higher rates of

• Page 11, Line 8health disparities and inequities. The department shall report on the

• Page 11, Line 9outreach and enrollment strategy outcomes, including enrollment of

• Page 11, Line 10eligible persons into these programs compared to those persons who are eligible for coverage, but not enrolled.

• Page 11, Line 11SECTION 14.  In Colorado Revised Statutes, 25.5-8-109,repeal (7) as follows:

• Page 11, Line 1225.5-8-109.  Eligibility - children - pregnant women - rules.

• Page 11, Line 13(7) (a)  Beginning no later than January 1, 2025, notwithstanding any

• Page 11, Line 14other provision of law, the department shall provide benefits pursuant to

• Page 11, Line 15this article 8 to a pregnant person who is not a citizen and is not eligible

• Page 11, Line 16pursuant to subsection (6) of this section, so long as the pregnant person

• Page 11, Line 17meets the eligibility criteria other than those related to citizenship or

• Page 11, Line 18immigration status. Eligibility pursuant to this section extends

• Page 11, Line 19continuously through the twelve-month postpartum period, so long as eligibility remains in effect pursuant to subsection (5.5)(a) of this section.

• Page 11, Line 20(b)  The department shall seek any necessary federal approvals to

• Page 11, Line 21maximize any available federal financial participation in implementing this subsection (7).

• Page 11, Line 22(c) (I)  During its 2024 presentation to the joint budget committee

• Page 12, Line 1of the general assembly and in its presentation to the health and human

• Page 12, Line 2services committee of the senate and the health and insurance committee

• Page 12, Line 3of the house of representatives, or any successor committees, at the

• Page 12, Line 4hearing held pursuant to section 2-7-203 (2)(a) of the "State Measurement

• Page 12, Line 5for Accountable, Responsive, and Transparent (SMART) Government

• Page 12, Line 6Act", the state department shall report on its plans and progress in

• Page 12, Line 7implementing the coverage expansion created pursuant to this subsection (7).

• Page 12, Line 8(II)  Beginning January 1, 2026, and continuing every January

• Page 12, Line 9thereafter, the state department, in its presentation to the joint budget

• Page 12, Line 10committee of the general assembly and in its presentation to the health

• Page 12, Line 11and human services committee of the senate and the health and insurance

• Page 12, Line 12committee of the house of representatives, or any successor committees,

• Page 12, Line 13at the hearing held pursuant to section 2-7-203 (2)(a) of the "State

• Page 12, Line 14Measurement for Accountable, Responsive, and Transparent (SMART)

• Page 12, Line 15Government Act", shall report on the cost savings and health

• Page 12, Line 16improvements associated with the coverage expansion created pursuant to this subsection (7).

• Page 12, Line 17(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.

• Page 12, Line 18SECTION 15.  In Colorado Revised Statutes, 25.5-8-109.3, repeal (1) and (3)(a) as follows:

• Page 12, Line 1925.5-8-109.3.  Health services initiatives. (1)  To the extent

• Page 12, Line 20federal financial participation is available, the department shall design

• Page 12, Line 21and implement health service initiatives pursuant to section

• Page 12, Line 222105(a)(1)(D)(ii) of the federal "Social Security Act", as amended, to

• Page 12, Line 23provide funding for continuous enrollment for the twelve-month

• Page 13, Line 1postpartum period for a person who is enrolled in health-care coverage pursuant to section 25.5-5-201 (6) or 25.5-8-109 (7).

• Page 13, Line 2(3) (a)  The department shall seek any necessary federal approvals

• Page 13, Line 3to obtain federal financial participation in implementing subsection (1) of this section.

• Page 13, Line 4SECTION 16.  Act subject to petition - effective date. This act

• Page 13, Line 5takes effect at 12:01 a.m. on the day following the expiration of the

• Page 13, Line 6ninety-day period after final adjournment of the general assembly; except

• Page 13, Line 7that, if a referendum petition is filed pursuant to section 1 (3) of article V

• Page 13, Line 8of the state constitution against this act or an item, section, or part of this

• Page 13, Line 9act within such period, then the act, item, section, or part will not take

• Page 13, Line 10effect unless approved by the people at the general election to be held in

• Page 13, Line 11November 2026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.