Senate Bill 25-228 Revised

A Bill for an Act

• Page 1, Line 101Concerning the creation of a cash fund within the Colorado

• Page 1, Line 102healthcare affordability and sustainability enterprise

• Page 1, Line 103for premiums paid by individuals to buy in to the state

• Page 1, Line 104medical assistance programs for low-income

• Page 1, Line 105individuals with disabilities, and, in connection

• Page 1, Line 106therewith, making and reducing appropriations.

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/.)

Joint Budget Committee. Under current law, there are 2 programs available to low-income individuals to buy in to the state medical assistance program: One for adults with disabilities and one for children with disabilities (medicaid buy-in programs). Individuals who participate in either program pay a premium based on their family income. The premiums are credited to the medicaid buy-in cash fund. The premiums credited to the medicaid buy-in cash fund are used to offset the costs of providing the medicaid buy-in programs. The costs of providing the medicaid buy-in programs are also offset by the money in the healthcare affordability and sustainability fee cash fund in the Colorado healthcare affordability and sustainability enterprise (CHASE) within the department of health care policy and financing (HCPF).

The bill repeals the existing medicaid buy-in cash fund and creates the healthcare affordability and sustainability medicaid buy-in cash fund (buy-in cash fund) within CHASE and directs that individuals who participate in the existing medicaid buy-in programs pay their premiums into the buy-in cash fund. The bill creates a medicaid buy-in enterprise support board within CHASE to support the existing enterprise with the implementation of the medicaid buy-in program, including consulting with HCPF and the state medical services board on the amount of the premiums for and other components of the medicaid buy-in programs. Because CHASE is an enterprise for purposes of the Taxpayer's Bill of Rights, its revenue does not count against the state fiscal year spending limit.

The bill also makes conforming amendments.

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

• Page 2, Line 2SECTION 1.  In Colorado Revised Statutes, 25.5-4-402.4, amend

• Page 2, Line 3(2) introductory portion, (2)(f), (2)(g), (3)(a), (3)(d)(I), and (3)(d)(III); and add (3)(c)(III), (5.1), and (7)(g) as follows:

• Page 2, Line 425.5-4-402.4.  Hospitals - healthcare affordability and

• Page 2, Line 5sustainability fee - Colorado healthcare affordability and

• Page 2, Line 6sustainability enterprise - federal waiver - fund created - reports -

• Page 2, Line 7rules - legislative declaration - repeal. (2)  Legislative declaration. The general assembly hereby finds and declares that:

• Page 2, Line 8(f)  Consistent with the determination of the Colorado supreme

• Page 2, Line 9court in Nicholl v. E-470 Public Highway Authority, 896 P.2d 859 (Colo.

• Page 3, Line 11995), that the power to impose taxes is inconsistent with enterprise status

• Page 3, Line 2under section 20 of article X of the state constitution, it is the conclusion

• Page 3, Line 3of the general assembly that the healthcare affordability and sustainability

• Page 3, Line 4fee and the medicaid buy-in premiums charged and collected by the

• Page 3, Line 5Colorado healthcare affordability and sustainability enterprise is a fee are

• Page 3, Line 6fees, not a tax taxes, because the fee is fees are imposed for the

• Page 3, Line 7specific purposes of allowing the enterprise to defray the costs of

• Page 3, Line 8providing the business services specified in subsections (2)(d)(I), and

• Page 3, Line 9(2)(d)(II), and (2)(c) of this section to hospitals and individuals that

• Page 3, Line 10pay the fee fees and is are collected at rates that are reasonably

• Page 3, Line 11calculated based on the benefits received by those hospitals and individuals; and

• Page 3, Line 12(g)  So long as the Colorado healthcare affordability and

• Page 3, Line 13sustainability enterprise qualifies as an enterprise for purposes of section

• Page 3, Line 1420 of article X of the state constitution, the revenues from the healthcare

• Page 3, Line 15affordability and sustainability fee fees charged and collected by the

• Page 3, Line 16enterprise are not state fiscal year spending, as defined in section

• Page 3, Line 1724-77-102 (17), or state revenues, as defined in section 24-77-103.6

• Page 3, Line 18(6)(c), and do not count against either the state fiscal year spending limit

• Page 3, Line 19imposed by section 20 of article X of the state constitution or the excess state revenues cap, as defined in section 24-77-103.6 (6)(b)(I).

• Page 3, Line 20(3) Colorado healthcare affordability and sustainability

• Page 3, Line 21enterprise. (a)  The Colorado healthcare affordability and sustainability

• Page 3, Line 22enterprise, referred to in this section as the "enterprise", is created. The

• Page 3, Line 23enterprise is and operates as a government-owned business within the state department for the purpose of:

• Page 3, Line 24(I)  Charging and collecting:

• (A)  The healthcare affordability and sustainability fee; and

• Page 4, Line 1(B)  Medicaid buy-in premiums;

• Page 4, Line 2(II)  Leveraging healthcare affordability and sustainability fee revenue to obtain federal matching money; and

• Page 4, Line 3(III)  Utilizing and deploying:

• Page 4, Line 4(A)  The healthcare affordability and sustainability fee revenue and

• Page 4, Line 5federal matching money to provide the business services specified in

• Page 4, Line 6subsections (2)(d)(I) and (2)(d)(II) of this section to hospitals that pay the healthcare affordability and sustainability fee; and

• Page 4, Line 7(B)  The medicaid buy-in premium revenue to provide the

• Page 4, Line 8medicaid buy-in programs created pursuant to part 14 of article

• Page 4, Line 96 of this title 25.5 and section 25.5-5-206, which are services and benefits specified in subsection (2)(c) of this section.

• Page 4, Line 10(c) (III)  The repeal of the medicaid buy-in cash fund, as it

• Page 4, Line 11existed in section 25.5-6-1404 (3)(b) before its repeal, effective

• Page 4, Line 12May 1, 2025, by this Senate Bill 25-228, enacted in 2025, and the

• Page 4, Line 13enterprise's ability to charge and collect the medicaid buy-in

• Page 4, Line 14premiums and provide premium-funded business services to

• Page 4, Line 15individuals and hospitals that replace and supplement services

• Page 4, Line 16previously funded both by the medicaid buy-in premiums and the

• Page 4, Line 17healthcare affordability and sustainability fee do not

• Page 4, Line 18constitute creation of a new enterprise or the qualification of

• Page 4, Line 19an existing government-owned business as an enterprise for

• Page 4, Line 20purposes of section 20 of article X of the state constitution,

• Page 4, Line 21section 24-77-103.6 (6)(b)(II), or section 24-77-108, and, therefore,

• Page 4, Line 22do not require or authorize adjustment of the state fiscal year

• Page 4, Line 23spending limit calculated pursuant to section 20 of article X of

• Page 5, Line 1the state constitution or the excess state revenues cap, as

• Page 5, Line 2defined in section 24-77-103.6 (6)(b)(I), and do not require voter approval.

• Page 5, Line 3(d)  The enterprise's primary powers and duties are:

• (I)  To charge and collect:

• Page 5, Line 4(A)  The healthcare affordability and sustainability fee as specified in subsection (4) of this section; and

• Page 5, Line 5(B)  The medicaid buy-in premiums described in subsection (5.1) of this section and sections 25.5-5-206 and 25.5-6-1404;

• Page 5, Line 6(III)  To expend:

• Page 5, Line 7(A)  Healthcare affordability and sustainability fee revenue,

• Page 5, Line 8matching federal money, and any other money from the healthcare

• Page 5, Line 9affordability and sustainability fee cash fund as specified in subsections (4) and (5) of this section; and

• Page 5, Line 10(B)  Medicaid buy-in premium revenue from the buy-in fund as specified in subsection (5.1) of this section;

• Page 5, Line 11(5.1) Healthcare affordability and sustainability medicaid

• Page 5, Line 12buy-in cash fund. (a)  The healthcare affordability and

• Page 5, Line 13sustainability medicaid buy-in cash fund, referred to in this

• Page 5, Line 14section as the "buy-in fund", is created in the state treasury. The

• Page 5, Line 15buy-in fund consists of the premiums credited to the buy-in fund

• Page 5, Line 16pursuant to sections 25.5-5-206 and 25.5-6-1404 and any other

• Page 5, Line 17money that the general assembly may appropriate or transfer

• Page 5, Line 18to the buy-in fund. Money in the buy-in fund shall not be

• Page 5, Line 19transferred to any other fund and shall not be used for any purpose other than the purposes specified in this subsection (5.1).

• Page 5, Line 20(b)  The state treasurer shall credit all interest and

• Page 6, Line 1income derived from the deposit and investment of money in the buy-in fund to the buy-in fund.

• Page 6, Line 2(c)  Subject to annual appropriation by the general

• Page 6, Line 3assembly, the enterprise may expend money from the buy-in fund

• Page 6, Line 4for the purpose of providing the medicaid buy-in programs

• Page 6, Line 5created pursuant to part 14 of article 6 of this title 25.5 and section 25.5-5-206.

• Page 6, Line 6(7) Colorado healthcare affordability and sustainability

• Page 6, Line 7enterprise board. (g) (I)  The medicaid buy-in enterprise support

• Page 6, Line 8board is created within the enterprise for the purpose of

• Page 6, Line 9supporting the enterprise board with the implementation of the

• Page 6, Line 10medicaid buy-in programs. The medicaid buy-in enterprise support

• Page 6, Line 11board consists of five members appointed by the governor, with the advice and consent of the senate, as follows:

• Page 6, Line 12(A)  One member who is a representative of persons with disabilities, who is living with a disability;

• Page 6, Line 13(B)  Two members who are representatives of a disability

• Page 6, Line 14rights organization or a disabled persons consumer advocacy organization;

• Page 6, Line 15(C)  One employee of the state department; and

• Page 6, Line 16(D)  One employee of the department of labor and employment created in section 24-1-121.

• Page 6, Line 17(II) (A)  Members of the medicaid buy-in enterprise support

• Page 6, Line 18board serve at the pleasure of the governor. All terms are for

• Page 6, Line 19four years. A member who is appointed to fill a vacancy shall serve the remainder of the unexpired term of the former member.

• Page 6, Line 20(B)  The governor shall make the initial appointments to

• Page 7, Line 1the medicaid buy-in enterprise support board as soon as practical following May 1, 2025.

• Page 7, Line 2(III)  The medicaid buy-in enterprise support board shall elect a chair and a vice-chair from among its members.

• Page 7, Line 3(IV)  On behalf of the enterprise, the medicaid buy-in

• Page 7, Line 4enterprise support board shall consult with the state

• Page 7, Line 5department and the state board on the amount of the premiums

• Page 7, Line 6for and other components of the medicaid buy-in programs

• Page 7, Line 7created pursuant to part 14 of article 6 of this title 25.5 and section 25.5-5-206.

• Page 7, Line 8(V)  Members of the medicaid buy-in enterprise support

• Page 7, Line 9board serve without compensation but must be reimbursed from

• Page 7, Line 10money in the buy-in fund for actual and necessary expenses

• Page 7, Line 11incurred in the performance of their duties pursuant to this section.

• Page 7, Line 12SECTION 2.  In Colorado Revised Statutes, 25.5-5-206, add (3) as follows:

• Page 7, Line 1325.5-5-206.  Medicaid buy-in program - disabled children -

• Page 7, Line 14disabled adults - federal authorization - rules. (3)  Any premiums or

• Page 7, Line 15cost-sharing charges paid for the medicaid buy-in programs

• Page 7, Line 16established pursuant to this section are credited to the

• Page 7, Line 17healthcare affordability and sustainability medicaid buy-in cash fund created in section 25.5-4-402.4 (5.1).

• Page 7, Line 18SECTION 3.  In Colorado Revised Statutes, 25.5-6-1404, amend (3)(a) and (3)(b) as follows:

• Page 7, Line 1925.5-6-1404.  Medicaid buy-in program - eligibility - premiums

• Page 7, Line 20- medicaid buy-in fund - report - rules - repeal. (3) Premiums. (a)  An

• Page 8, Line 1individual who is eligible for and receives medicaid under subsection (1)

• Page 8, Line 2of this section shall pay a premium pursuant to a payment schedule

• Page 8, Line 3established by the state department in consultation with the

• Page 8, Line 4Colorado healthcare affordability and sustainability

• Page 8, Line 5enterprise created in section 25.5-4-402.4 (3)(a). The amount of the

• Page 8, Line 6premium shall be determined from a sliding-fee scale adopted by rule of

• Page 8, Line 7the state board that is based on a percentage of the individual's income

• Page 8, Line 8adjusted for family size and on any impairment-related work expenses;

• Page 8, Line 9except that, consistent with federal law, if the amount of the individual's

• Page 8, Line 10adjusted gross income exceeds seventy-five thousand dollars, the

• Page 8, Line 11individual shall be responsible for paying one hundred percent of the

• Page 8, Line 12premium. The rules shall specify the amount of unearned income the state

• Page 8, Line 13department shall disregard in calculating the individual's income.

• Page 8, Line 14Premiums are credited to the healthcare affordability and

• Page 8, Line 15sustainability medicaid buy-in cash fund created in section 25.5-4-402.4 (5.1) for the purpose of offsetting program costs.

• Page 8, Line 16(b) (I)  The rules setting the premiums and the sliding-fee scale

• Page 8, Line 17shall must be based on an actuarial study of the disabled population in

• Page 8, Line 18this state. The state department may solicit and accept federal grants to

• Page 8, Line 19cover the costs of the actuarial study. Moneys Money received through

• Page 8, Line 20any grants and any premiums shall be is credited to the medicaid buy-in

• Page 8, Line 21cash fund, which fund is hereby created in the state treasury. Moneys

• Page 8, Line 22Money in the fund shall be is appropriated by the general assembly and

• Page 8, Line 23expended by the state department for the purpose of conducting

• Page 8, Line 24implementation activities as determined by the state department,

• Page 8, Line 25including conducting the actuarial study. Premiums shall be credited to

• Page 8, Line 26the fund for the purpose of offsetting program costs.

• Page 9, Line 1(II)  On June 30, 2025, the state treasurer shall transfer

• Page 9, Line 2the balance of the medicaid buy-in cash fund to the healthcare

• Page 9, Line 3affordability and sustainability medicaid buy-in cash fund created in section 25.5-4-402.4 (5.1).

• Page 9, Line 4(III)  This subsection (3)(b) is repealed, effective July 1, 2025.

• Page 9, Line 5SECTION 4.  In Colorado Revised Statutes, 25.5-6-1405, amend (1) as follows:

• Page 9, Line 625.5-6-1405.  Rule-making authority. (1)  The state board shall

• Page 9, Line 7promulgate rules necessary to implement and administer the medicaid

• Page 9, Line 8buy-in program created in this part 14, including, in consultation with

• Page 9, Line 9the Colorado healthcare affordability and sustainability

• Page 9, Line 10enterprise created in section 25.5-4-402.4 (3)(a), the establishment

• Page 9, Line 11of appropriate premium and cost-sharing charges on a sliding-fee scale

• Page 9, Line 12based on income. The premiums and cost-sharing charges shall be based upon an actuarial study of the disabled population in this state.

• Page 9, Line 13SECTION 5.  Appropriation - adjustments to 2025 long bill.

• Page 9, Line 14(1)  To implement this act, appropriations made in the annual general

• Page 9, Line 15appropriation act for the 2025-26 state fiscal year to the department of health care policy and financing are adjusted as follows:

• Page 9, Line 16(a)  The cash funds appropriation from the Medicaid buy-in cash

• Page 9, Line 17fund created in section 25.5-6-1404 (3)(b), C.R.S., for medical and

• Page 9, Line 18long-term care services for Medicaid-eligible individuals is decreased by $6,660,761.

• Page 9, Line 19(b)  The cash funds appropriation from the healthcare affordability

• Page 9, Line 20and sustainability Medicaid buy-in cash fund created in section

• Page 9, Line 2125.5-4-402.4 (5.1)(a), C.R.S., for medical and long-term care services for Medicaid-eligible individuals is increased by $6,660,761.

• Page 10, Line 1(2)  To implement this act, appropriations made in the annual

• Page 10, Line 2general appropriation act for the 2024-25 state fiscal year to the

• Page 10, Line 3department of health care policy and financing, as amended by Senate Bill 25-206, enacted in 2025, are adjusted as follows:

• Page 10, Line 4(a)  The cash funds appropriation from the Medicaid buy-in cash

• Page 10, Line 5fund created in section 25.5-6-1404 (3)(b), C.R.S., for medical and

• Page 10, Line 6long-term care services for Medicaid-eligible individuals is decreased by $1,110,126.

• Page 10, Line 7(b)  The cash funds appropriation from the healthcare affordability

• Page 10, Line 8and sustainability Medicaid buy-in cash fund created in section

• Page 10, Line 925.5-4-402.4 (5.1)(a), C.R.S., for medical and long-term care services for Medicaid-eligible individuals is increased by $1,110,126.

• Page 10, Line 10SECTION 6.  Effective date. This act takes effect May 1, 2025.

• Page 10, Line 11SECTION 7.  Safety clause. The general assembly finds,

• Page 10, Line 12determines, and declares that this act is necessary for the immediate

• Page 10, Line 13preservation of the public peace, health, or safety or for appropriations for

• Page 10, Line 14the support and maintenance of the departments of the state and state institutions.