A Bill for an Act
Page 1, Line 101Concerning prohibiting state reimbursement for certain
Page 1, Line 102services provided to certain individuals, and, in
Page 1, Line 103connection therewith, prohibiting reimbursement for
Page 1, Line 104a provider who, or entity or facility that, performs,
Page 1, Line 105assists, or refers a person to abortion or
Page 1, Line 106gender-affirming health-care services and prohibiting
Page 1, Line 107reimbursement for medical services to a person who
Page 1, Line 108does not satisfy certain citizenship or residency
Page 1, Line 109requirements.
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 bill prohibits the department of health care policy and financing (HCPF) from reimbursing a:
- Health-care provider who, or entity or facility that, performs, assists in the performance of, or refers a person to abortion or gender-affirming health-care services; or
- A health-care provider, entity, or facility for providing medical services to a person who does not satisfy citizenship or residency requirements.
The bill makes related conforming amendments.
Under current law, HCPF administers the reproductive health-care program, the state medical assistance program, and the state children's basic health plan (collectively, "the programs") to certain individuals who are ineligible for the programs due to their immigration status. The bill repeals the programs and makes related conforming amendments.
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 that:
Page 2, Line 3(a) In order to preserve access to the state's medicaid health
Page 2, Line 4services, Colorado must prioritize essential health-care coverage for the most vulnerable populations in the state;
Page 2, Line 5(b) Low-income children and families, the elderly, and individuals with disabilities rely on medicaid as an essential service that is a lifeline;
Page 2, Line 6(c) In pursuit of sustaining long-term funding for the state's
Page 2, Line 7medicaid health services for Colorado citizens, the state must correctly
Page 2, Line 8allocate funding to essential health services that have a direct impact on Colorado citizens' health;
Page 2, Line 9(d) Health first Colorado, Colorado's medicaid program, should
Page 2, Line 10not cover elective procedures. It should only cover procedures that are medically necessary for Colorado citizens.
Page 2, Line 11(e) Previously, due to insufficient data, the state was unable to
Page 3, Line 1accurately estimate the costs of Cover All Coloradans, OmniSalud,
Page 3, Line 2abortion, and gender mutilation. These fiscal impacts have led to a large
Page 3, Line 3discrepancy between the estimated costs and the true impact on health coverage for Colorado citizens.
Page 3, Line 4(f) Now, it is estimated that the state has spent $51 million on
Page 3, Line 5Cover All Coloradans, $90 million on OmniSalud, $6 million on
Page 3, Line 6abortions, and $4.5 million on gender mutilation, totaling over $150 million that could otherwise be spent on Colorado citizens;
Page 3, Line 7(g) While over $150 million is spent on elective procedures for
Page 3, Line 8individuals and health-care coverage for undocumented individuals, Colorado is anticipating a 28% increase in premiums in 2026; and
Page 3, Line 9(h) Although Amendment 79 permits the use of public funds for
Page 3, Line 10abortion, it does not explicitly require public funds to be used for abortion.
Page 3, Line 11(2) Therefore, the general assembly declares that state medicaid
Page 3, Line 12funding must not be used for abortion or gender mutilation for an
Page 3, Line 13individual, or health services for an undocumented individual. These
Page 3, Line 14limitations will protect Colorado's commitment to prioritizing and
Page 3, Line 15protecting essential health-care coverage for the most vulnerable
Page 3, Line 16populations in the state and supporting the ethical use of taxpayer dollars that align with the state's core values.
Page 3, Line 17SECTION 2. In Colorado Revised Statutes, add 25.5-4-415.5 as follows:
Page 3, Line 1825.5-4-415.5. Prohibition on reimbursement for abortion or
Page 3, Line 19gender-affirming health-care services - prohibition on
Page 3, Line 20reimbursement for medical services to a person who is not lawfully
Page 3, Line 21residing - definitions. (1) As used in this section, unless the context otherwise requires:
Page 4, Line 1(a) "Abortion" means any medical procedure, instrument,
Page 4, Line 2agent, or drug used to terminate the pregnancy of an individual
Page 4, Line 3known or reasonably believed to be pregnant with an intention other than to increase the probability of a live birth.
Page 4, Line 4(b) "Gender-affirming health-care services" means any
Page 4, Line 5diagnostic, therapeutic, pharmacological, procedural, or other
Page 4, Line 6care that leads to or involves puberty blockers, cross-sex
Page 4, Line 7hormones, or surgery for the purpose of affirming a gender other than the patient's biological sex.
Page 4, Line 8(2) Notwithstanding any law to the contrary, the state
Page 4, Line 9department shall not reimburse a health-care provider who, or
Page 4, Line 10an entity or facility that, performs, assists in performing, or
Page 4, Line 11refers a person to abortion or gender-affirming health-care
Page 4, Line 12services. This subsection (2) does not prohibit reimbursement for
Page 4, Line 13therapeutic services that are not for the purpose of affirming a
Page 4, Line 14gender other than the person's biological sex for an adult or
Page 4, Line 15for a person who is under eighteen years of age if the person's
Page 4, Line 16parent or legal guardian provides consent and guidance to the therapeutic services.
Page 4, Line 17(3) Notwithstanding any law to the contrary, the state
Page 4, Line 18department shall not reimburse a health-care provider, entity,
Page 4, Line 19or facility for providing medical services to a person unless the
Page 4, Line 20person is a citizen or national of the United States or is lawfully residing.
Page 4, Line 21SECTION 3. In Colorado Revised Statutes, 24-75-109, repeal
Page 4, Line 22(1)(a.7) and (1)(a.8); and repeal as it will become effective January 1, 2026, (1)(a.9) as follows:
Page 5, Line 124-75-109. Controller may allow expenditures in excess of
Page 5, Line 2appropriations - limitations - appropriations for subsequent fiscal
Page 5, Line 3year restricted - repeal. (1) For the purpose of closing the state's books,
Page 5, Line 4and subject to the provisions of this section, the controller may, on or
Page 5, Line 5after May 1 of any fiscal year and before the forty-fifth day after the close
Page 5, Line 6thereof, upon approval of the governor, allow any department, institution,
Page 5, Line 7or agency of the state, including any institution of higher education, to
Page 5, Line 8make an expenditure in excess of the amount authorized by an item of appropriation for such fiscal year if:
Page 5, Line 9(a.7)
The overexpenditure is by the department of health carePage 5, Line 10
policy and financing for the state medical assistance program, established pursuant to section 25.5-2-104; orPage 5, Line 11(a.8)
The overexpenditure is by the department of health carePage 5, Line 12
policy and financing for the state children's basic health plan, established pursuant to section 25.5-2-105; orPage 5, Line 13(a.9)
The overexpenditure is by the department of health carePage 5, Line 14
policy and financing for abortion care services provided pursuant to sections 25.5-2-106 and 25.5-8-107 (1)(a)(VI); orPage 5, Line 15SECTION 4. In Colorado Revised Statutes, 25.5-1-201, repeal (1)(f.5) as follows:
Page 5, Line 1625.5-1-201. Programs to be administered by the department
Page 5, Line 17of health care policy and financing. (1) The state department shall administer the following programs and perform the following functions:
Page 5, Line 18(f.5)
The reproductive health-care program that provides reproductive health-care services, as specified in section 25.5-2-103;Page 5, Line 19SECTION 5. In Colorado Revised Statutes, 25.5-4-201, amend (1) as follows:
Page 6, Line 125.5-4-201. Cash system of accounting - financial
Page 6, Line 2administration of medical services premiums - medical programs
Page 6, Line 3administered by department of human services - federal
Page 6, Line 4contributions - rules. (1) The state department shall utilize the cash
Page 6, Line 5system of accounting, as enunciated by the governmental accounting
Page 6, Line 6standards board, regardless of the source of revenues involved, for all
Page 6, Line 7activities of the state department relating to the financial administration
Page 6, Line 8of any nonadministrative expenditure that qualifies for federal financial
Page 6, Line 9participation under Title XIX of the federal "Social Security Act",
and forPage 6, Line 10
the administration of the state-funded health and medical care program,Page 6, Line 11
created pursuant to section 25.5-2-104, and for the state children's basicPage 6, Line 12
health plan, created pursuant to section 25.5-2-105, except forPage 6, Line 13expenditures under the program for the medically indigent, article 3 of this title 25.5.
Page 6, Line 14SECTION 6. In Colorado Revised Statutes, 25.5-4-412, amend as it will become effective January 1, 2026, (2)(a)(IV) as follows:
Page 6, Line 1525.5-4-412. Family planning services - family-planning-related
Page 6, Line 16services - rules - definitions. (2) As used in this section, unless the context otherwise requires:
Page 6, Line 17(a) "Family-planning-related services" means services provided
Page 6, Line 18in a family planning setting as part of or as a follow-up to a family planning visit, including:
Page 6, Line 19(IV) Any other medical diagnosis, treatment, or preventive service
Page 6, Line 20that is routinely provided pursuant to a family planning visit.
including abortion care.Page 6, Line 21SECTION 7. In Colorado Revised Statutes, 25.5-4-503, amend (2) as follows:
Page 7, Line 125.5-4-503. Waiver applications - authorization. (2) The state
Page 7, Line 2department shall pursue and, if approved, implement a demonstration
Page 7, Line 3waiver that authorizes the state to use federal medical assistance
Page 7, Line 4payments authorized pursuant to section 1903(v) of the federal "Social
Page 7, Line 5Security Act", as amended, in coordination with the division of insurance
Page 7, Line 6to enhance or expand a state-subsidized individual health coverage plan
Page 7, Line 7as defined in section 10-16-1203 (15).
and, only if needed to maximizePage 7, Line 8
federal financial participation, for Coloradans receiving state medicalPage 7, Line 9
assistance pursuant to section 25.5-2-104 or 25.5-5-201 (6). To the extentPage 7, Line 10
such federal funds are used to enhance or expand a state-subsidizedPage 7, Line 11individual health coverage plan, as defined in section 10-16-1203 (15),
Page 7, Line 12the health insurance affordability enterprise created pursuant to section
Page 7, Line 1310-16-1204 must receive, deposit into the health insurance affordability
Page 7, Line 14cash fund created in section 10-16-1206, and allocate the federal share of
Page 7, Line 15the medical assistance payments pursuant to section 10-16-1205 (2), subject to any conditions set forth in the approval of the waiver.
Page 7, Line 16SECTION 8. In Colorado Revised Statutes, 25.5-5-103, amend (3)(a) as follows:
Page 7, Line 1725.5-5-103. Mandated programs with special state provisions
Page 7, Line 18- rules. (3) (a) Emergency medical assistance
shall must be provided toPage 7, Line 19any person who is
not a citizen of the United States, includingPage 7, Line 20
undocumented aliens, aliens who are not qualified aliens, and qualifiedPage 7, Line 21
aliens who entered the United States on or after August 22, 1996, who hasPage 7, Line 22a qualified alien with an emergency medical condition and meets one
Page 7, Line 23of the categorical requirements set forth in section 25.5-5-101.
except thatPage 7, Line 24
such persons shall not be required to meet any residency requirement other than that required by federal law.Page 8, Line 1SECTION 9. In Colorado Revised Statutes, 25.5-5-201, repeal (6) as follows:
Page 8, Line 225.5-5-201. Optional provisions - optional groups - rules.
Page 8, Line 3(6)
(a) Beginning no later than January 1, 2025, a pregnant person whoPage 8, Line 4
is not a citizen and who is not eligible for medical assistance pursuant toPage 8, Line 5
subsection (4) of this section is eligible to receive medical assistancePage 8, Line 6
pursuant to this subsection (6)(a) if the individual meets the eligibilityPage 8, Line 7
requirements other than those related to citizenship and immigration status.Page 8, Line 8
(b) A pregnant person who is eligible for medical assistancePage 8, Line 9
pursuant to this subsection (6) remains continuously eligible for allPage 8, Line 10
medical services pursuant to the medical assistance program for thePage 8, Line 11
twelve-month postpartum period, so long as eligibility remains in effect pursuant to subsection (4.5)(a) of this section.Page 8, Line 12
(c) The state department shall seek any necessary federalPage 8, Line 13
approvals to maximize any available federal financial participation inPage 8, Line 14
implementing this subsection (6). Benefits for services obtained pursuantPage 8, Line 15
to this subsection (6) must be provided with only state funds if federal financial participation is unavailable for such services.Page 8, Line 16
(d) (I) During its 2024 presentation to the joint budget committeePage 8, Line 17
of the general assembly and in its presentation to the health and humanPage 8, Line 18
services committee of the senate and the health and insurance committeePage 8, Line 19
of the house of representatives, or any successor committees, at thePage 8, Line 20
hearing held pursuant to section 2-7-203 (2)(a) of the "State MeasurementPage 8, Line 21
for Accountable, Responsive, and Transparent (SMART) GovernmentPage 8, Line 22
Act", the state department shall report on its plans and progress inPage 9, Line 1
implementing the coverage expansion created pursuant to this subsection (6).Page 9, Line 2
(II) Beginning January 1, 2026, and continuing every JanuaryPage 9, Line 3
thereafter, the state department, in its presentation to the joint budgetPage 9, Line 4
committee of the general assembly and in its presentation to the healthPage 9, Line 5
and human services committee of the senate and the health and insurancePage 9, Line 6
committee of the house of representatives, or any successor committees,Page 9, Line 7
at the hearing held pursuant to section 2-7-203 (2)(a) of the "StatePage 9, Line 8
Measurement for Accountable, Responsive, and Transparent (SMART)Page 9, Line 9
Government Act", shall report on the cost savings and healthPage 9, Line 10
improvements associated with the coverage expansion created pursuant to this subsection (6).Page 9, Line 11SECTION 10. In Colorado Revised Statutes, 25.5-5-329, amend as it will become effective January 1, 2026, (1)(b)(IV) as follows:
Page 9, Line 1225.5-5-329. Family planning services - federal authorization
Page 9, Line 13- rules - definitions. (1) As used in this section, unless the context otherwise requires:
Page 9, Line 14(b) "Family-planning-related services" means services provided
Page 9, Line 15in a family planning setting as part of or as a follow-up to a family planning visit, including:
Page 9, Line 16(IV) Any other medical diagnosis, treatment, or preventive service
Page 9, Line 17that is routinely provided pursuant to a family planning visit.
including abortion care.Page 9, Line 18SECTION 11. In Colorado Revised Statutes, 25.5-5-335, amend (2)(a), (2)(b), and (7)(b) as follows:
Page 9, Line 1925.5-5-335. Continuous medical coverage for children and
Page 9, Line 20adults feasibility study - federal authorization - rules - report -
Page 10, Line 1definition. (2) At a minimum, the feasibility study must consider the
Page 10, Line 2costs; implementation factors, including county workload, training, and
Page 10, Line 3administrative burdens on the counties, information technology systems,
Page 10, Line 4upgrades, and associated costs; potential health benefits for individuals
Page 10, Line 5and communities, including disadvantaged and marginalized groups;
Page 10, Line 6impacts of increased use of preventive and high-value health services;
Page 10, Line 7administrative savings, including, but not limited to, reducing or
Page 10, Line 8eliminating eligibility processing for populations during the continuous
Page 10, Line 9eligibility period; reductions in administrative turnover and coverage loss;
Page 10, Line 10and, to the extent practicable, social and economic impacts with respect to the following:
Page 10, Line 11(a) Allowing an eligible child, as defined in this article 5 and
Page 10, Line 12articles 2, 3, 6, and 8 of this title 25.5,
including children eligible underPage 10, Line 13
sections 25.5-2-104 and 25.5-2-105, to remain continuously eligible forPage 10, Line 14medical 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 10, Line 15(b) Allowing an eligible child, as defined in this article 5 and
Page 10, Line 16articles 2, 3, 6, and 8 of this title 25.5,
including children eligible underPage 10, Line 17
sections 25.5-2-104 and 25.5-2-105 who are less than six years of age, toPage 10, Line 18remain continuously eligible for medical assistance or the children's basic
Page 10, Line 19health plan without regard to a change in household income until the child reaches six years of age;
Page 10, Line 20(7) (b) For purposes of seeking federal authorization pursuant to
Page 10, Line 21subsection (7)(a) of this section, an eligible child is, as defined in this
Page 10, Line 22article 5 and articles 2, 3, 6, and 8 of this title 25.5,
including a childPage 10, Line 23
eligible pursuant to sections 25.5-2-104 and 25.5-2-105, and must bePage 10, Line 24under three years of age. An eligible child shall remain continuously
Page 11, Line 1eligible without regard to household income until the eligible child
Page 11, Line 2reaches three years of age; except that a child is no longer eligible and
Page 11, Line 3must be disenrolled from a medical assistance program if the state
Page 11, Line 4department becomes aware that the child has moved out of the state, the
Page 11, Line 5state department or county possesses facts indicating that the family has
Page 11, Line 6requested the child's voluntary disenrollment, the state department determines eligibility was erroneously granted, or the child is deceased.
Page 11, Line 7SECTION 12. In Colorado Revised Statutes, 25.5-8-103, amend (4)(a)(I) and (4)(b)(I) as follows:
Page 11, Line 825.5-8-103. Definitions - rules. As used in this article 8, unless the context otherwise requires:
Page 11, Line 9(4) "Eligible person" means:
Page 11, Line 10(a) (I) A person who is less than nineteen years of age, who is a
Page 11, Line 11citizen or meets the immigration status requirements set forth in section
Page 11, Line 1225.5-8-109 (6),
or 25.5-8-109 (7), whose family income does not exceedPage 11, Line 13two hundred sixty percent of the federal poverty line, adjusted for family
Page 11, Line 14size, and who is not eligible for medical assistance pursuant to articles 4, 5, and 6 of this title 25.5.
Page 11, Line 15(b) (I) A pregnant person who is a citizen or meets the
Page 11, Line 16immigration status requirements set forth in section 25.5-8-109 (6),
orPage 11, Line 17
25.5-8-109 (7), whose family income does not exceed two hundred sixtyPage 11, Line 18percent of the federal poverty line, adjusted for family size, and who is
Page 11, Line 19not eligible for medical assistance pursuant to articles 4, 5, and 6 of this title 25.5.
Page 11, Line 20SECTION 13. In Colorado Revised Statutes, 25.5-8-107, repeal
Page 11, Line 21(1)(i); and repeal as it will become effective January 1, 2026, (1)(a)(VI)
Page 11, Line 22as follows:
Page 12, Line 125.5-8-107. Duties of the department - schedule of services -
Page 12, Line 2premiums - copayments - subsidies - purchase of childhood
Page 12, Line 3immunizations. (1) In addition to any other duties pursuant to this article 8, the department has the following duties:
Page 12, Line 4(a) (VI)
In addition to the items specified in subsections (1)(a)(I),Page 12, Line 5
(1)(a)(II), (1)(a)(III), and (1)(a)(V) of this section, and any additionalPage 12, Line 6
items approved by the medical services board, on and after January 1,Page 12, Line 7
2026, the medical services board shall include abortion care in the schedule of health-care services for all enrolled pregnant persons.Page 12, Line 8(i)
(I) The department shall develop and implement an outreachPage 12, Line 9
strategy for Coloradans who become eligible for health coverage pursuantPage 12, Line 10
to section 25.5-2-104, 25.5-2-105, 25.5-5-201 (6), or 25.5-8-109 (7). ThePage 12, Line 11
state department shall work with stakeholders to develop an outreach strategy that includes:Page 12, Line 12
(A) Funding for community-based organizations to partner with the department on outreach;Page 12, Line 13
(B) A method for providing information related to eligibility andPage 12, Line 14
enrollment that can be provided to nonprofit partners, school districts, and charter schools for outreach purposes; andPage 12, Line 15
(C) At a minimum, providing information related to eligibility andPage 12, Line 16
coverage in English, Spanish, and in each language spoken by at leastPage 12, Line 17
two-and-one-half percent of the population of any county who speakPage 12, Line 18
English less than very well, as defined by the United States bureau of thePage 12, Line 19
census American community survey, and who speak the minority language at home;Page 12, Line 20
(II) Approximately twelve and twenty-four months afterPage 12, Line 21
implementation of the strategy required pursuant to subsection (1)(i)(I) ofPage 13, Line 1
this section, the department shall convene stakeholders, including directlyPage 13, Line 2
impacted individuals, service providers, and advocacy organizations thatPage 13, Line 3
are diverse with regard to race, ethnicity, immigration status, sexualPage 13, Line 4
orientation, and gender identity and who are affected by higher rates ofPage 13, Line 5
health disparities and inequities. The department shall report on thePage 13, Line 6
outreach and enrollment strategy outcomes, including enrollment ofPage 13, Line 7
eligible persons into these programs compared to those persons who are eligible for coverage, but not enrolled.Page 13, Line 8SECTION 14. In Colorado Revised Statutes, 25.5-8-109, repeal (7) as follows:
Page 13, Line 925.5-8-109. Eligibility - children - pregnant women - rules.
Page 13, Line 10(7)
(a) Beginning no later than January 1, 2025, notwithstanding anyPage 13, Line 11
other provision of law, the department shall provide benefits pursuant toPage 13, Line 12
this article 8 to a pregnant person who is not a citizen and is not eligiblePage 13, Line 13
pursuant to subsection (6) of this section, so long as the pregnant personPage 13, Line 14
meets the eligibility criteria other than those related to citizenship orPage 13, Line 15
immigration status. Eligibility pursuant to this section extendsPage 13, Line 16
continuously through the twelve-month postpartum period, so long as eligibility remains in effect pursuant to subsection (5.5)(a) of this section.Page 13, Line 17
(b) The department shall seek any necessary federal approvals toPage 13, Line 18
maximize any available federal financial participation in implementing this subsection (7).Page 13, Line 19
(c) (I) During its 2024 presentation to the joint budget committeePage 13, Line 20
of the general assembly and in its presentation to the health and humanPage 13, Line 21
services committee of the senate and the health and insurance committeePage 13, Line 22
of the house of representatives, or any successor committees, at thePage 13, Line 23
hearing held pursuant to section 2-7-203 (2)(a) of the "State MeasurementPage 14, Line 1
for Accountable, Responsive, and Transparent (SMART) GovernmentPage 14, Line 2
Act", the state department shall report on its plans and progress inPage 14, Line 3
implementing the coverage expansion created pursuant to this subsection (7).Page 14, Line 4
(II) Beginning January 1, 2026, and continuing every JanuaryPage 14, Line 5
thereafter, the state department, in its presentation to the joint budgetPage 14, Line 6
committee of the general assembly and in its presentation to the healthPage 14, Line 7
and human services committee of the senate and the health and insurancePage 14, Line 8
committee of the house of representatives, or any successor committees,Page 14, Line 9
at the hearing held pursuant to section 2-7-203 (2)(a) of the "StatePage 14, Line 10
Measurement for Accountable, Responsive, and Transparent (SMART)Page 14, Line 11
Government Act", shall report on the cost savings and healthPage 14, Line 12
improvements associated with the coverage expansion created pursuant to this subsection (7).Page 14, Line 13
(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 14, Line 14SECTION 15. In Colorado Revised Statutes, 25.5-8-109.3, repeal (1) as follows:
Page 14, Line 1525.5-8-109.3. Health services initiatives. (1)
To the extentPage 14, Line 16
federal financial participation is available, the department shall designPage 14, Line 17
and implement health service initiatives pursuant to sectionPage 14, Line 18
2105(a)(1)(D)(ii) of the federal "Social Security Act", as amended, toPage 14, Line 19
provide funding for continuous enrollment for the twelve-monthPage 14, Line 20
postpartum 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 14, Line 21SECTION 16. In Colorado Revised Statutes, repeal 25.5-2-103,
Page 14, Line 2225.5-2-104, 25.5-2-105, and 25.5-2-106.
Page 15, Line 1SECTION 17. Safety clause. The general assembly finds,
Page 15, Line 2determines, and declares that this act is necessary for the immediate
Page 15, Line 3preservation of the public peace, health, or safety or for appropriations for
Page 15, Line 4the support and maintenance of the departments of the state and state institutions.