§ 25.5-5-101 — Mandatory provisions - eligible groups - rules

Colorado § 25.5-5-101

• Jurisdiction: Colorado
• Title 25.5: Health
• Art.: Colorado Medical Assistance Act -

Text

(1) In order to
participate in the medicaid program, the federal government requires the state to
provide medical assistance to certain eligible groups. Pursuant to federal law and
except as provided in subsection (2) of this section, any person who is eligible for
medical assistance under the mandated groups specified in this section must
receive both the mandatory services that are specified in sections 25.5-5-102 and
25.5-5-103 and the optional services that are specified in sections 25.5-5-202 and
25.5-5-203. Subject to the availability of federal financial participation, the
following are the individuals or groups that are mandated under federal law to
receive benefits under this article 5 and articles 4 and 6 of this title 25.5:

(a) Repealed.

(b) Parents and caretaker relatives living with a dependent child who meet
the eligibility criteria pursuant to section 1902 (a)(10)(A) of the federal Social
Security Act, including those who subsequently would have become ineligible
under such eligibility criteria because of increased earnings or increased hours of
employment whose eligibility is specified for a period of time by the federal
government;

(c) Pregnant women whose family income does not exceed one hundred
thirty-three percent of the federal poverty line, adjusted for family size, who meet
the requirements pursuant to section 1902 (a)(10)(A) of the federal Social Security
Act. Once initial eligibility has been established, the pregnant woman is
continuously eligible throughout the pregnancy and for the sixty days following the
pregnancy, even if the woman's eligibility would otherwise terminate during such
period due to an increase in income.

(d) A newborn child born of a woman who is categorically needy. Such child
is deemed medicaid-eligible on the date of birth and remains eligible for one year.

(e) Children for whom adoption assistance or foster care maintenance
payments are made under Title IV-E of the federal Social Security Act, as
amended, including foster care children, pursuant to section 1902 (a)(10)(A)(i)(IX) of
the federal Social Security Act, who are under twenty-six years of age, who were
in foster care under the responsibility of the state or a tribe, and who were enrolled
in medicaid under the state medicaid plan when they turned eighteen years of age;

(f) Individuals receiving supplemental security income;

(g) Individuals receiving mandatory state supplement, including but not
limited to individuals receiving old age pensions;

(h) Institutionalized individuals who were eligible for medical assistance in
December 1973;

(i) Individuals who would be eligible except for the increase in old-age,
survivors, and disability insurance under Pub.L. 92-336;

(j) Individuals who become ineligible for cash assistance as a result of old-age, survivors, and disability insurance cost-of-living increases after April 1977;

(k) Disabled widows or widowers fifty through sixty years of age who have
become ineligible for federal supplemental security income or state
supplementation as a result of becoming eligible for federal social security
survivor's benefits, in accordance with the social security act, 42 U.S.C. sec. 1383c;

(l) Individuals with income and resources at a level which qualifies them as
medicare-eligible under section 301 of Title III of the federal Medicare
Catastrophic Coverage Act;

(m) Children under the age of nineteen who meet the eligibility criteria
pursuant to section 1902 (a)(10)(A) of the federal Social Security Act.

(2) (a) A qualified alien who entered the United States before August 22,
1996, who meets the exceptions described in the federal Personal Responsibility
and Work Opportunity Reconciliation Act of 1996, Public Law 104-193, as
amended, shall receive benefits under this article and articles 4 and 6 of this title.

(b) (I) A qualified alien who entered the United States on or after August 22,
1996, shall not be eligible for benefits under this article or article 4 or 6 of this title,
except as provided in section 25.5-5-103 (3), for five years after the date of entry
into the United States unless he or she meets the exceptions described in the
federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996,
Public Law 104-193, as amended.

(II) Notwithstanding the five-year waiting period established in subparagraph
(I) of this paragraph (b), but subject to the availability of sufficient appropriations
and the receipt of federal financial participation, the state department may provide
benefits under this article and articles 4 and 6 of this title to a pregnant woman
who is a qualified alien and a child under nineteen years of age who is a qualified
alien so long as such woman or child meets eligibility criteria other than citizenship.

(3) Repealed.

(4) An asset test shall not be applied as a condition of eligibility for
individuals or families described in paragraphs (b), (c), (d), and (e) of subsection (1)
of this section.

(5) The county departments responsible for administering benefits programs
under the department of health care policy and financing and the department of
human services shall identify and review all current county guidance materials,
including forms, training materials, websites, and any other materials that
reference a prohibition on sponsorship as a condition of eligibility for benefits and
shall remove all such references from verbal and digital communications and from
all physical materials currently provided to applicants or beneficiaries.

(6) Repealed.

Legislative History

Source: L. 2006: Entire article added with relocations, p. 1854, � 7, effective July 1. L. 2009: (2)(b) amended, (HB 09-1353), ch. 360, p. 1869, � 1, effective July 1, 2010. L. 2010: (4)(c) added, (HB 10-1043), ch. 92, p. 312, � 1, effective April 15; (1)(m) amended, (HB 10-1422), ch. 419, p. 2110, � 143, effective August 11. L. 2011: (3) amended, (HB 11-1303), ch. 264, p. 1168, � 67, effective August 10. L. 2014: (1)(a) repealed and (1)(b), (1)(c), (1)(d), (1)(e), (1)(m), and (4) amended, (SB 14-067), ch. 12, p. 111, � 3, effective February 27. L. 2022: IP(1) amended, (SB 22-052), ch. 43, p. 216, � 2, effective March 24; (3) amended, (HB 22-1289), ch. 399, p. 2842, � 15, effective June 7. L. 2023: (6) added, (SB 23-182), ch. 118, p. 429, � 1, effective April 27; (3) repealed and (5) added, (HB 23-1117), ch. 65, p. 232, � 3, effective August 7. L. 2024: IP(6)(a), (6)(b), and (6)(c) amended, (HB 24-1400), ch. 77, p. 261, � 1, effective April 18.