Colorado § 25.5-5-204 Presumptive eligibility - pregnant person - children - long-term care - state plan

Colorado Statutes

§ 25.5-5-204 — Presumptive eligibility - pregnant person - children - long-term care - state plan

Colorado § 25.5-5-204

Title 25.5Health

Art.Colorado Medical Assistance Act -

This text of Colorado § 25.5-5-204 (Presumptive eligibility - pregnant person - children - long-term care - state plan) is published on Counsel Stack Legal Research, covering Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Colo. Rev. Stat. § 25.5-5-204 (2026).

Text

(1)For purposes of this section, presumptive eligibility means the self-declaration of income, assets, and status in order to promptly receive medical assistance services prior to the verification of income, assets, and status.

(2)(a) A pregnant person is presumptively eligible for the medical assistance program and shall receive services specified by federal law only if the person declares all pertinent information relating to the criteria of income, assets, and, only if necessary to administer reimbursement for services, status.

(b)(Deleted by amendment, L. 2022.) (2.5) A child less than nineteen years of age is presumptively eligible for the medical assistance program and shall receive services specified by federal law only if a parent or legal guardian of the child declar

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(1) For purposes of this section, presumptive eligibility
means the self-declaration of income, assets, and status in order to promptly
receive medical assistance services prior to the verification of income, assets, and
status.

(2) (a) A pregnant person is presumptively eligible for the medical assistance
program and shall receive services specified by federal law only if the person
declares all pertinent information relating to the criteria of income, assets, and,
only if necessary to administer reimbursement for services, status.

(b) (Deleted by amendment, L. 2022.)

(2.5) A child less than nineteen years of age is presumptively eligible for the
medical assistance program and shall receive services specified by federal law only
if a parent or legal guardian of the child declares all pertinent information relating
to the criteria of income, assets, and, only if necessary to administer reimbursement
for services, status of the child's family.

(2.7) (a) The state department is authorized to seek federal authorization to
allow a person who is in need of long-term services and supports, as defined in
section 25.5-6-1702 (10), to be presumptively eligible for the medical assistance
program pursuant to this article 5 and articles 4 and 6 of this title 25.5.

(b) [ Editor's note: This version of subsection (2.7)(b) is effective until
January 1, 2026. ] If the state department receives federal authorization pursuant to
subsection (2.7)(a) of this section and sufficient spending authority, a person in
need of long-term services and supports shall be presumptively eligible for the
medical assistance program if the person or the person's legal representative
declares all pertinent information relating to the criteria of income, assets, and
immigration status. The person shall be assessed for the appropriate level of care
pursuant to section 25.5-6-1704. If required due to limitations of federal
authorization or spending authority, the state department may implement this
subsection (2.7)(b) as a pilot program rather than statewide.

(b) [ Editor's note: This version of subsection (2.7)(b) is effective January 1,
2026. ] If the state department receives federal authorization pursuant to
subsection (2.7)(a) of this section and sufficient spending authority, a person in
need of long-term services and supports shall be presumptively eligible for the
medical assistance program if the person or the person's legal representative
declares all pertinent information relating to the criteria of income, assets,
immigration status, and any other information that may be required pursuant to the
federal authorization. If required due to limitations of federal authorization or
spending authority, the state department may implement this subsection (2.7)(b) as
a pilot program rather than statewide.

(c) The state department shall make any necessary changes to the state
plan waivers for home- and community-based service programs and any other
federal authorizations that are authorized pursuant to this article 5 and articles 4
and 6 of this title 25.5 to comply with this subsection (2.7).

(d) If it is determined that a member was not eligible for medical benefits
after the member had been determined to be eligible based upon presumptive
eligibility, the state department shall not pursue recovery from a county
department for the cost of medical services provided to the member, and the
county department shall not be responsible for any federal error rate sanctions
resulting from such determination.

(3) The state department shall make any necessary changes to the state
plan to comply with this section.

Legislative History

Source: L. 2006: Entire article added with relocations, p. 1864, � 7, effective July 1. L. 2007: (2.5) added, p. 1493, � 4, effective January 1, 2008. L. 2009: (2.7) added, (HB 09-1103), ch. 160, p. 694, � 1, effective April 22. L. 2021: (2.7)(a) and (2.7)(b) amended, (HB 21-1187), ch. 83, p. 332, � 26, effective July 1, 2024. L. 2022: (2) and (2.5) amended, (HB 22-1289), ch. 399, p. 2844, � 18, effective June 7. L. 2024: (2.7)(c) amended, (HB 24-1229), ch. 323, p. 2150, � 1, effective August 7; (2.7)(d) amended, (SB 24-176), ch. 152, p. 645, � 45, effective August 7; (2.7)(b) amended, (HB 24-1229), ch. 323, p. 2150, � 1, effective January 1, 2026.